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Ovary Dr. Amitabha Basu MD Topic Normal ovary Polycystic ovary Tumors of the ovary Normal ovary gross Micro Th) Theca (MG) Membrana granulosa (CR) Corona radiata (ZP) Zona pellucida (CL) Corpus luteum Polycystic ovarian disease Definition Morphology Clinical features Def: Multiple cystic follicles in the ovary. Pathophysiology Excessive secretion of estrogen and androgen. High LH Low FSH LH/FSH Ratio: high Clinical features/complications A. Oligomenorrhoea (Polycystic ovarian disease with oligomenorrhea is known as Stein-Leventhal syndrome) B. Hirsuitism C. Infertility D. Endometrial Hyperplasia. Tumors of the Ovary 1. 2. 3. 4. Classification Subtypes Age Incidence Etiopathogenesis A. B. C. D. E. Serous tumors Mucinous tumors Dysgerminoma Teratoma Granulosa-theca cell tumor F. Sertoli Leydig cell tumor G. Metastasic tumor Classification Classification A. Tumor arising form the surface epithelium B. Tumor arising form the germ cells C. Tumor arising form Sex-cord stroma surface epithelium D. Metastasic tumor Tumor arising form the surface epithelium Origin Frequency Proportion of malignant ovarian tumor. Age group Germ cells 15-20% 3-5% Types 1. Teratoma 2. Dysgerminoma 3. Endodermal sinus 0-25+ years tumor 4. Choriocarcinoma Tumor arising from sex cord stroma Frequency 5-10% Proportion of malignant ovarian tumor. 2-3% Age group All age Types 1. Fibroma 2. Granulosa- theca cell tumor 3. Sertoli Leydig cell tumor Metastasic tumor Frequency Proportion of malignant ovarian tumor. Age group 5% 5% Example : Krukenberg tumor All age Etiopathogenesis Multiparty Family history Genes 1. BRCA 1 AND BRCA 2 ( IN HEREDITARY OVARIAN CANCER) 1. ERB B2 2. K-RAS 3. TP53 Serous tumor : Types 1. Benign 2. Borderline 3. Malignant Note: All surface epithelial tumors can be divided in these three types Features of Serous tumor Common ovarian tumor. Mostly benign. Cysts are lined by single Ciliated columnar epithelium. Cyst contain serous fluid. Bilateral (25%) Usually Small. Microscopy of serus tumor: Cysts are lined by single Ciliated columnar epithelium Borderline Serous Tumor Between benign cyst adenomas and malignant cystadenocarcinomas lies the grey zone of "borderline" lesions that are not clearly malignant, but are treated as though they could be. Malignant serous Tumor : Papillary serous cystadenocarcinomas : note papillary areas. Microscopy : Papillary process and cellular crowding and Psammoma body (not seen) Psammomma body in serous tumors( malignant) Spread of the tumor These neoplasms characteristically spread by "seeding" along peritoneal surfaces. Marker for Surface epithelial tumors: CA 125 Features of Mucinous tumor Not common ( 10%), Large Cysts are lined by single layer Mucin secreting columnar epithelium. Cyst contain Mucinous gelatinous fluid: if rupture produce Pseudomyxoma peritonei. Histology : Multilocular cysts lined by a single layer of benign mucinous columnar epithelium. Compare Serous and mucinous tumors Teratoma Types Dermoid cyst Immature malignant Teratoma Struma Ovarii. Types 1. Benign Teratoma ( Mature: usually cystic) 2. Malignant Teratoma( Immature : usually solid) 3. Monodermal Teratoma ( carcinoid Tumor, struma ovarii) Benign Teratoma ( Mature) of ovary It is also called Dermoid cyst. ( because it contains dermal appendages). Dermoid cyst : Mature cystic Teratoma Immature Malignant Teratoma Mean age : 18 years Features : bulky, solid Histology : Tissue containing immature neural tissue with neuroepithelial differentiation. Dysgerminoma Etiopathogenesis : Occur with gonadal dygenesis. Radiosensitive tumor : 80% cure Unilateral Grey white homogenous Mimic Seminoma histology ! Granulosa-theca cell tumor Age : Post menopause but any age Unilateral Diagnostic point : Presence of call Exner body in Histology. Function: Secrete estrogen ; promote endometrial, breast carcinoma. Presence of call Exner body Sertoli Leydig cell tumor Age: all age Unilateral Point for identification: Gross: Yellow brown, solid. Micro: Pink Sertoli Leydig cells. Clinical effect: Masculinizing ( defeminizing). Gross: Yellow brown, solid. Struma ovarii In this tumor the Teratoma contain predominantly thyroid tissue. Struma ovarii : produce Hyperthyroidism Metastasic tumor Age: older age Primary Tumor: Breast, lung, GIT Big bilateral mass Example : Tumor name : Krukenberg tumor Krukenberg tumor 1. Primary tumor : Gastric adenocarcinoma 2. Route of metastasis : Seeding through body cavity. 3. Bilateral always. 4. Histology : contain “ signet ring” cells. Gross Nice to Know this Tumor: Thecoma-fibroma Any age Unilateral Produce Meigs syndrome( ovarian tumor with ascites and Hydrothorax) Review Endometriosis ( clinical features) Endometrial Hyperplasia . Etiology with C/F Dermoid cyst Gross identification. Leiomyoma identification and c/f Carcinoma in situ Granulosa theca cell tumor. Review Metastasic tumors Ectopic pregnancy Genes for Ovarian cancers. Clear cell carcinoma Vaginitis Lichen sclerosus Polycystic ovary Gonorrhea infection (PID) Anovulatory cycle : and other Causes of DUB Thank you!