Female Genitalia IV Ovary

l Inflammation l Non-neoplastic cysts l Neoplasms

Ovary Inflammation l Primary inflammation is rare l Usually secondary to spread from fallopian tube (tubo- ovarian abscess) l Other causes- appendicitis, diverticulitis etc

Ovary Non-neoplastic cysts l Follicular cysts - Polycystic Ovarian Syndrome (Stein-Leventhal) l Corpus luteum cysts - may cause intraperitoneal haemorrhage l Simple cysts l Endometriotic cysts - haemorrhage within endometriotic deposits; “chocolate cysts”

Ovary Neoplasms Classification of Primary Neoplasms l Surface (germinal) epithelium (approx. 65%) l Germ cells (approx. 20%) l Sex cord-stromal cells (approx. 10%) Miscellaneous, i.e. tumours not specific to the ovary (approx. 5%)

Surface Epithelial Neoplasms Classification l Serous l Mucinous l Endometrioid l Brenner l Clear cell l Undifferentiated

Surface Epithelial Neoplasms Cystadenomas/cystadenocarcinomas  Serous - lining resemble fallopian tube  Mucinous - resemble lining of cervix  Endometrioid - resemble endometrium  Brenner - resemble urothelium

Serous Tumours l 25% of all ovarian tumours l 30-50% bilateral l Benign ones, predominantly cystic l Malignant ones, more solid l Papillary projections into cyst cavities l Borderline (LMP) - features of malignancy but no stromal invasion

Mucinous & Endometrioid Neoplasms Mucinous l Less common than serous, 10-20% bilateral l Benign, borderline, malignant l Tend to grow to very large size l “Pseudomyxoma peritonei” Endometrioid l Resemble endometrial carcinoma and may coincide with it

Sex Cord-Stromal Tumours l Granulosa cell tumour l Thecoma/Fibroma l Sertoli-Leydig cell tumour

Granulosa Cell Tumours l Occur at any age l Peak incidence, postmenopausal l 25-75% produce excessive oestrogen  Children - precocious puberty  Reproductive age - menstrual irregularities  Older age - p.m.b. l All potentially malignant, but  Most behave benign  High-grade malignant varieties occur

Thecoma/Fibromas l Originate from theca cell l Thecoma  Solid, firm  May produce oestrogen; a few produce androgens  Nearly always benign l Fibroma  Solid, invariable benign  Meig’s syndrome

Sertoli-Leydig Cell Tumours l Resemble Sertoli & Leydig cells of testis l Predominantly solid l Usually found in young adults l About half accompanied by excess androgen secretion - virilization l Most are of low-grade malignancy

Germ Cell Tumours l Dysgerminoma l Yolk sac tumour (endodermal sinus; embryonal ca) l Choriocarcinoma l Teratoma Comprise about 20% of ovarian tumours, but are most COMMON ovarian tumour in girls and young women

Germ Cell Tumours l Dysgerminoma  All malignant  Very radiosensitive with  Up to 95% 5-yr survival l Yolk sac tumour - highly malignant; alpha-fetoprotein l Chorioca - Rare! Most are metastases from corpus

Teratoma Benign cystic teratoma (dermoid cyst)  Most common GCT (up to 95% of GCTs)  Are multilocular or unilocular cysts  Containing 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

Teratoma Solid teratomas  Are invariably malignant  Are also known as "immature teratomas"  Malignancy due to immaturity of the tissues – usually immature neuroepithelium

Secondary (Metastatic) Tumours l Most common - stomach, colon, breast, corpus and cervix uteri l Krukenberg tumour - bilateral, solid, mucin-secreting “signet ring” cells; usually from stomach, colon, breast l Mets to ovary connote poor prognosis

Ovarian Tumours General Features l USA - most fatal gynae. malignancy; kill more than ca.cx & corpus combined l Ranked 6th in women in Ja l Presentation - asymptomatic, pain, mass, signs of malignancy, hormonal changes etc l Prognosis - tumour type; grade; stage l Surgical +/- radioRx, chemoRx