CNCER DE OVARIO

LUIS ALBERTO SANCHEZ VILELA

MEDICINA ONCOLOGICA INEN

INEN: casos promedio por ao

Perodo 2000-2009

Ovarian carcinogenesis can be divided

into two broad phases:

malignant transformation

Benign borderline malignant ovarian

tumors.

peritoneal dissemination.

Now do not appear to be valid for the

majority of ovarian cancers

PATHOGENESIS

Role of ovulation (repetitive process of DNA damage,

inflammation, and repair of the surface epithelium) in the
pathogenesis of the malignancy

Epithelial ovarian neoplasms are thought to

arise from the surface epithelium covering the
ovary.

As repair follows multiple ovulations, the surface

epithelium of the ovary often extends into the ovarian
stroma to form inclusion glands and cysts.

The epithelium, via neoplastic

transformation, may exhibit
differentiation toward a
variety of mllerian-type cells

serous fallopian tubal lining

mucinous

Intestinal gastrointestinal
mucosa
Mllerian endocervix

Endometrioid endometrial
glands
Brenner/transitional bladder
clear cell mesonephric (renal
cell)

New model of ovarian

carcinogenesis

Surface epithelial tumors divides into two

broad categories: Type I and Type II

based on their clinicopathologic features and

characteristic molecular genetic changes

Type I

Low grade
Arise from precursor
lesion in a stepwise
fashion

High grade
Arise de novo

Cystadenoma
Borderline tumor

Typically present in stage I

Slow growing, indolent
Often remains low grade
E.g.

Type II

Low grade micropapillary

Mucinous
Clear cell
endometroid

Typically present in
advanced stage
Rapid growing,
aggressive
E.g.

High grade serous

MMMT

Molecular biologic evidence supports dualistic

model of ovarian carcinogenesis.

High-grade serous carcinomas p53 mutations

low grade serous carcinomas mutations in K-ras

and BRAF genes.

Pten mutations in endometrioid tumors and Kras in mucinous tumors also supports the
stepwise progression model.

Very recently, Lee et al. have proposed

many high-grade serous carcinomas actually

arise in the mucosa of the fimbriated end of the
fallopian tube.

Pathologic Classification

Surface epithelial
65-70%
Germ cell tumors
15-20%
Stromal 5-10%
Metastatic tumors
5%

World Health Organization Histologic Classification of Ovarian Neoplasms

1.Surface epithelial tumors
1. Serous tumors
2. Mucinous tumors
1. Endocervical-like
2. Intestinal type
3. Endometrioid tumors
4. Clear cell tumors
5. Transitional cell tumors
6. Squamous cell tumors
7. Mixed epithelial tumors
8. Undifferentiated and unclassified carcinoma
2.Sex cord-stromal tumors
1. Granulosa-stromal cell tumors
1. Granulosa cell tumors (adult and
juvenile)
2. Tumors in the thecomafibroma group
1. Thecoma
2. Fibroma
3. Cellular fibroma
4. Fibrosarcoma
5. Sclerosing stromal tumor
2. Sertoli/stromal-cell tumors
1. Sertoli cell tumors
2. Sertoli-Leydig cell tumors
3. Sex cord tumors with annular tubules
4. Gynandroblastoma
5. Unclassified
6. Steroid (lipid) cell tumors
1. Stromal luteoma
2. Leydig cell tumor
3. Steroid cell tumor, not otherwise
specified

3. Germ cell tumors

1. Dysgerminoma
2. Yolk sac tumor (endodermal sinus tumor)
3. Embryonal carcinoma
4. Polyembryoma
5. Choriocarcinoma
6. Teratoma
1. Immature
2. Mature
3. Struma ovarii
4. Carcinoid tumors
7. Mixed germ cell tumors
4. Gonadoblastoma
5. Miscellaneous
8. Small cell carcinoma
9. Malignant lymphomas, leukemias,
plasmacytomas
10. Unclassified
11. Metastatic tumors

Serous Tumors:

Frequently bilateral
(30-66%).
75% benign/bord.,
25% malignant.
Tall columnar ciliated
epithelium.

Estadios de la enfermedad

Estadios de la enfermedad

Estadios de la enfermedad

Estadios de la enfermedad

BIBLIOGRAFA:

Vela Vallespn, C., Lpez-Grado Padreny, J. and Marzo-Castillejo, M.

(2014). El cncer de ovario. FMC. Formacin Mdica Continuada en
Atencin Primaria, [online] 21(04), pp.201-210. Available at:
http://www.fmc.es/es/el-cancerovario/articulo/90300940/#.VWXuFkYavfc [Accessed 15 May 2015].
Cancer.org, (2015). Cncer de ovario: gua detallada. [online]
Available
at:
http://www.cancer.org/espanol/cancer/ovario/guiadetallada/spovar-dg-page [Accessed 17 May 2015]
Fernandez Calvo, O. and Charlin Patio, G. (2015). Gua clnica de
Cncer
de
ovario.
[online]
Fisterra.com.
Available
at:
http://www.fisterra.com/guias-clinicas/cancer-ovario/ [Accessed 17
May 2015].
Nice.org.uk, (2011). Ovarian cancer | 1-recommendations |
Guidance and guidelines | NICE. [online] Available at:
http://www.nice.org.uk/guidance/cg122/chapter/1recommendations [Accessed 17 May 2015].