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OVARY 2 Neoplasms of the Ovary
Epithelial, Sex Cord-Stromal, and Germ Cell
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Common Ovarian Tumors Benign Cystic Teratoma 32 Serous Cystadenoma 16
Mucinous Cystadenoma 14 Serous Carcinoma 9 Fibroma-Thecoma 8 Serous LMP 4 Endometrioid Carcinoma 3
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Pathologists examination
Classification by Cell Type of Most Differentiated Areas Malignant Potential Determined by Least Differentiated Areas Gross exam: Papillations, Nodular Thickening, Solid Areas, Hemorrhage, Necrosis 1 block per 1-2cm of maximum tumor size
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Epithelial Tumors General Consideration: Peri and Postmenopausal Women
Mean age of Cancer Diagnosis approx. 52 years LMP 4-10 years younger
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Benign Borderline (Low Malignant Potential) Malignant
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Serous Tumors LMP 9-15% of serous neoplasms cystic and papillary
14-40% bilateral 20-40% beyond ovaries at diagnosis excellent prognosis
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Serous LMP
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Serous Tumors Malignant Large 15cm or more Papillary, Cystic, Solid
35-50% bilateral poor prognosis
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Serous Tumors
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Variants Surface tumor Surface Serous Carcinoma of the Peritoneum
Psammocarcinoma
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Implants Invasive Noninvasive Epithelial Desmoplastic
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Mucinous LMP less common than Serous LMP Intestinal Type
Endocervical/ Muellerian Type Better prognosis than Serous
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Mucinous Malignant 10% bilateral
usually confined to ovary and (-) surface 66% 5yr Stage I 59% 10 yr Pseudomyxoma peritonei
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Mucinous Tumors
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Endometrioid LMP
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Endometrioid Malignant 16-30% of Ovarian Ca Less Cystic 10-20 cm
Well or Moderately Differentiated Assoc. EM Ca and Hyperplasia 40-55% 5yr survival
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Endometrioid Tumors
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Clear Cell Nearly all are Ca 5-11% of Ovarian Ca 10% Hypercalcemia
usually >15 cm Cystic and Solid 3% bilateral Endometriosis
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Clear Cell Carcinoma
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Brenner Tumor
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Transitional Cell LMP > 8-10 cm Cystic or Semicystic
Resemble LG Papillary TCC Usually Benign Clinical Course
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Transitional Cell Malignant Malignant Brenner vs. TCC rare
elderly women Unilateral and Cystic
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Undifferentiated Carcinoma
Poor Prognosis
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Mixed Epithelial Tumors
2 or more cell types in 10% of tumor Each 10% or more of total area Mixed LMP: Mucinous with Serous or Endometrioid Mixed Carcinoma: Endometrioid with Clear, Serous, Mucinous
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Misc. Small Cell Carcinoma of Hypercalcemic Type
Small Cell Carcinoma Carcinoma of Pulmonary Type Squamous Cell Carcinoma
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Sex Cord-Stromal Tumors
Ovarian Differentiation Testicular Differentiation
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Granulosa Cell Tumor Adult Type Juvenile Type <5% before puberty
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Adult Granulosa Cell Tumor
1/3 premenopausal 2/3 older assoc. with hyperestrogenic state vary in size characteristically yellow to white and cysts with blood
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Juvenile Granulosa Cell Tumor
Grossly similar to Adult Form Neoplastic Granulosa Cells scattered among which are varying numbers of follicles.
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Granulosa Cell Tumor
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Adult Granulosa Cell Tumor
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Germ Cell Tumors 30% Ovarian Tumors 95% Dermoid Cysts 3% Ovarian Ca
2/3 of Ca in first 2 decades
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3 Basic Types Immature Germ Cell (Children)
Immature Germ Cells (Dysgerminoma) Early Embryonic Development (Embryonal,Polyembryoma) Extraembryonic Differentiation (Choriocarcinoma, Yolk Sac Tumor) Immature Somatic Tissue (Immature Teratoma)
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Mature Germ Cell Tumor (Reproductive Years)
Most common Mature Somatic Tissue
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Benign Cystic Teratoma giving rise to malignancy (Postmenopausal)
Squamous Cell Carcinoma Carcinoid Malignant Thyroid Cancer
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Dysgerminoma Most Common Germ Cell Tumor 100% 5yr survival St I
Radio and Chemosensitive Solid, 15cm Primordial Germ Cells Fibrous Stroma w/ Lymphocytes
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Dysgerminoma
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Yolk Sac (Endodermal Sinus) Tumor
AFP Rapidly growing highly malignant Chemotx 80% 5yr survival St I 25% rupture hemorrhage, necrosis Schiller-Duvall bodies
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Yolk Sac Tumor
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Embryonal Very Rare mean age 15 HCG, AFP 15 cm Anaplastic large Cells
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Choriocarcinoma Very rare < 20 yr HCG
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Teratomas Immature 18cm, solid immature tissue neuroectodermal
neuroepithelial rosettes
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Immature Teratoma
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Metastatic Tumors Krukenberg Tumor
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