2. BY BY Prof. Mohammad Emam Prof. of OB & GYN. Mansoura Faculty of Medicine EGYPT

3. Pathologic behavior : Non neoplastic Neoplastic (benign,malign, borderline). Morphology(cystic,solid). Histogenesis.

4. Ovarian tumours Neoplastic Epithelial T Germ cell T. Sex cord T others( Metastatic ….) Non neoplastic Lutein cysts. Endometrial cysts: ( follicular hematoma & endometriosis). Inflammatory Watered inclusion cyst cystic C.L. Pcos

5. SEX CORD-STROMAL TUMORS( SCTS)

6. SEX CORD-STROMAL TUMORS SCTS are 15% of all malignant ovarian neoplasm The vast majority of these tumors are of low malignant potential or benign. Long term prognosis is good. Excessive estrogen production influences end organ responses. Endometrial and breast cancer must be remembered.

7. SEX CORD-STROMAL TUMORS CLASSIFICATION Granulosa cell tumor Adult Juvenile Thecoma- fibroma Thecoma Fibroma,sarco ma Sclerosing stromal tumor Sertoli cell Leydig cell Sertoli- Leydig Stromal luteoma Leydig cell Hilus cell Leydig cell Other 1-GRANULOSA-STROMAL 2-SERTOLI-STROMAL3-STEROID CELL 4-SEX CORD TUMOR WITH ANULAR TUBULES 5-UNCLASSIFIED6-GYNANDROBLASTOMA

8. Granulosa Cell Tumor:

9. Gonadal Stromal tumours

10. Metastatic Tumors of Ovary

11. METASTATIC TUMOR FROM BREAST CANCER both ovaries replaced by pale, rather nodular tumor, with breast cancer cells arranged in long lines perpendicular to the surface of the ovarian cortex

12. METASTATIC TUMOR FROM GASTRIC CANCER (Krukenberg ) gastric carcinoma of the fundus, with secondary ovarian tumor (Mucus-secreting signet-ring cells)

13. Krukenberg Tumor:

14. Endometrioid Ca:

15. complications of benign ov Tumours torsion hemorrhage rupture infection incarceration malignant change complications during pregnancy

16. Diagnostic tools History Exam (including rectal) Investigations:- TVS – masses and mass characteristics Tumor markers – CA-125, LPA (plasma lysophosphatidic acid) CT – assess spread to LN, pelvic and abdominal structures MRI – best for distinguishing malignant from benign tumors

17. Clinical picture of benign ov tumors Symptoms: functioning tumors nonfunctioning tumors swelling pressure symptoms pain menstrual disturbances ovarian cachexia Signs small ov tumors large ov tumors DD: from other pelvic swellings from other abdominal swellings

18. Clinical picture cancer ovary Benign ovarian Tumours + The following suggest malignancy age:mostly postmenopausal pain: chronic and persistent rapid course bilaterality Solidity ( variegated consistency ) fixity metastases :nodules in DP, lymph nodes ascitis edema LL cachexia

19. Treatment Depends on Staging Tumor type Age Desire for future fertility Include surgery, chemotherapy and/or radiation therapy

20. Surgery for ov. cancer Conservative surgery: unilateral adnexectomy indicated: stage Ia: intact capsule, negative peritoneal washing, free omentum, well differentiated T, young patient with low parity Complete surgery: TAH/BSO +omentectomy+lymphadenectomy other cases of stage Ia Stage Ib,c

21. Surgery for ov. Cancer cont… Cytoreductive surgery: for all other stages optimum cytoreduction leaving no macroscopic lesion or one less than 1.5 cm. consist of TAH/BSO +omentectomy+lymphadenectomy+may be bowel resection & anastmosis. Second look surgery after chemotherapy

22. Surgical treatment Primary debulking and cytoreduction; may include: Bilateral salpingo-oopherectomy Hysterectomy Lymphadenectomy (Para-aortic, inguinal) Omentectomy “ brushing ” of diaphragm Examination of liver

23. Chemotherapy & radiotherapy for ov cancer Chemotherapy: adjuvant to surgery to improve prognosis in early stages induce remission in advanced cases agents: alkylating agents,platinum: single drug and multible drug regimens

24. Chemotherapy & radiotherapy for ov cancer cont……… Radiotherapy : has less place in modern practice, replaced by chemotherapy was given for cases with small residual lesions (< 2 cm) forms are: radioactive isotope: intraperitoneal 32 P, external-beam radiotherapy

25. Chemotherapy and Radiation Usually 6 cycles of chemotherapy Cisplatin (or Carboplatin) plus Paclitaxel most commonly used combination therapy XRT

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