Ovary
Diseases of the ovary nonneoplastic lesions ovarian tumors - pelvic inflammatory disease - ovarian cysts - endometriosis ovarian tumors - epithelial (surface epithelial-stromal) - sex cord-stromal - germ cell - germ cell sex-cord stromal
Ovarian cysts Nonneoplastic Cystic tumors inclusion functional endometrioid epithelial tumors - cystadenoma (benign, borderline) - cystadenocarcinoma germ cell tumors - dermoid cyst
Nonneoplastic cysts inclusion cysts functional cysts endometrioid cyst - inclusions of the surface epithelium - inclusions from fimbrial epitehlium functional cysts - follicular cyst - corpus luteum cyst - hemorrhagic cyst endometrioid cyst
Ovarian tumors
Classification of ovarian tumors surface epithelial (epithelial-stromal) tumors sex cord-stromal tumors germ cell tumors germ cell sex cord-stromal tumors
Classification of surface epithelial tumors according to their gross features: - cystadenoma (cystadenocarcinoma) - cystadenofibroma - adenofibroma (adenocarcinofibroma) - surface papilloma (surface papillary carcinoma) according to their histogenesis
Surface epithelial tumors benign borderline malignant serous - low grade - high grade endometrioid clear cell mucinous
Benign epithelial tumors can be large (especially mucinous tumors – the world´s biggest tumor weighted 136 kilos) symptoms and signs usually nonspecific: - pelvic pain - discomfort - an asymptomatic pelvic mass up to 25% of tumors bilateral
Borderline tumors increased epithelial proliferation do not display invasion usually behave in a benign fashion but behavior can be malignant clinical features similar to those for benign tumors
Borderline tumor vs. carcinoma Borderline tumor Invasive caricnoma Median age 46 56-60 % of tumor in stage I 60-80 20-30 5-year survival rate for stage I 95-98 % 85-93 % 5-year survival rate for stage II 86-92 % 60-74 % 5-year survival rate for stage III 17-33 % 23-41 % metastatic spread rare common
Ovarian cancer about 30% of all cancers of the female genital tract incidence rates are highest in the economically advanced countries (most frequent cause of death due to gynecological cancer) epithelial carcinomas account for 90% of these cancers in North America and Western Europe in some Asian countries, including Japan, germ cell tumours account for a significant proportion (20%) of ovarian malignancies
Ovarian cancer Risk factors Protective factors age reproductive factors - early menarche, late menopause high socioeconomic status - lower fertility BRCA1/2 mutation (5-10% hereditary) increased parity oral contraceptive use surgically induced: - hysterectomy - tubal ligation - bilateral salpingo-oophorectomy
Classification of ovarian carcinomas (WHO) surface epithelial-stromal (98%) endometrioid (10%) carcinosarcoma low grade serous (<5%) uncertain histogenesis high grade serous (70%) undifferentiated mucinous (3%) unspecified small cell, lung type clear cell (10%) small cell, hypercalcemic type malignant Brenner tumor squamous cell large cell neuroendocrinne urothelial arising from teratoma(dermoid cyst) adenoid cystic adenocarcinoma hepatoid other types of carcinoma
Prognostic factors histologic subtype histologic grade stage advanced cancer: - macroscopic absence of residual tumor after primary surgery
Sex cord-stromal tumors granulosa cell tumor (adult or juvenile type) about 8 % of all ovarian tumors composed of: granulosa cells theca cells fibroblasts of stromal origin Sertoli cells Leydig cells singly or in various combinations thecoma fibroma fibrosarcoma Sertoli cell tumor Leydig cell tumor
Germ cell tumors different tumor types derived from the primitive germ cells of the embryonic gonad represents: - about 30% of all ovarian tumors (up to 95 % are mature cystic teratomas) - about 3 % of all ovarian cancers (western world) - up to 20 % of all ovarian cancers (Asia)