Download - ppt ovari
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Female Genitalia IV
Ovary
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OvaryInflammationNon-neoplastic cysts
Neoplasms
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OvaryInflammation
Primary inflammation is rare
Usually secondary to spread from fallopian tube (tubo-ovarian abscess)
Other causes- appendicitis, diverticulitis etc
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OvaryNon-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”
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OvaryNeoplasms
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%)
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Surface Epithelial Neoplasms
Classification Serous Mucinous Endometrioid Brenner Clear cell Undifferentiated
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Surface Epithelial Neoplasms
Cystadenomas/cystadenocarcinomasSerous - lining resemble fallopian tube
Mucinous - resemble lining of cervix
Endometrioid - resemble endometrium
Brenner - resemble urothelium
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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
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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
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Sex Cord-Stromal Tumours
Granulosa cell tumour
Thecoma/FibromaSertoli-Leydig cell tumour
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Granulosa Cell Tumours
Occur at any age Peak incidence, postmenopausal 25-75% produce excessive
oestrogenChildren - precocious pubertyReproductive age - menstrual irregularities
Older age - p.m.b. All potentially malignant, but
Most behave benign High-grade malignant varieties
occur
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Thecoma/Fibromas Originate from theca cell Thecoma
Solid, firmMay produce oestrogen; a few produce androgens
Nearly always benign Fibroma
Solid, invariable benignMeig’s syndrome
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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
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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
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Germ Cell Tumours Dysgerminoma
All malignant Very radiosensitive withUp to 95% 5-yr survival
Yolk sac tumour - highly malignant; alpha-fetoprotein
Chorioca - Rare! Most are metastases from corpus
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TeratomaBenign cystic teratoma (dermoid
cyst)Most common GCT (up to 95% of
GCTs) Are multilocular or unilocular
cystsContaining 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
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TeratomaSolid teratomas
Are invariably malignantAre also known as "immature teratomas"
Malignancy due to immaturity of the tissues – usually immature neuroepithelium
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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
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Ovarian TumoursGeneral 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