You are on page 1of 83

Ovarian Cysts and Tumors

Ovaries

The most important medical problems in ovaries are the neoplasms Death from ovarian cancers is more than that of cervix and uterus together Silent growth of ovarian tumors is the rule ,which make them so dangerous

Ovarian Cysts and Tumors

Non neoplastic cysts are common but they are not serious problems Primary inflammation of ovaries is rare Salpingitis of fallopian tubes frequently causes periovarian reaction (salpingo-Oophoritis) Frequently ,the ovaries affected by endometriosis.

Non-Neoplastic and Functional Cysts of ovary

Non Neoplastic Cyst are more common than the neoplastic ones Follicular and Luteal cysts are most probably physiologic cystic follicles:Innocent lesions originate from unruptured follicles or in follicles that have ruptured and sealed. Usually they are small 1 1.5 cm ,and filled by clear fluid

Follicular Cyst

Is due to distention of unruptured graafian follicle It is sometimes associated with hyperestrinism and endometrial hyperplasia.

Corpus luteum cyst

It results from hemorrhage into a persistent mature corpus luteum.

Theca lutein cyst


Results from gonadotropin stimulation. Often multiple and bilateral.

Chocolate cyst

Is a blood containing cyst resulting from ovarian endometriosis with hemorrhage. The ovary is the most common site for endometriosis.

10

11

12

13

Polycystic Ovaries Stein-Leventhal Syndrome


Young women ,and usually in girls after menarche. -Oligomenorrhea -hirsutism -infertility -Obesity

14

Polycystic Ovaries Stein-Leventhal Syndrome


Secondary to excessive production of estrogens and androgens, mainly androgens The ovaries are usually twice normal in size ,graywhite with smooth outer surface Studded with sub cortical cysts 0.5 to 1.5 cm in diameter.

15

Polycystic Ovaries Stein-Leventhal Syndrome


Histologically ,thickened fibrosed outer tunica Multiple cysts lined by granulosa cells Absence of corpora lutea High level of LH and low FSH

16

17

Figure 22-36 Polycystic ovarian disease and cortical stromal hyperplasia. A, The ovarian cortex reveals numerous clear cysts. B, Sectioning of the cortex reveals several subcortical cystic follicles. C, Cystic follicles seen in a low-power microphotograph. D, Cortical stromal hyperplasia manifests as diffuse stromal proliferation with symmetrical enlargement of the ovary.

18

Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 28 April 2008 01:14 PM) 2007 Elsevier

Figure 22-36 Polycystic ovarian disease and cortical stromal hyperplasia. A, The ovarian cortex reveals numerous clear cysts. B, Sectioning of the cortex reveals several subcortical cystic follicles. C, Cystic follicles seen in a low-power microphotograph. D, Cortical stromal hyperplasia manifests as diffuse stromal proliferation with symmetrical enlargement of the ovary.

19

Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 28 April 2008 01:14 PM) 2007 Elsevier

Ovarian Tumors

Fifth most common cancer in the USA Fifth leading cause of cancer death in women Diversity of pathologic entities because of the three cell types make up the normal ovary

21

Ovarian Tumors classification


Three cell types : 1- the surface epithelium tumors 2- Germ cells tumors 3- Stromal /sex cord cells tumors

22

Figure 22-37 Derivation of various ovarian neoplasms and some data on their frequency and age distribution.

23

Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 28 April 2008 01:14 PM) 2007 Elsevier

Classification of Ovarian Tumors, Surface Epithelial Tumors


: -Serous Tumors : Benign ,Borderline,And malignant -Mucinous T. : Benign ,Borderline , and malignant -Endometrioid T. : Benign, Borderline, and malignant -Transitional cell T. : Brenner tumors, Benign ,Borderline ,and malignant -Undifferentiated Carcinoma

24

Classification of Ovarian Tumors,


Sex Cord-Stromal tumors
-

-Granulosa Cell tuomr -Thecoma Fibroma -Sertoli-Leydig cell tumor -Gynandroblastoma -Unclassified

25

Classification of Ovarian Tumors, Germ Cell Tumors


- -Dysgerminoma - -Yolk Sac Tumor - -Embryonal Carcinoma - -Choriocarcinoma - -Teratoma : Mature, Immature - -Polyembryoma

26

Ovarian Tumors Surface Epithelium Origin

Neoplasms of surface epithelium account for the great majority of all primary ovarian tumors.

28

Ovarian Tumors , Surface Epithelium Origin


65 70 % of overall tumors 90 % of malignant tumors Age 20+ Traditionally divided into Benign ,Malignant ,and Borderline in malignancy Can be strictly epithelial (serous ,Mucinous)

29

Ovarian Tumors , Surface Epithelium Origin

Can have stromal component (Cystadenofibroma , Brenner tumor )

30

Ovarian Tumors , Surface Epithelium Origin

The intermediate ,or the borderline tumors are referred as tumors of low malignant potential These appear to be low grade cancers with limited invasive potential They have better prognosis

31

Serous Tumors

The most frequent ovarian tumor Age is 30 -40 May be solid ,usually cystic Cystadenoma or Cystadenofibroma 65% benign ,15% low malignant potential , and 25% malignant 65 % of all ovarian cancers

32

Serous Tumors

Most are large ,spherical to ovoid ,cystic structures 5 10 cm and might be 30-40 cm 25% of benign tumors are bilateral The surface of the benign is smooth and glistening .In contrast to the malignant forms ,the surface is nodular and irregular

33

Serous Tumors

Cystic spaces are filled by serous fluide Papillary formation is very important and need to be sampled well Histologically the benign tumors are lined by a single layer of tall columnar epithelium Papillary formation can be seen in both the benign and the malignant ones

34

Serous Tumors

Psammoma bodies could be seen Between the clearly benign and the solid malignant tumors we can see the tumors of low malignant potential LMP tumors may seed the peritoneum, the implants of tumors are non invasive. Sometimes may behave as invasive peritoneal implants

35

Serous Tumors

The prognosis of LMP tumors is determined mainly by the nature of the peritoneal implants Prognosis of invasive Serous cystadenocarcinoma after surgery ,chemotherapy ,and radiation is poor and depend on stage 70% 5 year survival for the tumors confined to the ovary

36

Serous Tumors

5 year survival f0r LMP is 100% , Malignant Tumors with capsular invasion ,survival for 10 years is 13% LMP with capsular invasion the 10 year survival is 80%.

