Download - Ovarian tumors
OVARIAN NEOPLASMOVARIAN NEOPLASM
ORIGIN OF OVARIAN TUMORSORIGIN OF OVARIAN TUMORS
OVARIAN NEOPLASMOVARIAN NEOPLASM
►NON-NEOPLASTIC functional cystNON-NEOPLASTIC functional cyst
►PrimaryPrimary
►SecondarySecondary
Non-neoplasticNon-neoplastic
►Follicular cyst:Follicular cyst:- usually less than 5 cmusually less than 5 cm- Benign and a symptomaticBenign and a symptomatic- Thin wall, contain clear fluidThin wall, contain clear fluid
Non-neoplasticNon-neoplastic
►Corpus lutealCorpus luteal- Hemorrahgic corpus luteumHemorrahgic corpus luteum- Cyst filled with bloodCyst filled with blood- Follicular cystsFollicular cysts
Non-neoplasticNon-neoplastic
►Granulosa-theca lutein cystGranulosa-theca lutein cyst- in molar pregnancy or part of in molar pregnancy or part of
hyperstimulation syndromehyperstimulation syndrome- Polycystic ovaryPolycystic ovary- Endometriotic cyst Endometriotic cyst
Primary ovarian tumorsPrimary ovarian tumors
►EpithelialEpithelial - BenignBenign- BorderlineBorderline- MalignantMalignant
• • Germ cell tumorsGerm cell tumors
• • Sex cord (gonadal stromal) Sex cord (gonadal stromal) tumorstumors
Epithelial tumorsEpithelial tumors
► Serous : most commonSerous : most common► MucinousMucinous► EndometrioidEndometrioid► Clear cell(mesonephroid)Clear cell(mesonephroid)► BrennerBrenner
Epithelial tumorsEpithelial tumors
• • Serous:Serous:- contain clear fluidcontain clear fluid- Often bilateral. Around age of menopauseOften bilateral. Around age of menopause- Malignant type is the commonest ovarian Malignant type is the commonest ovarian
cancercancer
SEROUS CYT ADENOMASEROUS CYT ADENOMA
SEROUS BORDERLINE SEROUS BORDERLINE TUMORTUMOR
SEROUS CYST SEROUS CYST ADENOCARCINOMAADENOCARCINOMA
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►Mucinous:Mucinous:► large tumors. Multilocular filled with large tumors. Multilocular filled with
mucinmucin► If ruptured………pseudomyxoma If ruptured………pseudomyxoma
peritoneiperitonei
MUCINOUS CYST ADENOMAMUCINOUS CYST ADENOMA
MUCINOUS BORDERLINE MUCINOUS BORDERLINE TUMORTUMOR
MUCINOUS CYST MUCINOUS CYST ADENOCARCINOMAADENOCARCINOMA
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Epithelial tumorsEpithelial tumors
► Endometrioid:Endometrioid:- Few cases arise in endometriosisFew cases arise in endometriosis- 30% coexist with primary endometrial 30% coexist with primary endometrial
cancercancer- the second most common type of epithelial the second most common type of epithelial
ovarian cancerovarian cancer- occurs primarily in women who are between occurs primarily in women who are between
50 and 70 years of age.50 and 70 years of age.
BRENNER TUMORSBRENNER TUMORS
►usually benign.occur in reproductive usually benign.occur in reproductive lifelife
►They can be malignant.They can be malignant.►May be associated with endometrial May be associated with endometrial
hyperplasiahyperplasia►May coexist with mucinous May coexist with mucinous
cystadenomacystadenoma
BENIGN BRENNER TUMORBENIGN BRENNER TUMOR
BRENNER BORDERLINE BRENNER BORDERLINE TUMORTUMOR
BRENNER MALIGNANT BRENNER MALIGNANT TUMORTUMOR
Clear cell carcinomaClear cell carcinoma
► Clear cell ovarian tumors are part of the surface Clear cell ovarian tumors are part of the surface epithelial tumor group of ovarian cancers, epithelial tumor group of ovarian cancers,
► Accounting for 6% of these cancers.Accounting for 6% of these cancers.► Polypoid masses that protrude into the cyst.Polypoid masses that protrude into the cyst.► On microscopic examination, composed of cells On microscopic examination, composed of cells
with clear cytoplasm (that contains glycogen) with clear cytoplasm (that contains glycogen) ►Hob nail cells. Hob nail cells. ► The pattern may be glandular, papillary or solid.The pattern may be glandular, papillary or solid.
Germ cell tumorsGerm cell tumors
►Dermoid cyst (benign cystic teratomaDermoid cyst (benign cystic teratoma))- 25% of all ovarian neoplasm25% of all ovarian neoplasm- Contain tissue derived from two or more Contain tissue derived from two or more
germ cell layersgerm cell layers- Unilocular cyst. May contain teeth, bone , Unilocular cyst. May contain teeth, bone ,
cartilage, nerves, hair, thyroid,.. Tissuescartilage, nerves, hair, thyroid,.. Tissues- Almost always benign. Malignant changes Almost always benign. Malignant changes
may occur in any componentmay occur in any component- Occur at any age.peak is 20-30 years.Occur at any age.peak is 20-30 years.- Bilateral in 20%Bilateral in 20%
Malignant Germ cell tumorsMalignant Germ cell tumors
►Rare. 3% of ovarian cancersRare. 3% of ovarian cancers►TeratomaTeratoma: peak incidence in second : peak incidence in second
decadedecade►Malignant teratomaMalignant teratoma►Immature teratomaImmature teratoma
IMMATURE TERATOMAIMMATURE TERATOMA
CHORIOCARCINOMACHORIOCARCINOMA
►Non-gestational choriocarcinomaNon-gestational choriocarcinoma►secrete HCGsecrete HCG►May be component of solid teratomaMay be component of solid teratoma
Malignant Germ cell tumorsMalignant Germ cell tumors
► Yolk-sac (endodermal sinus)Yolk-sac (endodermal sinus)
- Highly malignant. Highly malignant.
