salpinx: salpingitis l cause: chlamydia and gonococcus = most l route: cervix lymphatics adnexae l...

SALPINX: SALPINGITISSALPINX: SALPINGITIS

Cause: chlamydia and gonococcus = mostCause: chlamydia and gonococcus = most

Route: cervix Route: cervix lymphatics lymphatics adnexae adnexae

Complications: Complications:

abscess tubes, ovaries, tubo-ovarian, peritonitis,abscess tubes, ovaries, tubo-ovarian, peritonitis,

tubal scarring, hydrosalpinx, adhesions, bowel tubal scarring, hydrosalpinx, adhesions, bowel

obstruction, ectopic pregnancy, infertilityobstruction, ectopic pregnancy, infertility

Tuberculosis: usually part of endometritisTuberculosis: usually part of endometritis

Supprative salpingitis with massively swollen fallopian tube

Purulent exudate flowing from transected fallopian tube

Wall and lumen of fallopian tube is filled with PMNs

Bilateral hydrosalpinx dwarfs uterus: hydrosalpinx may be end result of resolution of infection

Hydrosalpinx

SALPINX: NEOPLASMSSALPINX: NEOPLASMS

Adenomatoid tumors (mesothelioma) Adenomatoid tumors (mesothelioma) subserosally on tube subserosally on tube Incidental finding Incidental finding Small nodules of benign appearing glands within muscular wallSmall nodules of benign appearing glands within muscular wall

Paratubal cysts & hydatid cysts of Morgagni Paratubal cysts & hydatid cysts of Morgagni common serous common serous filled cysts usually near fimbriafilled cysts usually near fimbria

Adenocarcinoma: Adenocarcinoma: Sx late, so prognosis poor Sx late, so prognosis poor

Adenomatoid tumor as seen at surgery in wall of fallopian tube

Adenomatoid tumor of fallopian tube

PREGNANCY-RELATED LESIONS (1)PREGNANCY-RELATED LESIONS (1)

Ectopic pregnancyEctopic pregnancy

Frequency: 1% of all pregnancies!Frequency: 1% of all pregnancies!

Sites: Sites: tube (85%)tube (85%), ovary (14%), abdomen (1%), ovary (14%), abdomen (1%)

Cause: Cause: PIDPID (50%), endometriosis, leiomyomas, (50%), endometriosis, leiomyomas,

I.U.D., adhesionsI.U.D., adhesions

Course: tube and ovary: Course: tube and ovary: placenta perforates wall placenta perforates wall hemorrhage hemorrhage

bleeding is often life-threateningbleeding is often life-threatening

PREGNANCY-RELATED LESIONS (2)PREGNANCY-RELATED LESIONS (2)

Dx: clinical suspicion (acute abdomen) Dx: clinical suspicion (acute abdomen) pelvic exam, pregnancy test, ultrasound, pelvic exam, pregnancy test, ultrasound,

laparoscopylaparoscopy D&C = D&C = deciduous stroma but no villideciduous stroma but no villi

Abdominal pregnancy may implant on psoas Abdominal pregnancy may implant on psoas muscle muscle to term to term Fetus may die and calcify Fetus may die and calcify lithopedion lithopedion

Ectopic pregnancy within fallopian tube

Ruptured ectopic pregnancy of fallopian tube

Ectopic pregnancy near fimbriated end of tube. A corpus luteum is present within the ovary (arrow)

Chorionic villi within lumen of fallopian tube Thin arrows point to chorionic villi

Ectopic pregnancy

Placental insertion into liver

Ectopic pregnancy associated with IUD use

PREGNANCY-RELATED LESIONS (3)PREGNANCY-RELATED LESIONS (3)

Toxemia (pre-eclampsia, eclampsia):Toxemia (pre-eclampsia, eclampsia): Pre-eclampsia = hypertension, proteinuria and Pre-eclampsia = hypertension, proteinuria and

edema (~ 6% of pregnancies)edema (~ 6% of pregnancies) eclampsia = convulsions tooeclampsia = convulsions too

