DISEASES OF THE OVARIES DR HEYAM AWAD

FOLLICULAR AND LUTEAL CYSTS. POLYCYSTIC OVARY. OVARIAN TUMORS.

FOLLICULAR AND LUTEAL CYSTS COMMON. CONSIDERED VARIANTS OF NORMAL PHYSIOLOGY. ORIGENATE FROM UNRUPTURED FOLLICLES. USUALLY MULTIPLE. SMALL AND FILLED WITH SEROUS FLUID. LINED BY GRANULOSA OR LUTEAL CELLS. MAY RUPTURE AND CAUSE INTRAPERITONEAL BLEEDING OR ACUTE ABDOMEN.

POLYCYSTIC OVARY (PCO) MULTIPLE CYSTIC FOLLICLES IN THE OVARIES. PRODUCE EXCESS ESTROGEN AND ANDROGENS. PRESENT IN TEENAGE GIRLS, WITH OLIGOMENORRHEA, HIRSITUISM, INFERTILITY, AND OBESITY.

PCO MORPHOLOGY OVARIES TWICE THE NORMAL SIZE. MULTIPLE SUBCORTICAL CYSTS. HISTOLOGICALLY: THICK FIBROTIC OVARIAN CAPSULE, NUMEROUS CYSTS LINED BY GRANULOSA CELLS, AND ABSENT CORPORA LUTEA.

PCO HIGH ANDROGEN LEVEL. HIGH LH. LOW FSH. ANDROGENS CONVERTED TO ESTROGEN WHICH INHIBITS FSH.

OVARIAN TUMORS EIGHTH MOST COMMON CANCER IN USA. FIFTH LEADING CAUSE OF CANCER DEATH IN WOMEN. THREE TUMOR TYPES: SURFACE EPITHELIAL TUMORS, GERM CELL NEOPLASMS AND SEX CORD TUMORS..

SURFACE EPITHELIAL TUMORS CAN BE CYSTIC OR SOLID. CAN BE BENIGN OR MALIGNANT. USUALLY BENIGN LESIONS ARE CYSTIC. MAIGNANT LESIONS CAN BE SOLID OR CYSTIC WITH A SOLID COMPONENT.

RISK FACTORS NULLIPARITY. FAMILY HISTORY. .. 5-10 % OF OVARIAN TUMORS ARE FAMILIAL. MOST OF THESE ASSOCIATED WITH BRCA 1 AND 2 GENES. MUTATIONS IN CERTAIN TUMOR SUPRESSOR GENES.

SURFACE EPITHELIAL TUMORS SEROUS. MUCINOUS. ENDOMETRIOID. BRENNER TUMOR.

SEROUS TUMORS THE MOST COMMON EPITHELIALTUMORS. 60% ARE BENIGN. 15% LOW MALIGNANT POTENTIAL. 25% MALIGNANT.

BENIGN SEROUS TUMORS USUALLY CYSTIC AND OCCUR IN PATIENTS BETWEEN 30 AND 40 YEARS. MALIGNANT TUMORS AT 45-65 YEARS OF AGE. BORDERLINE AND MALIGNANT SEROUS TUMORS ARE THE MOST COMMON OVARIAN MALIGNANCY (60%)

BENIGN SEROUS TUMORS 25% OF BENIGN SEROUS TUMORS ARE BILATERAL. CYSTIC. SMOOTH SURFACE. HISTOLOGICALLY: LINED BY A SINGLE LAYER OF TALL COLUMNER OR CUBOIDAL CILIATED CELLS. PSAMMOMA BODIES ARE COMMON.

SEROUS CARCINOMA SEROUS CYST ADENOCARCINOMA OR SOLID SEROUS CARCINOMA. IF CYSTIC, SOLID AREAS PRESENT. HISTOLOGICALLY: STRATIFICATION, ANAPLASIA, MITOSES, COMPLEX PAPILLARY FORMATION AND INASION. BETTER PROGNOSIS IF CONFINED TO OVARY.

BORDERLINE SEROUS TUMORS LESS ATYPIA AND LITTLE OR NO STROMAL INVASION. NEARLY 100% SURVIVAL. .

MUCINOUS TUMORS 80% BENIGN. 10% BORDERLINE. 10% MALIGNANT.

MUCINOUS TUMORS GROSSLY SIMILAR TO SEROUS COUNTERPARTS. HISTOLOGICALLY LINED BY COLUMNER MUCIN SECRETING EPITHELIUM. LESS LIKELY TO BE BILATERAL. IF RUPTURED THEY SEED THE PERITONEUM AND CAUSE LARGE AMOUNT OF MUCIN = PSEUDOMYXOMA PERITONEI

PSEUDOMYXOMA PERITOME

ENDOMETRIOID TUMORS MAJORITY MALIGNANT. 30% BILATERAL. 15-38% HAVE ALSO ENDOMETRIAL CARCINOMA.

BRENNER TUMOR UNCOMMON. SOLIOD. USUALLY UNILATERAL. NESTS OF TRANSITIONAL EPITHELIUM IN ABUNDANT STROMA. MOST ARE BENIGN ALTHOUGH BORDERLINE AND MALIGNANT COUNTERPARTS EXIST.

TUMORS OF GERM CELL ORIGIN DYSGERMINOMA: USUALLY UNILATERAL AND MALIGNANT. RESPONDS TO RADIOTHERAPY WITH 80% CURE RATE. CHORIOCARCINOMA :UNILATERAL AND METASTASIZES EARLY. TERATOMA

SEX CORD TUMORS GRANULOSA CELL TUMOR. THECOMA FIBROMA. SERTOLI_ LEYDIG CELL TUMOR.

METASTATIC TUMORS MOSTLY BILATERAL. GI IS THE MOST COMMON PRIMARY METASTASIZING TO OVARIES= KRUKENBURG TUMORS. OTHER PRIMARIES.. LUNG AND BREAST

TERATOMA 15-20 % OF OVARIAN TUMORS. IN THE FIRST TWO DECADES OF LIFE. THE YOUNGER THE PATIENT , THE MORE LIKELIHOOD OF MALIGNANCY. 90% ARE BENIGN CYSTIC TERATOMAS.

BENIGN CYSTIC TERATOMA= MATURE TERATOMA MATURE TISSUE FROM THE THREE GERM CELL LINES: ENDODERM, MESODERM AND ECTODERM. 90% UNILATERAL. IN 1% OF CASES MALIGNANT TRANSFORMATION SEEN, USUALLY SCC.

IMMATURE TERATOMA MALIGNANT. YOUNG AGE. USUALLY SOLID. IMMATURE TISSUE SEEN HISTOLOGICALLY.

SPECIALIZED TERATOMAS RARE. ONE TYPE OF TISSUE. STRUMA OVARII… MATURE THYROID TISSUE…. CAN CAUSE HYPERTHYROIDISM. OVARIAN CARCINOID.