1. Ovary

2. 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

3. Ovarian cysts Nonneoplastic Cystic tumors inclusion functional
endometrioid
epithelial tumors
- cystadenoma (benign, borderline)
- cystadenocarcinoma
germ cell tumors
- dermoid cyst

4. 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

5. Ovarian tumors

6. Classification of ovarian tumors
surface epithelial (epithelial-stromal) tumors
sex cord-stromal tumors
germ cell tumors
germ cell sex cord-stromal tumors

7. Classification of surface epithelial tumors
according to their gross features:
- cystadenoma (cystadenocarcinoma)
- cystadenofibroma
- adenofibroma (adenocarcinofibroma)
- surface papilloma (surface papillary carcinoma)
according to their histogenesis

8. Surface epithelial tumors
benign
borderline
malignant
serous
- low grade
- high grade
endometrioid
clear cell
mucinous

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. Prognostic factors histologic subtype histologic grade stage
advanced cancer:
- macroscopic absence of residual tumor after primary surgery

16. 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

17. 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)