Usually last trimesterUsually last trimester Pathology: Pathology:

DICDIC fibrinoid vascular necrosis and thrombosis with fibrinoid vascular necrosis and thrombosis with

multiple small infarcts of liver, brain, kidney and multiple small infarcts of liver, brain, kidney and placentaplacenta

PREGNANCY-RELATED LESIONS (5)PREGNANCY-RELATED LESIONS (5)

Placenta accreta:Placenta accreta:

Absence of decidua of endometrium so placenta adheres Absence of decidua of endometrium so placenta adheres

directly to myometrium: failure of placental separation directly to myometrium: failure of placental separation

during pregnancyduring pregnancy

Often when placenta implants on scar (C-section)Often when placenta implants on scar (C-section)

60% associated with placenta previa60% associated with placenta previa

Bleeding may be life-threatening Bleeding may be life-threatening hysterectomy hysterectomy

Placenta previa: placenta implants over lower uterine segment Placenta previa: placenta implants over lower uterine segment

or cervix. During labor or cervix. During labor hemorrhage. hemorrhage.

PREGNANCY-RELATED LESIONS (6)PREGNANCY-RELATED LESIONS (6)

Hydatidiform mole (partial and complete)Hydatidiform mole (partial and complete)

Most present with spontaneous abortion or are Dx’ed at U/SMost present with spontaneous abortion or are Dx’ed at U/S

Complete moleComplete mole

Placental villi massively edematous (hydropic) Placental villi massively edematous (hydropic)

center of villi = hyaline; no embryo; trophoblast center of villi = hyaline; no embryo; trophoblast

proliferative.proliferative.

Mechanism: Mechanism: ovum loses nuclear DNAovum loses nuclear DNA; sperm ; sperm

“fertilizes” with 23X, doubles to 46XX“fertilizes” with 23X, doubles to 46XX

Or two sperm fertilize empty ovum, 46XX or 46XYOr two sperm fertilize empty ovum, 46XX or 46XY

all chromosomes paternal.all chromosomes paternal.

PREGNANCY-RELATED LESIONS (7)PREGNANCY-RELATED LESIONS (7)

Complete moleComplete mole Rapid uterine enlargement to excessive size; high Rapid uterine enlargement to excessive size; high

urinary gonadotropin; expelled @urinary gonadotropin; expelled @10-18 weeks 10-18 weeks

bleedingbleeding

2% 2% choriocarcinoma choriocarcinoma (mole histology doesn’t (mole histology doesn’t

predict) Malignant tumor of trophoblastic tissue predict) Malignant tumor of trophoblastic tissue

(cytotrophoblasts and synctiotrophoblasts)(cytotrophoblasts and synctiotrophoblasts)

May be Dx at ultrasound May be Dx at ultrasound Rx: suction curettage; Rx: suction curettage; follow urinary gonadotropinsfollow urinary gonadotropins

PREGNANCY-RELATED LESIONS (8)PREGNANCY-RELATED LESIONS (8)

Partial molePartial mole

About 1/2 villi = normal (with fetal RBC), rest = hydropicAbout 1/2 villi = normal (with fetal RBC), rest = hydropic

Focal trophoblast proliferationFocal trophoblast proliferation

Mechanism:Mechanism: 2 sperm fertilize ovum that retains its 2 sperm fertilize ovum that retains its

nucleus nucleus triploidy (69, XXY or 69,XXX) or rarely triploidy (69, XXY or 69,XXX) or rarely

tetraploid (92, XXXY)tetraploid (92, XXXY)

Embryo formed, dies 4-8 weeks Embryo formed, dies 4-8 weeks fetal parts fetal parts

Less Less in serum HCG than complete mole in serum HCG than complete mole

These rarely lead to choriocarcinomaThese rarely lead to choriocarcinoma

PREGNANCY-RELATED LESIONS (9)PREGNANCY-RELATED LESIONS (9)

