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SURFACE EPITHELIAL OVARIAN TUMORS

SEROUS TUMORS
Most common ovarian neoplasm
Occur between ages of 20-50 yrs, the malignant tumors being seen
later in life
Most are cystic, but solid tumors may occur
60 % - benign : serous cystadenomas
25% - frankly malignant : serous cystadenocarcinoma
15% - low malignant potential : borderline serous tumors
Bilaterality occurs in :
20% of benign tumors
30% of borderline tumors
66% of frankly malignant
GROSS
May be small, but most are large
Serosal covering of :
benign serous cystadenoma - smooth and glistening
serous cystadenocarcinoma show irregularities
On sectioning - small cystic tumors are unilocular
- large cystic tumors are multilocular
filled
with serous fluid
Papillae projecting from internal surface of cyst cavities and
more marked in malignant tumors
MICRO
Benign
Lined by a
single layer of
tall columnar
ciliated
epithelium
Papillae have
delicate fibrous
cores covered
by single layer
of columnar
cells

Borderline
Malignant
Stratification of
Complex papillae
epithelial cells
present
Moderate atypia Piling up of epithelial
of clles and
lining into more than
moderate
one layer
mitotic activity
Formation of large
of their nuclei
solid epithelial masses
No obvious
Marked anaplasia of
invasion of
epithelial lining
stroma
Psammoma bodies
present
Invasion of underlying
stroma

INCIDENCE

o
o
o

MORPHOLOGY

MUCINOUS TUMORS
Less common than serous tumors
Occur between ages of 30-40 yrs
80% - benign : mucinous cystadenomas
10% - frankly malignant : mucinous cystadenocarcinoma
10% - low malignant potential : borderline tumors
Mostly are unilateral, but bilaterality is present in :
5% of mucinous cystadenoma
25% of malignant tumors

GROSS
Large, multilocular cysts containing mucinous (sticky, slightly
gelatinous fluid rich in glycoproteins) fluid in their cavities
Solid growth appear in walls of malignant mucinous
cycsadenocarcinoma
MICRO

Benign
Lined by a single layer
of tall columnar non
ciliated with apical
vacuolation and basal
nuclei
2 histologic types:
1)endocervical-like type
(resemble endocervical
epithelium)
2) intestinal-like type
(resemble colonic
epithelium)

Borderline
Stratification
of lining
epithelial
cells
Atypia of
tumor cells
No invasion
of stroma

Malignant
Formation of
solid masses
Feat of
malignancy in
tumor cells
Invasion of
stroma malignant

PROGNOSIS

Are usually asymptomatic till they become large and cause local pressure symptoms
Serologic tumor marker found in surface epithelial tumors is CA-125

Better prognosis than serous tumors


Rupture or metastasis of mucinous cystadenocarcinoma and
mucinous borderline tumor pseudomyxoma peritonei
the peritoneal cavity becomes filled with mucinous material
(resembling cystic contents of tumor)
Multiple tumor implants or seedlings are found on all the
serosal surfaces leading to adhesions of abdominal viscera

GERM CELL TUMORS

Incidence

TERATOMA
Constitute 20% of ovarian tumors
There are 4 types :
mature (benign) cystic
immature
teratoma with
teratoma
(malignant)
malignant change
solid
(teratoteratoma
carcinoma)
Marked by
Rare
ectodermal
Occurs in
differentiation
prepuberta
(dermoid cyst)
l
Occurs in young
adolescent
women during
s and
active reproductive
young
years
women at
Usually unilateral
mean age
and more
of 18 yrs
commonly in the
right side

monodermal
(highly
specialized)
teratoma
Small
Solid
Unilateral
Eg :
1. Struma ovarii
(composed of
thyroid tissue
and might be
associated
with
hyperthyroidis
m)
2. Ovarian
carcinoid
(arise from
intestinal
epithelium,
may produce
carcinoid syd)

DYSGERMINOMA
Constitute 2% of
all ovarian cancer
Ovarian
counterpart of
seminoma of
testis
Occurs most
commonly in
young age (2nd or
3rd decades of
life)
Usually
associated with
gonadal
dysgenesis
Unilateral

YOLK SAC TUMOR


Occurs in young
age
Shows aggressive
pathological
behavior
Associated with
elevated serum
levels of -feto
protein

CHORIOCARCINOMA
Similar to uterine
choriocarcinoma
but does not
respond to
chemotherapy

