Transcript Ovary - University of the West Indies Mona Jamaica

Female Genitalia
IV
Ovary
Ovary
Inflammation
Non-neoplastic
Neoplasms
cysts
Ovary
Inflammation
 Primary
inflammation is rare
 Usually secondary to spread
from fallopian tube (tuboovarian abscess)
 Other causes- appendicitis,
diverticulitis etc
Ovary
Non-neoplastic cysts
Follicular cysts - Polycystic Ovarian
Syndrome (Stein-Leventhal)
 Corpus luteum cysts - may cause
intraperitoneal haemorrhage
 Simple cysts
 Endometriotic cysts - haemorrhage
within endometriotic deposits;
“chocolate cysts”

Ovary
Neoplasms
Classification of Primary Neoplasms
 Surface
(germinal) epithelium (approx.
65%)
 Germ cells (approx. 20%)
 Sex cord-stromal cells (approx. 10%)
 Miscellaneous, i.e. tumours not
specific to the ovary (approx. 5%)
Surface Epithelial Neoplasms
Classification
 Serous
 Mucinous
 Endometrioid
 Brenner
 Clear
cell
 Undifferentiated
Surface Epithelial
Neoplasms
Cystadenomas/cystadenocarcinomas
 Serous - lining resemble fallopian
tube
 Mucinous - resemble lining of cervix
 Endometrioid - resemble
endometrium
 Brenner - resemble urothelium
Serous Tumours
 25%
of all ovarian tumours
 30-50% bilateral
 Benign ones, predominantly cystic
 Malignant ones, more solid
 Papillary projections into cyst cavities
 Borderline (LMP) - features of
malignancy but no stromal invasion
Mucinous & Endometrioid Neoplasms
Mucinous
Less common than serous, 10-20%
bilateral
 Benign, borderline, malignant
 Tend to grow to very large size
 “Pseudomyxoma peritonei”

Endometrioid

Resemble endometrial carcinoma
and may coincide with it
Sex Cord-Stromal Tumours
Granulosa
cell tumour
Thecoma/Fibroma
Sertoli-Leydig cell
tumour
Granulosa Cell Tumours
 Occur
at any age
 Peak incidence, postmenopausal
 25-75%
produce excessive oestrogen
Children - precocious puberty
Reproductive age - menstrual
irregularities
Older age - p.m.b.
 All
potentially malignant, but
 Most behave benign
 High-grade malignant varieties occur
Thecoma/Fibromas

Originate from theca cell

Thecoma
Solid, firm
May produce oestrogen; a few
produce androgens
 Nearly always benign

Fibroma
Solid, invariable benign
Meig’s syndrome
Sertoli-Leydig Cell Tumours
 Resemble
Sertoli & Leydig cells of
testis
 Predominantly solid
 Usually found in young adults
 About half accompanied by excess
androgen secretion - virilization
 Most are of low-grade malignancy
Germ Cell Tumours
 Dysgerminoma
 Yolk
sac tumour (endodermal sinus;
embryonal ca)
 Choriocarcinoma
 Teratoma
Comprise about 20% of ovarian
tumours, but are most COMMON
ovarian tumour in girls and young
women
Germ Cell Tumours
 Dysgerminoma
All malignant
Very radiosensitive with
Up to 95% 5-yr survival
 Yolk
sac tumour - highly malignant;
alpha-fetoprotein
 Chorioca - Rare! Most are metastases
from corpus
Teratoma
Benign cystic teratoma (dermoid cyst)
Most common GCT (up to 95% of
GCTs)
Are multilocular or unilocular cysts
Containing cheesy or porridge-like
sebaceous material with matted hair
Sometimes cartilage, bone and/or teeth
grossly
Tissues from all 3 germ cell layers but
ectodermal tissues predominate
“Struma ovarii” – may be functional
Teratoma
Solid teratomas
Are invariably malignant
Are also known as "immature
teratomas"
Malignancy due to immaturity of
the tissues – usually immature
neuroepithelium
Secondary (Metastatic)
Tumours
 Most
common - stomach, colon,
breast, corpus and cervix uteri
 Krukenberg tumour - bilateral, solid,
mucin-secreting “signet ring” cells;
usually from stomach, colon, breast
 Mets to ovary connote poor prognosis
Ovarian Tumours
General Features
USA - most fatal gynae. malignancy;
kill more than ca.cx & corpus combined
 Ranked 6th in women in Ja
 Presentation - asymptomatic, pain,
mass, signs of malignancy, hormonal
changes etc
 Prognosis - tumour type; grade; stage
 Surgical +/- radioRx, chemoRx