Invasive mole: mole that penetrates & may perforate Invasive mole: mole that penetrates & may perforate

uterine walluterine wall

Gross: trophoblastic invasion of myometrium (shallow or Gross: trophoblastic invasion of myometrium (shallow or

perforating)perforating)

Micro: trophoblast invades myometrial veins and spreads Micro: trophoblast invades myometrial veins and spreads

to lungs or brain but does not thrive there, withersto lungs or brain but does not thrive there, withers

Threat: bleeding from ruptured uterus or at distant sitesThreat: bleeding from ruptured uterus or at distant sites

Has persistently elevated HCGHas persistently elevated HCG

Rx: chemotherapy and/or hysterectomyRx: chemotherapy and/or hysterectomy

Hydatidiform mole fills and expands uterus: hydropic villi are evident

Hydatidiform mole: uterus is filled with thin-walled, translucent, polypoid masses consisting of hydropic villi

Hydropic villi of mole

Markedly swollen (hydropic) villi of mole

Central cavitation (cisterns) of complete mole

PREGNANCY-RELATED LESIONS (10)PREGNANCY-RELATED LESIONS (10)

ChoriocarcinomaChoriocarcinoma

Malignant transformation of trophoblastic tissue from any form of Malignant transformation of trophoblastic tissue from any form of

pregnancy, 1 in 20-30,000 pregnancies in USpregnancy, 1 in 20-30,000 pregnancies in US

1 in 40 hydatidiform moles1 in 40 hydatidiform moles

Lacking its own vessels, necrosis and hemorrhage commonLacking its own vessels, necrosis and hemorrhage common

Early metastasis—widely hematogenouslyEarly metastasis—widely hematogenously

First symptom usually hemorrhage, but may be metastases First symptom usually hemorrhage, but may be metastases

Markedly elevated serum HCGMarkedly elevated serum HCG

PREGNANCY-RELATED LESIONS (11)PREGNANCY-RELATED LESIONS (11)

Choriocarcinoma (cont.) Choriocarcinoma (cont.)

Dx: Dx: dimorphic histologydimorphic histology (cytotrophoblasts & (cytotrophoblasts &

syncytiotrophoblasts) without chorionic villisyncytiotrophoblasts) without chorionic villi

Rx: chemo Rx Rx: chemo Rx 70% survival 5 yr even if metastatic 70% survival 5 yr even if metastatic

Placental site trophoblastic tumor = intermediate Placental site trophoblastic tumor = intermediate

trophoblast, lower gonadotropin level trophoblast, lower gonadotropin level

Local invasionLocal invasion

10% metastasize10% metastasize

Hemorrhagic tumor nodules of choriocarcinoma has distorted uterus

Dimorphic histology of choriocarcinoma. Cytotrophoblasts have clear cytoplasm.

Choriocarcinoma: syncytiotrophoblasts (arrows) flanked by cytotrophoblasts and necrotic tissue

Multiple hemorrhagic nodules of metastatic choriocarcinoma in lungs

Germinal epithelium of fetal ovary

Numerous follicles in various stages of development

Maturing follicle with thecal cells (pink arrow) and granulosa cells (blue arrow)

Mature Graafian follicle (arrow depicts oocyte)

Site of rupture of ovum on surface of ovary

Cut surface of corpus luteum

Corpus luteum with luteinized granulosa cells & theca cells (arrow)

Granulosa cells

Atretic follicle – scarring in center where ovum was and stuff around it

OVARY: CYSTS, NON-NEOPLASTICOVARY: CYSTS, NON-NEOPLASTIC

Follicular:Follicular: cystic dilatation of unruptured graafian follicle cystic dilatation of unruptured graafian follicle Luteal cyst:Luteal cyst: cystic dilatation of corpus luteum cystic dilatation of corpus luteum Polycystic ovaryPolycystic ovary (Stein-Leventhal) syndrome: (Stein-Leventhal) syndrome:

