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OVARY CANCER. II.

(Prof. A. Riccardi)
CARCINOMA OF THE OVARY
Pathology. I. Histologic classification. I.
* from all cells of the ovary (epithelial,
germinal, and stromal);
* 85% = of epithelial origin (from coelomic
epithelium or mesothelium from embryonal
gonadal ridge);
* 15% = from a variety of cell types (the
tissue of origin is often identified, but some
tumors have more than one cell type)
PAR THOLOGY OF CARCI
NOMA OF THE OVARY
CARCINOMA OF THE OVARY
Histologic classification
I. Epithelial cell = 85%: III. Germ cell < 5%:
Serous; Teratoma (NOS,
dermoid cyst, struma
Mucinous; ovarii);
Endometrioid; Teratocarcinoma;
Mesonefroid (clear cell); Dysgerminoma;
Brenner; Embryonal carcinoma;
Undifferentiated; Endodermal sinus;
Carcinosarcoma; Chorioncarcinoma;
II. Stromal cell < 10%: Gonadoblastoma;
Granulosa; Mixed tumors;
Thecoma; IV. Mesenchymal cell = 2%
Arrhenoblastoma;
Sertoli;
Gynandroblastoma;
Lipoid
OVARIAN CANCER
Pathology. II. Histologic classification
II. Epithelial tumors
* benign = 50%;
- low malignant potential = 16% (tumors of
borderline malignancy, with cytologic features
of malignancy but not invading the ovarian
stroma; > 75% in early stage and in younger
women; a much better natural history than
their malignant counterpart), and
- malignant = 33%;
* histologic grade: from the most aggressive
cytologic and histologic pattern
OVARIAN CANCER
Pathology. III. Benign tumors
* 2 major subtypes: serous or mucinous;
- usually, age = 20 - 60 yrs;
- frequently large (20 - 30 cm), bilateral, and
cystic
BENIGN
OVARIAN TUMORS

pseudomucinous
cystoadenona
BENIGN
OVARIAN TUMORS

mutilocular
cystoadenoma

simple cyst
BENIGN
OVARIAN TUMORS

fibroma
with Meigs’ syndrome
OVARIAN CANCER
Pathology. IV.
Tumors of borderline malignancy

* low malignant potential = 16%;
- > 75% in early stage and in relatively young
women;
- a much better natural history than their
malignant counterpart
OVARIAN TUMORS
OF
BORDERLINE
MALIGNANCY

papillary
cystoadenoma
OVARIAN TUMORS
OF
BORDERLINE MALIGNANCY

papilloma

adenofibroma

cistoadenifibroma
OVARIAN CANCER
Pathology. V. Malignant tumors
* 5 major subtypes [serous (50%), mucinous
(25%), endometroid (15%), clear cell (5%), and
Brenner tumors (1%, from the urothelium)];
* usually in women > 40 yrs;
- solid masses, with necrosis and hemorrhage;
- masses > 10 - 15 cm usually spread into the
intraabdominal space, with eventually
intraabdominal carcinomatosis (leading to
bowel and renal obstruction and cachexia)
MALIGNANT
OVARIAN TUMORS

solid carcinoma
MALIGNANT
OVARIAN TUMORS

cystoadenocarcinoma
PAPILLARY CYSTOADENOCARCINOMA
OF THE OVARY

left: well differentiated (papillae and minimal atypia);
center: moderately differentiated (more proliferative epithelium);
right: poorly differentiated (solid nests)
BENIGN
OVARIAN TUMORS

dysgerminoma

Brenner’s tumor
OVARIAN CANCER
Pathology. VI. Stromal and germ cell tumors

* with respect to epithelial OC, these tumors
are distinct in their cell of origin, have different
clinical presentations and natural histories and
are often managed differently
OVARIAN CANCER
Pathology. VII. Metastases to ovary
* from breast (hematogenous spread) and
colon, gastric, and pancreatic cancers
(locoregional o intra-abdominal diffusion);
- classic Krukenberg’s tumor = bilateral
ovarian masses from metastatic mucin-
secreting gastrointestinal cancers
SECONDARY
INVOLVEMENT
TO OVARY

from gastric cancer

from colon cancer
METASTATIC TUMOR FROM GASTRIC CANCER

gastric carcinoma of the fundus, with secondary ovarian tumor
(mucus-secreting signet-ring cells)
METASTATIC TUMOR FROM BREAST CANCER

both ovaries replaced by pale, rather nodular tumor,
with breast cancer cells arranged in long lines
perpendicular to the surface of the ovarian cortex