37

38

39

40

41

42

43

44

Figure 22-39 A, Borderline serous cystadenoma opened to display a cyst cavity lined by delicate papillary tumor growths. B, Cystadenocarcinoma. The cyst is opened to reveal a large, bulky tumor mass. C, Another borderline tumor growing on the ovarian surface (lower).

45

Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 28 April 2008 01:14 PM) 2007 Elsevier

Figure 22-39 A, Borderline serous cystadenoma opened to display a cyst cavity lined by delicate papillary tumor growths. B, Cystadenocarcinoma. The cyst is opened to reveal a large, bulky tumor mass. C, Another borderline tumor growing on the ovarian surface (lower).

46

Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 28 April 2008 01:14 PM) 2007 Elsevier

Figure 22-40 Papillary serous cystadenoma revealing stromal papillae with a columnar epithelium.

47

Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 28 April 2008 01:14 PM) 2007 Elsevier

Figure 22-41 Borderline serous cystadenoma exhibiting increased architectural complexity and epithelial cell stratification.

48

Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 28 April 2008 01:14 PM) 2007 Elsevier

49

Figure 22-42 Papillary serous cystadenocarcinoma of the ovary with invasion of underlying stroma.

50

Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 28 April 2008 01:14 PM) 2007 Elsevier

51

52

53

54

Mucinous Tumors

Epithelium is consists of mucin-producing cells Less likely to be malignant 10% of ovarian cancers 80% of them benign 10% LMP 10% malignant

55

Figure 22-44 A, A mucinous cystadenoma with its multicystic appearance and delicate septa. Note the presence of glistening mucin within the cysts. B, Columnar cell lining of mucinous cystadenoma.

56

Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 28 April 2008 01:14 PM) 2007 Elsevier

57

Brenner Tumor

Transitional cell epithelium Most are benign

58

59

60

Figure 22-46 A, Brenner tumor (right) associated with a benign cystic teratoma (left). B, Histologic detail of characteristic epithelial nests within the ovarian stroma. (Courtesy of Dr. M. Nucci, Brigham and Women's Hospital, Boston, MA.)

61

Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 28 April 2008 01:14 PM) 2007 Elsevier

Sex Cord Tumors, Granulosa Cell Tumor


Most postmenopausal ,could be any age Unilateral Solid and cystic Tiny to large in size Produce estrogen Malignant behaviour in 5-25%

63

64

Sex Cord Tumors, Thecoma-Fibroma


Any age Unilateral Solid gray to yellow Rarely malignant

65

66

Sex Cord Tumors Sertoli - Leydig


All ages Unilateral Gray to yellow Produce androgens Uncommonly malignant

67

68

Germ Cell Tumors Dysgerminoma


2nd and 3rd decades Unilateral Counterpart to Seminoma Solid ,gray to yellow All malignant PLAP positive

69

70

Embryonal carcinoma

2nd and 3rd decade Solid Aggressive CD 30 positive.

71

Germ Cell Tumors Teratoma


15-20 % of Ovarian tumors Majority in the first 2 decades The younger the patient ,the greater the likelihood of malignancy Over 90% are benign cystic ,mature teratomas Immature teratomas are malignant and are rare.

72

73

Figure 22-48 Opened mature cystic teratoma (dermoid cyst) of the ovary. Hair (bottom) and a mixture of tissues are evident.

74

Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 28 April 2008 01:14 PM) 2007 Elsevier

75

76

77

Figure 22-49 Benign cystic teratoma. Low-power view of skin (top), beneath which there is brain tissue (bottom).

78

Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 28 April 2008 01:14 PM) 2007 Elsevier

Endodermal Sinus (Yolk Sac) Tumor


the tumor is rich in -fetoprotein and 1-antitrypsin. Its characteristic histologic feature is a glomerulus-like structure composed of a central blood vessel enveloped by germ cells within a space lined by germ cells (SchillerDuval body) stained for -fetoprotein by immunoperoxidase techniques Most patients are children or young women presenting with abdominal pain and a rapidly developing pelvic mass. The tumors usually appear to involve a single ovary but grow rapidly and aggressively.

79

Figure 22-52 A Schiller-Duval body in yolk sac carcinoma.

80

Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 28 April 2008 01:14 PM) 2007 Elsevier

Choriocarcinoma

More commonly of placental origin, the choriocarcinoma, similar to the Most ovarian choriocarcinomas exist in combination with other germ cell tumors, and pure choriocarcinomas are extremely rare. are aggressive tumors that generally have metastasized widely through the bloodstream to the lungs, liver, bone, and other viscera by the time of diagnosis. high levels of chorionic gonadotropins that are sometimes helpful in establishing the diagnosis or detecting recurrences.

81

Ovarian Tumors Metastatic Carcinoma


Older ages Mostly Bilateral Primaries are Breast ,lung, and G.I.T. (Krukenberg Tumors)

82

83

You might also like