Pathology: multiple follicular cysts and foci of hyperthecosis Pathology: multiple follicular cysts and foci of hyperthecosis with stromal fibrosis with stromal fibrosis

3-6% of reproductive-age women3-6% of reproductive-age women Clinical: persistent anovulation, hirsutism (50%), obesity Clinical: persistent anovulation, hirsutism (50%), obesity

(40%), infertility(40%), infertility Mechanism: Mechanism: excessive LHexcessive LH causes theca lutein causes theca lutein androgen androgen Rx: hormonal (used to be surgical – didn’t help)Rx: hormonal (used to be surgical – didn’t help)

Follicular cyst

Opened follicular cyst

Wall of luteal cyst with luteinized granulosa cells

Cut surfaces of polycystic ovary

Polycystic ovary

Type % of Malignant Ovarian Tumors % Bilateral

____________________________________________________________________

Serous 40

Benign (60%) 25

Borderline (15%) 30

Malignant (25%) 65

Mucinous 10

Benign (80%) 5

Borderline (10%) 10

Malignant (10%) 20

Endometriod carcinoma 20 40

Undifferentiated carcinoma 10

Clear cell carcinoma 6 40

Granulosa cell tumor 5 5

Teratoma

Benign (96%)

Malignant (4%) 1 rare

Metastatic 5 >50

OVARY: NEOPLASMS: OVERVIEWOVARY: NEOPLASMS: OVERVIEW

Surface (coelomic) epitheliumSurface (coelomic) epithelium benign cysts, both benign cysts, both

serous and mucinous, serous & mucinous tumors, serous and mucinous, serous & mucinous tumors,

endometrioid, clear-cell, Brenner tumorsendometrioid, clear-cell, Brenner tumors

Germ cellGerm cell dysgerminoma, teratoma, chorioca, dysgerminoma, teratoma, chorioca,

endodermal sinus tumorendodermal sinus tumor

Sex-cord-stromaSex-cord-stroma fibroma, granulosa-theca, Sertoli-fibroma, granulosa-theca, Sertoli-

Leydig cell tumorsLeydig cell tumors

OVARY: CYSTIC TUMORS (1)OVARY: CYSTIC TUMORS (1)

Serous cystadenomasSerous cystadenomas (__ca): watery fluid, partly ciliated (__ca): watery fluid, partly ciliated

epithelium (salpinx-type)epithelium (salpinx-type)

Mucinous:Mucinous: slimy content; columnar mucinous (cervical) slimy content; columnar mucinous (cervical)

epitheliumepithelium

Malignancy odds related to: Malignancy odds related to:

gross: gross: solid/cystic ratio, fixation to neighboring solid/cystic ratio, fixation to neighboring

structures – structures – the more solid the more likely to be the more solid the more likely to be

malignantmalignant

micro: micro: amount and extent of lining papillation; amount and extent of lining papillation;

nuclear atypia, invasion of stromanuclear atypia, invasion of stroma

OVARY: CYSTIC TUMORS (2)OVARY: CYSTIC TUMORS (2)

Above changes progress: benign Above changes progress: benign borderline borderline malignant. Prognosis inverse (malignant malignant. Prognosis inverse (malignant 70% 70% 5 yr survival, 25% if fixed)5 yr survival, 25% if fixed)

General: mucinous larger, less often malignant General: mucinous larger, less often malignant pseudomyxoma peritoneipseudomyxoma peritonei (tumor produces massive (tumor produces massive mucin with peritoneal implants) mucin with peritoneal implants) may cause fatal may cause fatal obstructionobstruction

Bilaterally Bilaterally toward malignancy toward malignancy

Benign

Borderline

Malignant

Serous cystadenoma (3-10 cm is typical)– most common tumor of ovary, smooth cyst with no necrosis and typically no solid areas, smooth lining. Contains watery fluid and explode when cut into.

