1. Ovarian Tumors Epidemiology - Ranks below only carcinoma of the cervix and the endometrium. -Ovarian cancer accounts for 6% of all cancers in the female -fifth most common form of cancer in women in the United States (excluding skin cancer). -

2. Ovarian Tumors Risk Factors 1-Nulliparity: Higher frequency of carcinoma in unmarried women and in married women with low parity. 2-family history. 5-10% of ovarian cancers are familial. Two genes may be altered in susceptible families (i.e., ovarian cancer genes). mutations in both BRCA1 and BRCA2 increase susceptibility to ovarian cancer. The estimated risk of ovarian cancer in women bearing BRCA1 or BRCA2 is 16% by the age of 70 years. Prolonged use of oral contraceptives reduce the risk of developing ovarian cancer

3. Ovarian Tumors Classification

4. Serous Tumor -These are the most common ovarian tumors. They are usually cystic filled with clear serous fluid. Together the benign, borderline, and malignant types account for about 30% of all ovarian tumors. About 75% are benign or of borderline malignancy, and 25% are malignant. Serous cystadenocarcinomas account for approximately 40% of all cancers of the ovary and are the most common malignant ovarian tumors. Benign and borderline tumors are most common between the ages of 20 and 50 years. Cystadenocarcinomas occur later in life on average.

5. Serous Tumor Gross

6. Serous Tumor Micro Benign tumors: The lining epithelium is composed of columnar epithelium with abundant cilia, microscopic papillae may be found. Borderline tumors: There is increased complexity of the stromal papillae with stratification of the epithelium and nuclear atypia, but no destructive infiltrative growth into the stroma.

7. Serous Tumor Micro psammoma bodies

8. Serous Tumor Prognosis -The 5-year survival rate for borderline and malignant tumors confined within the ovarian mass is 100% and 70%. -Whereas the 5-year survival rate for the same tumors involving the peritoneum is about 90% and 25%, respectively. -Borderline tumors may recur after many years, and 5-year survival is not synonymous with cure.

9. Mucinous Tumors These tumors closely resemble their serous counterparts. They are less common, accounting for about 25% of all ovarian neoplasms. They occur principally in middle adult life and are rare before puberty and after menopause. 80% are benign, 10 % borderline, and about 10% are malignant. Mucinous cystadenocarcinomas are relatively uncommon and account for only 10% of all ovarian cancers.

10. Endometrioid Tumors These neoplasms account for approximately 20% of all ovarian cancers. Most endometrioid tumors are carcinomas. They are distinguished from serous and mucinous tumors by the presence of tubular glands bearing a close resemblance to benign or malignant endometrium.

11. Brenner Tumor These are uncommon ovarian tumors in which the epithelial component consists of nests of transitional cells resembling those lining the urinary bladder. Less frequently, the nests contain microcysts or glandular spaces lined by columnar, mucin- secreting cells.

12. Clear cell carcinoma Uncommon highly malignant ovarian tumor.

13. Germ Cell Tumors Teratomas These are divided into three categories: 1-Mature (benign) 2-Immature (malignant) 3-Monodermal or highly specialized Dysgerminoma. Yolk Sac tumor (endodermal sinus tumors) Choriocarcinoma.

15. Mature Cystic Teratoma Microscopic

16. Dysgerminoma