Ovary

Dr. Raid Jastania

Ovary

• Salpingo-oophoritis

• Endometriosis

• Cysts– Follicle cyst– Luteal cyst– Common, 1-1.5 cm, clear fluid– May be palpable, cause pain or acute abdomen

Polycystic Ovary Disease

• Stein-Leventhal Syndrome

• Young, obese, infertile

• Oligo or amenorrhea

• Hirsutism (excess androgens, high LH, low FSH)

• Mild enlarged ovaries, multiple cysts 0.5 cm, follicle cysts

Case Presentation

• 52-year-old, fit, slim former dancer goes to her internist because of vague abdominal pain and a feeling of fullness. Her medical history is noncontributory. Her gynecologic history includes: menarche, age 13; coitarche, age 18; lifetime sexual partners, 3; no IV drug use or transfusions. Her internist examines her, but can find no problems, so he sends her to a gastroenterologist. The GI specialist examines her, finds no problems, and orders upper and lower GI studies, which are negative

• The woman continues to see these physicians, with worsening symptoms, over five months; it is decided that, because no disease has been found, she needs a psychiatric consultation to aid with her developing anxiety and depression. The psychiatrist knows he needs to exclude organic disease before he treats emotional symptoms, so he performs a physical examination. He notes abdominal fullness with a fluid wave, consistent with ascites. He also performs a pelvic examination. A 10-cm left adnexal mass is easily felt.

• Cytologic examination of the ascitic fluid is performed. At laparotomy, a tumor is diagnosed by the pathologist by doing a frozen section. Tumor is found to have spread to her other ovary, omentum, and numerous sites on her peritoneum. She receives chemotherapy, but dies one year after diagnosis.

Ovarian Tumors

• Ovarian carcinoma is the 5th most common cancer in US

• Classification:– Surface epithelial tumors– Germ cell tumors– Sex cord-stromal tumors

Ovarian Tumors

• Risk factors:– Nulliparity– Family history (5-10% are familial)– BRCA1, BRCA2– K-ras, P53

Ovarian tumors

• Presentation: mass, pressure, obstruction, torsion

• Pseudomysoma• Hormone production• Meigs syndrome (ovarian tumor, ascites

and hydrothorax)• Krukenberg tumor (metastatic gastric

cancer to the ovary)

Classification of Ovarian Tumors

• Surface epithelial tumors– Serous

– Mucinous

– Endometrioid

– Clear cell

– Brenner

• Sex cord tumors– Fibroma/Thecoma

– Granulosa cell tumor

– Sertoli-Leydig cell tumor

• Germ cell tumors– Dysgerminoma

– Teratoma• Mature

• Immature

– Embryonal carcinoma

– Yolk sac tumor

– choriocarinoma

• Surface epithelial-stromal tumors

• Classification : – Bening, borderline (low malignant potential),

Malignant

– Serous– Mucinous– Endometrioid– Clear cell– Brenner tumor

Serous tumors

• 60% benign, 15% LMP, 25% malignant

• Cystic – feature of benign (cystadenoma, cystadenofibroma

• Solid- fearture of malignant

• Papillary projections, nodular

• 25% are bilateral

Serous tumors

• Benign- single layer of cuboidal/columnar epithelium

• LMP- papillary projections

• Carcinoma- invasion of stroma, features of malignancy

Serous tumors

• Prognosis:

LMPMalignant Carcinoma

Limited to ovary

100% 70%

Extend beyond ovary

80% 13%

Mucinous Tumors

• Similar to serous

• Can be benign, LMP or malignant

• The lining is mucus producing epithelium

• Benign>malignant

• Usually multilocular

• May present as Pseudomyxoma peritonei

Endometrioid tumors

• Mostly malignant

• Associated with endometrial carcinoma in 15-30% of cases

Brenner Tumor

• Small, solid

• Incidental

• Transitional epithelium

• Mostly benign

Germ Cell Tumors

• Mature cystic teratoma (dermoid cyst)– Incidental, mass lesion, torsion, infertility– 90% unilateral– Can show all the 3 germ lines (endoderm,

ectoderm, mesoderm)• skin, appendeges, hair, sebaceous gland

• bone, cartilage, teeth, muscle

• neural tissue

Germ Cell Tumors

• Immature Teratoma– 18 years– Bulky solid– Mostly mesoderm: cartilage, bone, muscle– Ectoderm: neural tissue

Germ Cell Tumors

• Dysgerminoma– Malignant tumor– Similar to seminoma in males– 2nd or 3rd decade– Associated with gonadal dysgenesis– Solid large turmors– Sheets of large cells – Lymphoid component

Germ Cell Tumors

• Choriocarcinoma:– Young adults– Small hemorrahgic– Cytotrophoblast, syncytiotrophoblast– Metastasize early.

Sex cord tumors

• Fibroma-thecoma– Benign– Solid gray fibrous– Can produce estrogen– Meigs syndrome (ascites and hydrothorax)– Fibrous proliferation with theca like cells

Sex cord tumors

• Granulosa cell tumor– Postmenopausal– Solid mainly with small cysts– Gray yellow– Call-Exner bodies– Most produce estrogen (risk for breast and

endomertial cancer)

Sex cord tumors

• Sertoli-Leydig cell tumor– Small yellow-orange-brown – Produce androgen

Krukenberg Tumor

Pictures

Testis

Testicular Germ cell tumors

– Seminoma Non-Seminom

1. Teratoma

2. Embryonal carcinoma

3. Yolk sac tumor

4. Choriocarcinoma

– Mixed Germ cell tumors (60%)

Classification of Ovarian Tumors

• Surface epithelial tumors– Serous

– Mucinous

– Endometrioid

– Clear cell

– Brenner

• Sex cord tumors– Fibroma/Thecoma

– Granulosa cell tumor

– Sertoli-Leydig cell tumor

• Germ cell tumors– Dysgerminoma

– Teratoma• Mature

• Immature

– Embryonal carcinoma

– Yolk sac tumor

– choriocarinoma