OVARIAN NEOPLASM

ORIGIN OF OVARIAN TUMORS

OVARIAN NEOPLASM
NON-NEOPLASTIC
Primary
Secondary

functional cyst

Non-neoplastic
Follicular

cyst:
- usually less than 5 cm
- Benign and a symptomatic
- Thin wall, contain clear fluid

Non-neoplastic
Corpus

luteal
- Hemorrahgic corpus luteum
- Cyst filled with blood
- Follicular cysts

Non-neoplastic
Granulosa-theca

lutein cyst
- in molar pregnancy or part of
hyperstimulation syndrome
- Polycystic ovary
- Endometriotic cyst

Primary ovarian tumors

Epithelial

Benign
- Borderline
- Malignant
Germ cell tumors
Sex cord (gonadal stromal)
tumors
-

Epithelial tumors

Serous : most common

Mucinous
Endometrioid
Clear cell(mesonephroid)
Brenner

Epithelial tumors
Serous:
- contain clear fluid
- Often bilateral. Around age of menopause
- Malignant type is the commonest ovarian
cancer

SEROUS CYT ADENOMA

SEROUS BORDERLINE TUMOR

SEROUS CYST
ADENOCARCINOMA

 Mucinous:
large

tumors. Multilocular filled with

mucin
If rupturedpseudomyxoma
peritonei

MUCINOUS CYST ADENOMA

MUCINOUS BORDERLINE
TUMOR

MUCINOUS CYST
ADENOCARCINOMA

Epithelial tumors
Endometrioid:
-

Few cases arise in endometriosis

30% coexist with primary endometrial
cancer
the second most common type of epithelial
ovarian cancer
occurs primarily in women who are between
50 and 70 years of age.

BRENNER TUMORS
usually

benign.occur in reproductive

life
They can be malignant.
May be associated with endometrial
hyperplasia
May coexist with mucinous
cystadenoma

BENIGN BRENNER TUMOR

BRENNER BORDERLINE
TUMOR

BRENNER MALIGNANT
TUMOR

Clear cell carcinoma

Clear

cell ovarian tumors are part of the surface

epithelial tumor group of ovarian cancers,
Accounting for 6% of these cancers.
Polypoid masses that protrude into the cyst.
On microscopic examination, composed of cells
with clear cytoplasm (that contains glycogen)
Hob nail cells.
The pattern may be glandular, papillary or solid.

Germ cell tumors

Dermoid
-

cyst (benign cystic teratoma)

25% of all ovarian neoplasm
Contain tissue derived from two or more
germ cell layers
Unilocular cyst. May contain teeth, bone ,
cartilage, nerves, hair, thyroid,.. Tissues
Almost always benign. Malignant changes
may occur in any component
Occur at any age.peak is 20-30 years.
Bilateral in 20%

Malignant Germ cell tumors

Rare.

3% of ovarian cancers
Teratoma: peak incidence in second
decade
Malignant teratoma
Immature teratoma

IMMATURE TERATOMA

CHORIOCARCINOMA
Non-gestational
secrete

choriocarcinoma

HCG
May be component of solid teratoma

Malignant Germ cell tumors

Yolk-sac

(endodermal sinus)

Highly malignant.

Affect young age

Partly solid.

Secrete alpha feto-protein

 Dysgerminoma
Most

common. Highly malignant

Usually spread by lymphatics
Very radiosensitive
Occur in young women.
May arise in gonadal dysgenesis

Sex cord tumors

Granulosa-theca
-

cell tumors
Moderate to large size
Solid, as enlarge may have cystic spaces
Yellow tinge on cut surface
Thecoma is benign,but granulosa cell is
malignant
Occur at any age .50% postmenopausal
Secret estrogen
Usually stage 1. Late recurrence

GRANULOSA CELL TUMOR

Sex cord tumors

Androgen-

secreting tumors
- Androblastoma,Sertoli-leydig,
Gynandroblastoma
- Cause virilization
Fibroma
- solid tumor
- May be associated with meigs syndrome
- Tend to have long pedicle

FIBROMA

THECOMA

SERTOLI-LEYDIG CELL TUMOR

Metastatic tumors
Always

bilateral. From mucin secreting

tumors, stomach and colon
(krukenberg tumors)

May

be secondary to breast

Metastatic ovarian
Kurkenberg
cancer

tumor

Complication of ovarian
tumors
Torsion

common with dermoid/fibroma

- Severe abdominal pain/vomitting
Rupture
Haemorrhage
Impaction
infection
-

Physical signs
Benign:
-

usually mobile.unless large or complicated

Dermoid cyst anterior to bladder
Malignant:
Bilateral
Ascites
Hard deposit in pelvis
Leg edema
Signs of bowel obstruction of ureteric
obstruction

FIGO Staging
Stage 1

Growth limited to one or

both ovaries

Stage 2

Growth limited to one or

both ovaries with pelvic
extension

Stage 3

Tumor involving
one/both ovaries with
peritoneal implants
outside pelvis/positive
retroperitoneal or
inguinal nodes

Stage 4

Growth involving one or

both ovaries with distant
metastasis

MANAGMENT
Surgery

:
primary
interval debulking
palliative
second look surgery

Chemotherapy

Primary surgery
Primary

cytoreduction
TAH,BSO,OMETECTOMY,WASHINGS
BOWEL SURGERY
Optimal debulking: less than 2 cm
residual tumors
Staging once histology is available
If confined to ovary and young age
conservative surgery

Palliative surgery
Removal
Survival
Quality

of intestinal obstruction

is very poor

of life considerations