1
Fifth stage
Gynecology
Lec-4
د. احمد جاسم
6/4/2016
Ovarian Neoplasms
Objectives of this lecture
To learn the different type of ov. Tumor .
To differentiate between benign& malignant ov.tumor .
To know the clinical presentation, staging &diagnosis of ov. Tumor.
To learn the managment of ov. Tumor .
1.Tumors of Surface Epithelium form 90% of ovarian tumors
2. Germ Cell Tumors
3. Sex cord-stromal tumour
4.Metastatic Tumors of Ovary.
Surface Epithelium
• 1.Mucinous Tumors
– Incidence – 30% of ovarian neoplasms
• Mucinous cyst adenoma
– Commonest tumor
– Age group: 30-50 yrs
– Bilateral in 10%
• Mucinous cystadenocarcinoma
– Age group: 40-60 yrs
– Bilateral in 10 %
– Features
• Large multilocular pedunculated cyst
• Rare complication may occur with involvement of the peritoneum
– Psedomyxoma peritonei (jelly belly)
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• May produce coarse calcifications in primary or metastases
– 2.Serous Tumors
– Incidence – 50% of ovarian neoplasms
• Serous cystadenoma:
– Age group: 20 – 30 yrs
– Bilateral in 15%
– Malignant transformation in 20 – 30 %
• Serous cystadenocarcinoma:
– Age group: 40 – 60 yrs
– Bilateral in 30%
– 5 year survival rate: 30 – 50 %
– Features:
• Contain fibrous walled cysts with papillary excrescences
• Locules contain straw-colored fluid
• Psammoma bodies=concentric calcification in papillary process
– Usually fine sand-like calcification frequently difficult to see on
plain radiographs
– 3.Endometrial tumors
– Incidence – 20% of ovarian tumors
– Morphology:
• Tumors containing solid and cystic areas
• Filled with hemorrhagic fluid
• Lined by glandular epithelium
– 4.Clear Cell (mesonephroid tumor)
– Incidence: uncommon
– Age group: 50 – 60 yrs
– Morphology:
• Unilocular cysts with small cystic spaces
– 5.Brenner tumor:
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• Incidence: 1- 2%
• Occur commonly in perimenopausal women
Germ Cell Tumors
– Origin : cells derived form oocytes
– Incidence: 15- 20% of all ovarian tumors, 5% malignant
• Age: young age
• 1.Dysgerminoma
– Incidence : very common
• Age : 20 – 20 yrs
– Bilateral : 10 – 15 %
– Macroscopic features :
• Solid tumors, elastic rubbery consistency having smooth, firm capsule
• 2.Teratoma
– Derived from cells of all three germ layers
– Types:
• Mature or benign type (e.g. Dermoid cysts)
• Immature or malignant type (e.g. Solid Teratoma)
• Monodermal or highly specialized (e.g. Struma ovarii)
• 3.Choriocarcinoma and Embryonal Cell Carcinoma
– Choriocarcinoma mostly of placental origin occurs in prepubertal girls. Highly
malignant
• Contains syncytiotrophoblasts and cytotrophoblasts
• Secretes large quantities of the tumor marker - HCG
– Embryonal cell carcinoma
• Incidence : rare
– Highly malignant
• 4.Ovarian Fibroma:
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– Meig’s syndrome
• Ascites
• Right sided effusion
• Krukenberg tumor
– Primary : 15% - small & large bowel , 20% - stomach, 6% - breast
– Bilateral smooth surface
– Histologically cellular or myxomatous stroma with scattered large signet ring
cells
• Routes of Peritoneal Spread
– Right subphrenic space
– The greater omentum
– The Pouch of Douglas