Typically asymptomatic so picked up incidentally on pelvic exam or vague minor discomfort

Serous cystadenoma

Opened serous cystadenoma with a smooth lining and very thin walled

Serous epithelium of cystadenoma with some papillations (papillary serous cystadenoma)

Ciliated epithelium of a serous cystadenoma

Numerous psammona bodies in paillary serous tumor – not clinically significant, found in both benign and malignant papillary tumors

Benign serous tumors may become large (20cm)

52 lb benign serous cystadenoma

Papillary excrescences from lining of serous tumor (papillary serous cystadenoma) – always section any one that looks papillary to check

Borderline papillary serous cystadenocarcinoma with epithelial atypia

Borderline tumor: no stromal invasion is present

Multiloculated and solid papillary serous cystadenocarcinoma

Solid areas in papillary serous cystadenocarcinoma

Papillary serous cystadenocarcinoma: tumor has breached surface of ovary

Mostly solid papillary serous cystadenocarcinoma

Papillary serous cystadenocarcinoma

Stratified, atypical nuclei in papillary serous cystadenocarcinoma: stromal invasion is present

Mucin producing lining cells in benign mucinous cystadenoma

Borderline mucinous tumor

Mucin production and stromal implants in pseudomyxoma peritonei

Nuclear atypia & mitotic figures in mucinous cystadenocarcinoma

OVARY: ENDOMETRIOID CARCINOMAOVARY: ENDOMETRIOID CARCINOMA

Gross: mixed solid/cystic structureGross: mixed solid/cystic structure

Histo: endometrium-like malignant glandsHisto: endometrium-like malignant glands

25% = concurrent but independent endometrial 25% = concurrent but independent endometrial

ca in uterusca in uterus

Minority = benign cystadenofibromaMinority = benign cystadenofibroma

Variant: clear cell carcinomaVariant: clear cell carcinoma

Endometrioid ovarian Ca

Endometrioid cancer of ovary

Benign cystadenofibroma of ovary

Cystadenofibroma: benign dilated glands within fibrous stroma

Clear cell adenocarcinoma of ovary

OVARY: BRENNER TUMOROVARY: BRENNER TUMOR

Gross: Gross:

solid or cysticsolid or cystic

usually more solidusually more solid

Micro: Micro:

fibrous stroma; fibrous stroma; transitionaltransitional (urothelial) epithelium (urothelial) epithelium

microcystic to macrocytic (adenofibroma)microcystic to macrocytic (adenofibroma)

Majority = benignMajority = benign

Mostly solid Brenner tumor

Solid and cystic Brenner tumor

Brenner tumor with transitional epithelium with microcysts & fibrous stroma

Glandular spaces or microcysts in benign Brenner tumor

OVARY: GERM CELL TUMORS (1)OVARY: GERM CELL TUMORS (1)

TeratomaTeratoma:: Mature: Mature:

““Dermoid cystDermoid cyst”: predominantly skin, hair ”: predominantly skin, hair and teethand teeth

Most benignMost benign 10% bilateral10% bilateral Young adult. 46XXYoung adult. 46XX

Dominant subtypes: Dominant subtypes: thyroid (struma ovarii) thyroid (struma ovarii) hyperthyroidism hyperthyroidism

Carcinoid Carcinoid carcinoid syndrome carcinoid syndrome Malignancy rareMalignancy rare

OVARY: GERM CELL TUMORS (2)OVARY: GERM CELL TUMORS (2)

Teratoma (cont.):Teratoma (cont.):

Immature (malignant teratoma): Immature (malignant teratoma): adolescent and young adultadolescent and young adult

solidsolid

Malignant histologyMalignant histology

early capsule penetration early capsule penetration seeding abdomen seeding abdomen

more more embryonic tissueembryonic tissue

prognosis stage + grade-dependentprognosis stage + grade-dependent

Dermoid cyst filled with hair and keratin

Opened dermoid cyst with keratin and hair

Teeth (arrows), skin and hair in dermoid cyst

Cartilage, glands and keratin cyst in benign teratoma

Teratoma with squamous epithelium, mucin producing glands and cartilage (arrow)

