1. 17 th century microscopes In The Name of God PARISA REZAEI,M.D.,AP.CP

2. Ascites fluid of a 65 year old woman

15. WHAT IS YOUR DIAGNOSIS ?

16. ALL RIGHT !

17. Papillary Serous Cyst Adenocarcinoma of The Ovary

18. Papillary Serous Cyst Adenocarcinoma The cells occur singly and in structured, approximately spherical and papillary clusters. The cytoplasm is usually delicate and finely vacuolated. The dominant feature of these cells is nuclear abnormalities: nuclear enlargement irregular nuclear configuration presence of prominent, often multiple nucleoli Such malignant cells may be occasionally confused with benign mesothelial or epithelial cells which, however, are usually much smaller.

19. Papillary clusters of cancer cells with nuclear hyperchromasia, of the type commonly observed in cells of ovarian cancer in cervicovaginal material are less common but may occur A central core of connective tissue may be sometimes observed in the papillary clusters, a feature that is usually better seen in cell block preparations Psammoma bodies may occur, but, unless accompanied by cancer cells, have limited diagnostic value Papillary Serous Cyst Adenocarcinoma

20. Tumors mimicking ovarian serous carcinomas may originate in the peritoneum. Various names have been applied to this group of rare tumors: Peritoneal papillary serous carcinoma ( large cohesive clusters of cancer cells) Multifocal extraovarian serous carcinoma Serous surface papillary carcinoma The survival of patients is very poor, probably because these rare tumors are disseminated at the time of diagnosis. The cytologic presentation of such tumors in fluids is similar to that of primary ovarian tumors Differential Diagnosis

21. The low-grade (borderline) serous ovarian tumors shed atypical but not clearly cancerous epithelial cells, usually forming cohesive clusters. The nuclear abnormalities are usually more modest than in high grade carcinomas, specifically the nucleoli are usually small and inconspicuous, but in some cases the cells are similar to those of a well-differentiated serous carcinoma. The borderline tumors displayed less nuclear pleomorphism and were diploid, whereas the carcinomas were aneuploid. Differential Diagnosis

22. I Growth limited to the ovaries la Growth limited to one ovary; no ascites; no tumor on the external surface; capsule intact Ib Growth limited to both ovaries; no ascites; no tumor on the external surfaces; capsules intact lc** Tumor either stage la or Ib, but with (1) tumor on surface of one or both ovaries or (2) capsule(s) ruptured or (3) ascites present containing malignant cells or (4) positive peritoneal washings II Growth involving one or both ovaries with pelvic extension IIa Extension and/or metastases to the uterus and/or tubes IIb Extension to other pelvic tissues IIc** Tumor either stage IIa or IIb, but with (1) tumor on surface of one or both ovaries or (2) capsule(s) ruptured or (3) ascites present containing malignant cells or (4) positive peritoneal washings STAGING OF PRIMARY CARCINOMA OF THE OVARY (FIGO) At least

23. III Tumor involving one or both ovaries with peritoneal implants outside the pelvis and/or positive retroperitoneal or inguinal nodes (superficial liver metastasis equals stage III);tumor is limited to the true pelvis, but with histologically proven malignant extension to small bowel or omentum IIIa Tumor grossly limited to the true pelvis with negative nodes but with histologically confirmed microscopic seeding of abdominal peritoneal surfaces IIIb Tumor of one or both ovaries with histologically confirmed implants of abdominal peritoneal surfaces, none exceeding 2cm in diameter; nodes are negative IIIc Abdominal implants> 2 cm in diameter and/or positive retroperitoneal or inguinal nodes IV Growth involving one or both ovaries with distant metastases; if pleural effusion is present, there must be positive cytology to allot a case to stage IV(parenchymal liver metastasis equals stage IV) STAGING OF PRIMARY CARCINOMA OF THE OVARY (FIGO)

24. Special thanks : Dr. Mansour Mehzad

25. THANKS FOR YOUR ATTENTION ESFAHAN ZAYANDE ROOD RIVER