Transcript 18435: Small Bowel - mucosal necrosis, Adhesions

OVARY 2
 Neoplasms
of the Ovary
 Epithelial, Sex Cord-Stromal, and Germ
Cell
Common Ovarian Tumors
 Benign
Cystic Teratoma
 Serous Cystadenoma
 Mucinous Cystadenoma
 Serous Carcinoma
 Fibroma-Thecoma
 Serous LMP
 Endometrioid Carcinoma
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Pathologists examination
 Classification
by Cell Type of Most
Differentiated Areas
 Malignant Potential Determined by Least
Differentiated Areas
– Gross exam: Papillations, Nodular Thickening, Solid
Areas, Hemorrhage, Necrosis
– 1 block per 1-2cm of maximum tumor size
Epithelial Tumors
General Consideration:
Peri and Postmenopausal Women
Mean age of Cancer Diagnosis approx. 52 years
LMP 4-10 years younger
 Benign
 Borderline
 Malignant
(Low Malignant Potential)
Serous Tumors
 LMP
– 9-15% of serous
neoplasms
– cystic and papillary
– 14-40% bilateral
– 20-40% beyond
ovaries at diagnosis
– excellent prognosis
Serous LMP
Serous Tumors
 Malignant
–
–
–
–
Large 15cm or more
Papillary, Cystic, Solid
35-50% bilateral
poor prognosis
Serous Tumors
Variants
 Surface
tumor
 Surface Serous Carcinoma of the Peritoneum
 Psammocarcinoma
Implants
 Invasive
 Noninvasive
– Epithelial
– Desmoplastic
Mucinous
 LMP
– less common than
Serous LMP
– Intestinal Type
– Endocervical/
Muellerian Type
– Better prognosis than
Serous
Mucinous
 Malignant
– 10% bilateral
– usually confined to
ovary and (-) surface
– 66% 5yr Stage I
– 59% 10 yr
– Pseudomyxoma
peritonei
Mucinous Tumors
Endometrioid
 LMP
Endometrioid
 Malignant
–
–
–
–
16-30% of Ovarian Ca
Less Cystic
10-20 cm
Well or Moderately
Differentiated
– Assoc. EM Ca and
Hyperplasia
– 40-55% 5yr survival
Endometrioid Tumors
Clear Cell
 Nearly
all are Ca
 5-11% of Ovarian Ca
 10% Hypercalcemia
 usually >15 cm
 Cystic and Solid
 3% bilateral
 Endometriosis
Clear Cell Carcinoma
Brenner Tumor
Transitional Cell
 LMP
– > 8-10 cm
– Cystic or Semicystic
– Resemble LG Papillary
TCC
– Usually Benign Clinical
Course
Transitional Cell
 Malignant
 Malignant
Brenner vs.
TCC
– rare
– elderly women
– Unilateral and Cystic
Undifferentiated Carcinoma
 Poor
Prognosis
Mixed Epithelial Tumors
2
or more cell types
in 10% of tumor
 Each 10% or more of
total area
 Mixed LMP:
Mucinous with
Serous or
Endometrioid
 Mixed Carcinoma:
Endometrioid with
Clear, Serous,
Misc.
 Small
Cell Carcinoma
of Hypercalcemic
Type
 Small Cell Carcinoma
Carcinoma of
Pulmonary Type
 Squamous Cell
Carcinoma
Sex Cord-Stromal Tumors
 Ovarian
Differentiation
 Testicular
Differentiation
Granulosa Cell Tumor
 Adult
Type
 Juvenile Type
– <5% before puberty
Adult Granulosa Cell Tumor
 1/3
premenopausal
 2/3 older
 assoc. with
hyperestrogenic state
 vary in size
 characteristically
yellow to white and
cysts with blood
Juvenile Granulosa Cell Tumor
 Grossly
similar to
Adult Form
 Neoplastic Granulosa
Cells scattered
among which are
varying numbers of
follicles.
Granulosa Cell Tumor
Adult Granulosa Cell Tumor
Germ Cell Tumors
 30%
Ovarian Tumors
 95% Dermoid Cysts
 3% Ovarian Ca
 2/3 of Ca in first 2
decades
3 Basic Types
 Immature
Germ Cell (Children)
– Immature Germ Cells (Dysgerminoma)
– Early Embryonic Development
(Embryonal,Polyembryoma)
– Extraembryonic Differentiation
(Choriocarcinoma, Yolk Sac Tumor)
– Immature Somatic Tissue (Immature
Teratoma)
 Mature
Germ Cell Tumor (Reproductive
Years)
– Most common
– Mature Somatic Tissue
 Benign
Cystic Teratoma giving rise to
malignancy (Postmenopausal)
– Squamous Cell Carcinoma
– Carcinoid
– Malignant Thyroid Cancer
Dysgerminoma
 Most
Common Germ
Cell Tumor
 100% 5yr survival St I
 Radio and
Chemosensitive
 Solid, 15cm
 Primordial Germ
Cells Fibrous Stroma
w/ Lymphocytes
Dysgerminoma
Yolk Sac (Endodermal Sinus)
Tumor
 AFP
 Rapidly
growing
highly malignant
 Chemotx
 80% 5yr survival St I
– 25% rupture
– hemorrhage, necrosis
– Schiller-Duvall bodies
Yolk Sac Tumor
Embryonal
 Very
Rare
 mean age 15
 HCG, AFP
– 15 cm
– Anaplastic large Cells
Choriocarcinoma
 Very
rare
 < 20 yr
 HCG
Teratomas
 Immature
 18cm,
solid
 immature tissue
– neuroectodermal
– neuroepithelial rosettes
Immature Teratoma
Metastatic Tumors
 Krukenberg
Tumor