Female Genitalia IV

Ovary

OvaryInflammationNon-neoplastic cysts

Neoplasms

OvaryInflammation

Primary inflammation is rare

Usually 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 cervix

Endometrioid - 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

Sex Cord-Stromal Tumours

Granulosa cell tumour

Thecoma/FibromaSertoli-Leydig cell tumour

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 Thecoma

Solid, firmMay produce oestrogen; a few produce androgens

Nearly always benign Fibroma

Solid, 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 grossly

Tissues from all 3 germ cell layers but ectodermal tissues predominate

“Struma ovarii” – may be functional

TeratomaSolid teratomas

Are 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

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