Ovarian neoplasm II

AP DR. MIE MIE SEIN

MBBS BLOCK 4
Learning Outcomes
Ovarian neoplasms
Classify ovarian neoplasms. (C4)
Epithelial neoplasms
1. Explain the aetiopathogenesis of epithelial ovarian neoplasms. (C2)
2. Classify ovarian epithelial neoplasms. (C4)
3. Describe the morphology, complications and prognosis of ovarian epithelial neoplasms. (C2)
Teratomas
Describe the types, morphology and prognosis of teratomas. (C2)
Krukenberg tumour
1. List the possible sites of origin. (C1)
2. Describe the morphology of Krukenberg tumour. (C2)
Tumour markers of ovary
Explain the role of tumour markers in the diagnosis and prognosis of ovarian tumours. (C2)

Manipal University College Malaysia 2

 Endometrioid Tumours

-may be solid or cystic; they sometimes develop in

association with endometriosis.
-On microscopic examination, they are
distinguished by the formation of tubular glands,
similar to those of the endometrium,
-usually, malignant Polypoid mass protruding from the opened cyst
Endometriosis present on the posterior surface of the uterus
-They are bilateral in about 30% of cases, and 15%
to 30% of women with these ovarian tumours have
a concomitant endometrial carcinoma.

Manipal University College Malaysia 3

Source: pathology outlines and NUS-webpath
 Brenner Tumour

-uncommon, solid
-usually, unilateral ovarian tumour consisting of abundant
stroma containing nests of transitional-type epithelium
resembling that of the urinary tract.
-Occasionally, the nests are cystic and are lined by
columnar mucus-secreting cells.
-smoothly encapsulated and gray-white on cut section -
arise from the surface epithelium or from urogenital
epithelium trapped within the germinal ridge.
-most are benign, both malignant and borderline tumors +

Manipal University College Malaysia 4

source: webpathology
 Teratomas

• Teratomas constitute 15% to 20% of ovarian tumours

• Arise in the first 2 decades of life
• More than 90% of these germ cell neoplasms are benign mature cystic teratomas
• The immature, malignant variant is rare

Types

• Benign (Mature) Cystic Teratomas

• Immature Malignant Teratomas
• Specialized Teratomas

Manipal University College Malaysia 5

 Mature cystic teratoma (dermoid cyst)

-marked by the presence of mature tissues derived from all three

germ cell layers: ectoderm, endoderm, and mesoderm.
-Usually, these tumors contain cysts lined by epidermis replete with
adnexal appendages (dermoid cysts).
-Most are discovered in young women as ovarian masses or are
found incidentally on abdominal radiographs or scans because they
contain foci of calcification produced by tooth like structures
-About 90% are unilateral, with the right side more commonly
affected.
-On cut section, they often are filled with sebaceous secretion and
matted hair that, when removed, reveal a hair-bearing epidermal
lining
Mature cystic teratoma of the ovary
-foci of bone and cartilage, nests of bronchial or gastrointestinal A ball of hair (bottom) and a mixture of tissues are evident.
epithelium, or other tissues are present
- Malignant transformation, usually to a squamous cell carcinoma
Source: Courtesy of Dr. Christopher Crum, Brigham and Women’s Hospital, Boston,
(1% of cases) Massachusetts

Manipal University College Malaysia 6

 Well-developed in ovarian mature cystic teratoma

Various Tissue Components of Mature Cystic Teratoma of

Ovary: Skin adnexa, glial tissue, and choroid plexus

Manipal University College Malaysia Source: Rosai and Ackerman’s surgical pathology 7
 Immature Malignant Teratomas

- found early in life (18 years)

- typically, bulky and appear solid on cut section
- they often contain areas of necrosis
- uncommonly, cystic foci are present that contain sebaceous secretion,
hair, and other features similar to those of mature teratomas.
- On microscopic examination, the distinguishing feature is the presence
of immature elements or minimally differentiated cartilage, bone,
muscle, nerve, or other tissues.
- the prognosis depends on grade and stage.

Manipal University College Malaysia 8

 Specialized Teratomas

- composed entirely of specialized tissue.

- The most common example is struma ovarii, composed entirely of mature
thyroid tissue that may actually produce hyperthyroidism.
- These tumours appear as small, solid, unilateral brown ovarian masses.
- Other specialized teratomas include ovarian carcinoid, produces carcinoid
syndrome.

Struma ovarii - usually predominantly solid with small cystic

areas. It has a yellow to reddish-brown surface resembling normal
thyroid

Source: pathorama.ch

Manipal University College Malaysia 9

 Krukenberg tumour

• Generally, affects women more than 45 years

• Diffuse type of gastric cancer metastasizes to ovaries (Most common)
• Spread due to shedding of cells into peritoneum (Transcoelomic spread)
• Other cancer associated with Krukernberg tumour are CA breast, uterus, colon and
lung

Manipal University College Malaysia 10

Morphology

Gross Histology

-Bilateral
-Symmetrically enlarged ovaries
-multinodular outer appearance

Source: National University of Singapore (Pathweb)

Manipal University College Malaysia 11
 Tumour markers of Ovary

• Cancer Antigen-125 (CA-125)

predicting prognosis, in follow-up, and in screening for ovarian cancer
low specificity
• Cancer Associated Serum Antigen (CASA) may reflect more accurately the
clinical situation
(some ovarian malignancies do not produce considerable amounts of CA 125)

Manipal University College Malaysia 12

 Diagnosis

• Pelvic examination
• USG
• CT scan
• MRI – to detect tumours/recurrences
• Positron emission tomography (PET) scan uses a radioactive tracer

Manipal University College Malaysia 13

 TAKE HOME MESSAGE

• Tumours may arise from epithelium, sex cord–stromal cells, or germ cells.
• Epithelial tumours are the most common malignant ovarian tumour and are more common in women
older than 40 years of age.
• The major types of epithelial tumours are serous, mucinous, and endometrioid. Each has a benign,
malignant, and borderline counterpart.
• Serous carcinoma is the most common and many arise in the distal fallopian tube.
• Germ cell tumours (mostly cystic teratomas) are the most common ovarian tumour in young women; the
vast majority are benign.
VIGILANCE IS PREVENTION

Manipal University College Malaysia 14

References:

Robbins and Cotran Pathologic Basis of Disease 10th Edition

Robbins basic pathology 10th Edition
Underwood’s pathology: A clinical approach 7th edition

Manipal University College Malaysia 15

 Thank you!

Manipal University College Malaysia 16