CNS tissue with neurons (arrow) in mature teratoma

Mature thyroid tissue in monodermal teratoma: struma ovarii

Thyroid follicles in struma ovarii

Mostly solid malignant teratoma

Malignant Transformation: Squamous cell carcinoma in malignant teratoma: arrows point to keratin pearls

OVARY: DYSGERMINOMAOVARY: DYSGERMINOMA

Gross: solid, fleshyGross: solid, fleshy Histo: Histo:

identical to testicular seminomaidentical to testicular seminoma solid sheets similar cellssolid sheets similar cells stromal lymphocytesstromal lymphocytes

Behavior: Behavior: no endocrine functionno endocrine function unilateralunilateral radiosensitiveradiosensitive 80% 5 yr survival80% 5 yr survival

Dysgerminoma – white, fleshy

Sheets of polyhedral cells separated by scant fibrous septa (arrow) in dysgerminoma

OVARY: ENDODERMAL SINUS (YOLK SAC) OVARY: ENDODERMAL SINUS (YOLK SAC) TUMORTUMOR

Gross: solid, unilateral; necrosis; children or young Gross: solid, unilateral; necrosis; children or young

adults, 2nd most common germ cell tumoradults, 2nd most common germ cell tumor

Histo: resembles glomeruloid structure of rat yolk Histo: resembles glomeruloid structure of rat yolk

sac (Schiller-Duval body)sac (Schiller-Duval body)

Behavior: Behavior:

Makes alpha fetoprotein and alpha antitrypsin Makes alpha fetoprotein and alpha antitrypsin

(hyaline droplets – can be indentified by stains)(hyaline droplets – can be indentified by stains)

Respond well to chemoRx (much better than Respond well to chemoRx (much better than

vaginal yolk sac tumors do)vaginal yolk sac tumors do)

Prominent hemorrhage in endodermal sinus (yolk sac) tumor – necrosis and hemorrhage are very common b/c modeling itself after yolk sac which is very blood vessel rich

Schiller-Duval body in endodermal sinus tumor

OVARY: CHORIOCARCINOMAOVARY: CHORIOCARCINOMA

Gross: usually part of other germ cell tumors. Gross: usually part of other germ cell tumors.

Bloody, solid, unilateral.Bloody, solid, unilateral.

Histo: like placental tumors (cytotrophoblasts and Histo: like placental tumors (cytotrophoblasts and

syncytial trophoblasts)syncytial trophoblasts)

Behavior: aggressive 4+. Usually metastatic when Behavior: aggressive 4+. Usually metastatic when

found. Ovarian found. Ovarian choriocarcinoma does not choriocarcinoma does not

respond to chemoRx.respond to chemoRx.

Function Function chorionic gonadotropins. In children chorionic gonadotropins. In children

precocious pubertyprecocious puberty

OVARY: SEX-CORD-STROMAL TUMORS (1)OVARY: SEX-CORD-STROMAL TUMORS (1)

Granulosa-theca cell tumor: Granulosa-theca cell tumor: Derived from Derived from ovarian stromaovarian stroma Predominantly granulosa cells, minority Predominantly granulosa cells, minority

theca cellstheca cells Most postmenopausal, unilateral, solid to Most postmenopausal, unilateral, solid to

partly cystic partly cystic Histo: cords or sheets cells (occ. “follicle” = Histo: cords or sheets cells (occ. “follicle” =

Call-Exner body); by IHC + for inhibinCall-Exner body); by IHC + for inhibin

Granulosa-Theca Cell TumorsGranulosa-Theca Cell Tumors

some clumps theca cells, some some clumps theca cells, some luteinizedluteinized

Behavior: subset Behavior: subset estrogen estrogen adults adults cystic endometrial hyperplasia or cystic endometrial hyperplasia or endometrial ca or cystic breast. Few endometrial ca or cystic breast. Few androgen androgen

