female genitalia iv ovary. l inflammation l non-neoplastic cysts l neoplasms
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OvaryInflammation
Primary inflammation is rareUsually secondary to spread from fallopian tube (tubo-ovarian abscess)
Other causes- appendicitis, diverticulitis etc
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”
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%)
Surface Epithelial Neoplasms
Classification Serous Mucinous Endometrioid Brenner Clear cell Undifferentiated
Surface Epithelial Neoplasms
Cystadenomas/cystadenocarcinomasSerous - lining resemble fallopian tube
Mucinous - resemble lining of cervixEndometrioid - 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
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
Thecoma/Fibromas Originate from theca cell
ThecomaSolid, firmMay produce oestrogen; a few produce androgens
Nearly always benign
FibromaSolid, invariable benignMeig’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 withUp to 95% 5-yr survival
Yolk sac tumour - highly malignant; alpha-fetoprotein
Chorioca - Rare! Most are metastases from corpus
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 grosslyTissues from all 3 germ cell layers but
ectodermal tissues predominate“Struma ovarii” – may be functional
Teratoma
Solid teratomasAre invariably malignantAre 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