- Affect young ageAffect young age
- Partly solid. Partly solid.
- Secrete alpha feto-proteinSecrete alpha feto-protein
►DysgerminomaDysgerminoma►Most common. Highly malignantMost common. Highly malignant►Usually spread by lymphaticsUsually spread by lymphatics►Very radiosensitiveVery radiosensitive►Occur in young women. Occur in young women. ►May arise in gonadal dysgenesisMay arise in gonadal dysgenesis
Sex cord tumorsSex cord tumors
►Granulosa-theca cell tumorsGranulosa-theca cell tumors- Moderate to large sizeModerate to large size- Solid, as enlarge may have cystic spacesSolid, as enlarge may have cystic spaces- Yellow tinge on cut surfaceYellow tinge on cut surface- Thecoma is benign,but granulosa cell is Thecoma is benign,but granulosa cell is
malignantmalignant- Occur at any age .50% postmenopausalOccur at any age .50% postmenopausal- Secret estrogenSecret estrogen- Usually stage 1. Late recurrenceUsually stage 1. Late recurrence
GRANULOSA CELL TUMORGRANULOSA CELL TUMOR
Sex cord tumorsSex cord tumors
►Androgen- secreting tumorsAndrogen- secreting tumors- Androblastoma,Sertoli-leydig,Androblastoma,Sertoli-leydig,
GynandroblastomaGynandroblastoma- Cause virilizationCause virilization
• • FibromaFibroma- solid tumorsolid tumor- May be associated with meigs’ syndromeMay be associated with meigs’ syndrome- Tend to have long pedicleTend to have long pedicle
FIBROMAFIBROMA
THECOMATHECOMA
SERTOLI-LEYDIG CELL SERTOLI-LEYDIG CELL TUMORTUMOR
Metastatic tumorsMetastatic tumors
►Always bilateral. From mucin secreting Always bilateral. From mucin secreting tumors, stomach and colon tumors, stomach and colon (krukenberg tumors)(krukenberg tumors)
►May be secondary to breastMay be secondary to breast
Metastatic ovarian Metastatic ovarian KurkenbergKurkenberg
cancer tumor cancer tumor
Complication of ovarian Complication of ovarian tumorstumors
►TorsionTorsion- common with dermoid/fibromacommon with dermoid/fibroma- Severe abdominal pain/vomittingSevere abdominal pain/vomitting►RuptureRupture►HaemorrhageHaemorrhage► ImpactionImpaction► infectioninfection
Physical signsPhysical signs
► Benign:Benign:- usually mobile.unless large or complicatedusually mobile.unless large or complicated- Dermoid cyst anterior to bladderDermoid cyst anterior to bladder• • Malignant:Malignant:- BilateralBilateral- AscitesAscites- Hard deposit in pelvisHard deposit in pelvis- Leg edemaLeg edema- Signs of bowel obstruction of ureteric Signs of bowel obstruction of ureteric
obstructionobstruction
FIGO StagingFIGO Staging
Stage 1Stage 1 Growth limited to one or Growth limited to one or both ovariesboth ovaries
Stage 2Stage 2 Growth limited to one or Growth limited to one or both ovaries with pelvic both ovaries with pelvic extensionextension
Stage 3Stage 3 Tumor involving Tumor involving one/both ovaries with one/both ovaries with peritoneal implants peritoneal implants outside pelvis/positive outside pelvis/positive retroperitoneal or retroperitoneal or inguinal nodes inguinal nodes
Stage 4Stage 4 Growth involving one or Growth involving one or both ovaries with distant both ovaries with distant metastasismetastasis
MANAGMENTMANAGMENT
►Surgery :Surgery :
primaryprimary
interval debulkinginterval debulking
palliativepalliative
second look surgerysecond look surgery
►ChemotherapyChemotherapy
Primary surgeryPrimary surgery
►Primary cytoreductionPrimary cytoreduction►TAH,BSO,OMETECTOMY,WASHINGSTAH,BSO,OMETECTOMY,WASHINGSBOWEL SURGERYBOWEL SURGERY►Optimal debulking: less than 2 cm Optimal debulking: less than 2 cm
residual tumorsresidual tumors►Staging once histology is availableStaging once histology is available► If confined to ovary and young age… If confined to ovary and young age…
conservative surgeryconservative surgery
Palliative surgeryPalliative surgery
►Removal of intestinal obstructionRemoval of intestinal obstruction
►Survival is very poorSurvival is very poor
►Quality of life considerationsQuality of life considerations