Morpho

mature (benign) cystic


teratoma

immature
(malignant) solid
teratoma

GROSS
1. Cystic tumor,
rarely exceed
10cm in diameter
2. Cut section :
unilocular cyst,
thin wall lined by
wrinkled
epidermis, from
which teeth
structures
protrude
3. Lumen of cysts
filled with
sebaceous
secretion admixed
with strands of
hair
MICRO
1. Cyst wall composed
of stratified sq
epithelium with hair
shafts and
sebaceous glands
(ectodermal origin)
2. Teeth structures,
bone, cartilage
(mesodermal)
3. Thyroid tissue, nests
of bronchial or GIT
epithelium
(endodermal)
4. Sometimes solid and
is formed of benign
looking mature
structures derived
from 3 germ layers

GROSS
1. Bulky, solid, with
areas of necrosis
and hemorrhage
2. Hair, cartilage,
bone or
calcification may
present

MICRO
1. Varying amounts
of immature
tissues
differentiating
towards
cartilage, bone,
muscle, nerve,
glands,
2. foci of
neuroepithelial
differentiation
are present
3. grading depends
on proportion of
tissues
containing
immature neuroepithelium

teratoma with
malignant change
(teratocarcinoma)

monodermal
(highly
specialized)
teratoma

DYSGERMINOMA

GROSS
1. Solid
MICRO
1. Large cells with
clear
cytoplasm,
vesicular nuclei,
2. well-defined
cell boundaries

YOLK SAC
TUMOR

CHORIOCARCINOMA

prognosis
&
complications

may undergo
torsion causing
acute abdomen
about 1% dermoid
cysts undergo
malignant changes
: sq cell carcinoma,
malignat
melanoma or
thyroid carcinoma

tends to grow
rapidly and
penetrate the
capsule and
spreads or
metastasizes
prognosis is
best with
immature
teratoma of low
grade and
confined within
capsule

most tumors
have no
endocrine
function
a few produce
HCG

SEX CORD STROMAL TUMORS

40% of fibroma
associated with
hydrothorax (usually
on right side) and
ascitis leading to
Meigs Syd

1.
2.
3.
4.
5.
6.

Granulosa cell tumor


Granulosa-theca cell tumor
Thecoma
Fibroma
Fibrothecoma
Sertoli-leydig cell tumor

Secrete large amounts of estrogen


leading to :
1.

2.

3.
4.
Androgen secreting tumors leading
to musculinization of female

Precocious sexual
development in prepubertal
girls
Endometrial hyperplasia and
endometrial carcinoma in adult
females
Endometrial carcinoma in
postmenopausal women
Fibrocystic disease of breast
and breast carcinoma

Clinical presentation of 1ry ovarian tumor :


1. Small ovarian tumors maybe found incidentally during pelvic
exam., radiography, or surgery
2. Large tumors of epithelium may cause local pressure symptoms
3. Torsion can result in severe abdominal pain

TUMORS OF THE OVARY

PRIMARY

SECONDARY
(METATSTATIC)

SURFACE
EPITHELIAL

1. Serous Tumors
2. Mucinous
Tumors
3. Endometrioid
tumors
4. Brenners
tumors

GERM
CELL

SEX-CORD
STROMAL

Yolk sac tumor

Dysgerminoma

Choriocarcinoma

Teratoma

General feat of 1ry ovarian tumors


75-80% are benign
Malignant ovarian tumors account for 5% of
cancers in females
Benign tumors : younger age group (20-40 yrs)
Malignant tumors : 40-60 yrs
But there is considerable overlap
Spread of malignant ovarian tumors
1. local spread : peritoneal cavities & ascites
2. lymphatic spread : iliac & para-aortic LNs
3. blood spread : lungs

1. Mature cystic
(benign) teratoma
2. Immature
(malignant) solid
teratoma
3. Teratocarcinoma
4. Monodermal
(highlt specialized)
carcinoma

1. Granulosa cell
tumor
2. Granulosatheca tumor
3. Thecoma
4. Fibroma
5. Fibrothecoma
6. Sertoli-leydig
cell tumor

Etiology maybe due to :


1. Carcinomas arising from other pelvic
organs
2. Carcinomas arising in breast or lungs
3. Carcinoma arising in upper GIT
(stomach, biliary tract, pancreas)
4. Krukenbergs tumor is a classical
example of metastatic GIT to ovary
- it is bilateral, composed of mucinproducing signet ring cells,
- most often from gastric carcinoma
spreading by transcoelemic method