Transcript DISEASES OF THE OVARIES

DISEASES OF THE OVARIES
DR HEYAM AWAD
• FOLLICULAR AND LUTEAL CYSTS.
• POLYCYSTIC OVARY.
• OVARIAN TUMORS.
FOLLICULAR AND LUTEAL CYSTS
• COMMON.
• CONSIDERED VARIANTS OF NORMAL
PHYSIOLOGY.
• ORIGENATE FROM UNRUPTURED FOLLICLES.
• USUALLY MULTIPLE.
• SMALL AND FILLED WITH SEROUS FLUID.
• LINED BY GRANULOSA OR LUTEAL CELLS.
• MAY RUPTURE AND CAUSE INTRAPERITONEAL
BLEEDING OR ACUTE ABDOMEN.
POLYCYSTIC OVARY (PCO)
• MULTIPLE CYSTIC FOLLICLES IN THE OVARIES.
• PRODUCE EXCESS ESTROGEN AND
ANDROGENS.
• PRESENT IN TEENAGE GIRLS, WITH
OLIGOMENORRHEA, HIRSITUISM, INFERTILITY,
AND OBESITY.
PCO MORPHOLOGY
• OVARIES TWICE THE NORMAL SIZE.
• MULTIPLE SUBCORTICAL CYSTS.
• HISTOLOGICALLY: THICK FIBROTIC OVARIAN
CAPSULE, NUMEROUS CYSTS LINED BY
GRANULOSA CELLS, AND ABSENT CORPORA
LUTEA.
PCO
• HIGH ANDROGEN LEVEL.
• HIGH LH.
• LOW FSH.
• ANDROGENS CONVERTED TO ESTROGEN
WHICH INHIBITS FSH.
OVARIAN TUMORS
• EIGHTH MOST COMMON CANCER IN USA.
• FIFTH LEADING CAUSE OF CANCER DEATH IN
WOMEN.
• THREE TUMOR TYPES: SURFACE EPITHELIAL
TUMORS, GERM CELL NEOPLASMS AND SEX
CORD TUMORS..
SURFACE EPITHELIAL TUMORS
•
•
•
•
CAN BE CYSTIC OR SOLID.
CAN BE BENIGN OR MALIGNANT.
USUALLY BENIGN LESIONS ARE CYSTIC.
MAIGNANT LESIONS CAN BE SOLID OR CYSTIC
WITH A SOLID COMPONENT.
RISK FACTORS
• NULLIPARITY.
• FAMILY HISTORY. .. 5-10 % OF OVARIAN
TUMORS ARE FAMILIAL. MOST OF THESE
ASSOCIATED WITH BRCA 1 AND 2 GENES.
• MUTATIONS IN CERTAIN TUMOR SUPRESSOR
GENES.
SURFACE EPITHELIAL TUMORS
•
•
•
•
SEROUS.
MUCINOUS.
ENDOMETRIOID.
BRENNER TUMOR.
SEROUS TUMORS
•
•
•
•
THE MOST COMMON EPITHELIALTUMORS.
60% ARE BENIGN.
15% LOW MALIGNANT POTENTIAL.
25% MALIGNANT.
• BENIGN SEROUS TUMORS USUALLY CYSTIC
AND OCCUR IN PATIENTS BETWEEN 30 AND 40
YEARS.
• MALIGNANT TUMORS AT 45-65 YEARS OF
AGE.
• BORDERLINE AND MALIGNANT SEROUS
TUMORS ARE THE MOST COMMON OVARIAN
MALIGNANCY (60%)
BENIGN SEROUS TUMORS
• 25% OF BENIGN SEROUS TUMORS ARE
BILATERAL.
• CYSTIC.
• SMOOTH SURFACE.
• HISTOLOGICALLY: LINED BY A SINGLE LAYER OF
TALL COLUMNER OR CUBOIDAL CILIATED
CELLS.
• PSAMMOMA BODIES ARE COMMON.
SEROUS CARCINOMA
• SEROUS CYST ADENOCARCINOMA OR SOLID
SEROUS CARCINOMA.
• IF CYSTIC, SOLID AREAS PRESENT.
• HISTOLOGICALLY: STRATIFICATION,
ANAPLASIA, MITOSES, COMPLEX PAPILLARY
FORMATION AND INASION.
• BETTER PROGNOSIS IF CONFINED TO OVARY.
BORDERLINE SEROUS TUMORS
• LESS ATYPIA AND LITTLE OR NO STROMAL
INVASION.
• NEARLY 100% SURVIVAL.
.
MUCINOUS TUMORS
• 80% BENIGN.
• 10% BORDERLINE.
• 10% MALIGNANT.
MUCINOUS TUMORS
• GROSSLY SIMILAR TO SEROUS
COUNTERPARTS.
• HISTOLOGICALLY LINED BY COLUMNER MUCIN
SECRETING EPITHELIUM.
• LESS LIKELY TO BE BILATERAL.
• IF RUPTURED THEY SEED THE PERITONEUM
AND CAUSE LARGE AMOUNT OF MUCIN =
PSEUDOMYXOMA PERITONEI
PSEUDOMYXOMA PERITOME
ENDOMETRIOID TUMORS
• MAJORITY MALIGNANT.
• 30% BILATERAL.
• 15-38% HAVE ALSO ENDOMETRIAL
CARCINOMA.
BRENNER TUMOR
•
•
•
•
UNCOMMON.
SOLIOD.
USUALLY UNILATERAL.
NESTS OF TRANSITIONAL EPITHELIUM IN
ABUNDANT STROMA.
• MOST ARE BENIGN ALTHOUGH BORDERLINE
AND MALIGNANT COUNTERPARTS EXIST.
TUMORS OF GERM CELL ORIGIN
• DYSGERMINOMA: USUALLY UNILATERAL AND
MALIGNANT.
RESPONDS TO RADIOTHERAPY WITH 80% CURE
RATE.
• CHORIOCARCINOMA :UNILATERAL AND
METASTASIZES EARLY.
• TERATOMA
SEX CORD TUMORS
• GRANULOSA CELL TUMOR.
• THECOMA FIBROMA.
• SERTOLI_ LEYDIG CELL TUMOR.
METASTATIC TUMORS
• MOSTLY BILATERAL.
• GI IS THE MOST COMMON PRIMARY
METASTASIZING TO OVARIES= KRUKENBURG
TUMORS.
• OTHER PRIMARIES.. LUNG AND BREAST
TERATOMA
• 15-20 % OF OVARIAN TUMORS.
• IN THE FIRST TWO DECADES OF LIFE.
• THE YOUNGER THE PATIENT , THE MORE
LIKELIHOOD OF MALIGNANCY.
• 90% ARE BENIGN CYSTIC TERATOMAS.
BENIGN CYSTIC TERATOMA= MATURE
TERATOMA
• MATURE TISSUE FROM THE THREE GERM CELL
LINES: ENDODERM, MESODERM AND
ECTODERM.
• 90% UNILATERAL.
• IN 1% OF CASES MALIGNANT
TRANSFORMATION SEEN, USUALLY SCC.
IMMATURE TERATOMA
•
•
•
•
MALIGNANT.
YOUNG AGE.
USUALLY SOLID.
IMMATURE TISSUE SEEN HISTOLOGICALLY.
SPECIALIZED TERATOMAS
• RARE.
• ONE TYPE OF TISSUE.
• STRUMA OVARII… MATURE THYROID TISSUE….
CAN CAUSE HYPERTHYROIDISM.
• OVARIAN CARCINOID.