Few Few malignant but histology can’t malignant but histology can’t predict which onespredict which ones

Granulosa cell tumor

Foci of hemorrhage in granulosa cell tumor

Granulosa cell tumor with Call-Exner bodies (arrow)

Oil red O fat stain of luteinized theca cells in granulosa cell tumor

Granulosa cell tumor: coffee bean nuclei with grooves & Call-Exner bodies

OVARY: SEX-CORD-STROMAL TUMOR (2)OVARY: SEX-CORD-STROMAL TUMOR (2)

Thecoma-fibroma:Thecoma-fibroma:

Gross: solid, fibrous (white), unilateral, more thecoma (yellow)Gross: solid, fibrous (white), unilateral, more thecoma (yellow)

Micro: fibrous; fat stains + for theca cellsMicro: fibrous; fat stains + for theca cells

Behavior: benign; some Behavior: benign; some fibromas fibromas estrogen; also estrogen; also effusion effusion

(Meig’s syndrome = hydrothorax, ascites & ovarian tumor)(Meig’s syndrome = hydrothorax, ascites & ovarian tumor)

May be part of basal cell nevus syndrome: multiple basal cell May be part of basal cell nevus syndrome: multiple basal cell

carcinomas with abnormalities of ovaries, eyes, bone and CNScarcinomas with abnormalities of ovaries, eyes, bone and CNS

Fibroma-Thecoma

Fibroma-Thecoma

Yellow-white cut surface of fibroma-thecoma

Fibroblasts intermixed with lipid laden thecal cells

Oil red O stain demonstrates thecoma elements

OVARY: SEX-CORD-STROMAL TUMORS (3)OVARY: SEX-CORD-STROMAL TUMORS (3)

Sertoli-Leydig cell tumors (androblastoma)Sertoli-Leydig cell tumors (androblastoma) Gross: young adult, unilateral, solidGross: young adult, unilateral, solid Micro: Micro:

Sertoli or Leydig cells in cords in fibrous stromaSertoli or Leydig cells in cords in fibrous stroma Some Some tubules (like testis) tubules (like testis) Some heterologous elementsSome heterologous elements Reinke crystalloidsReinke crystalloids

Behavior: most benign; few = aggressiveBehavior: most benign; few = aggressive Function: 1/2 Function: 1/2 androgens androgens masculinization masculinization

Hilus cell tumor (Leydig cells only):Hilus cell tumor (Leydig cells only): lipid-filled cells with Reinke lipid-filled cells with Reinke crystalloids (usually incidental finding), may cause hirsutism, crystalloids (usually incidental finding), may cause hirsutism, masculinizationmasculinization

Well circumscibed Sertoli-Leydig cell tumor

Tubules composed of Sertoli cells

Prominent Leydig cells in Sertoli-Leydig Cell Tumor

Sertoli-Leydig Cell tumor with Reinke crystalloids

Solid, yellow Hilus Cell Tumor (pure Leydig Cell)

OVARY: METASTATIC LESIONSOVARY: METASTATIC LESIONS

Uterus and tube Uterus and tube ovarian metastases (most common mets to ovarian metastases (most common mets to ovary)ovary)

Gastric mucinous ca Gastric mucinous ca both ovaries = Krukenberg tumor both ovaries = Krukenberg tumor (signet-ring ca) (simulates ovarian primary ca)(signet-ring ca) (simulates ovarian primary ca) Breast, pancreas and gallbladder and especially colon Breast, pancreas and gallbladder and especially colon Pseudomyxoma peritonei from appendix may present with Pseudomyxoma peritonei from appendix may present with

ovarian metsovarian mets

Bilateral metastases to ovaries

Metastaic adenocarcinoma to ovary with signet cells