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Ovary

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Ovary

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  1. Ovary

  2. Diseases of the ovary • nonneoplasticlesions • - pelvicinflammatorydisease • - ovariancysts • - endometriosis • ovariantumors • - epithelial (surfaceepithelial-stromal) • - sex cord-stromal • - germ cell • - germ cell sex-cordstromal

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

  4. Nonneoplasticcysts • inclusioncysts • - inclusionsofthesurfaceepithelium • - inclusionsfromfimbrialepitehlium • functionalcysts • - follicular cyst • - corpus luteum cyst • - hemorrhagic cyst • endometrioid cyst

  5. Ovarian tumors

  6. Classification of ovarian tumors • surfaceepithelial (epithelial-stromal) tumors • sex cord-stromaltumors • germ cell tumors • germ cell sex cord-stromaltumors

  7. Classificationofsurfaceepithelialtumors • according to their gross features: • - cystadenoma (cystadenocarcinoma) • - cystadenofibroma • - adenofibroma (adenocarcinofibroma) • - surfacepapilloma (surfacepapillarycarcinoma) • according to theirhistogenesis

  8. Surfaceepithelialtumors • benign • borderline • malignant • serous • - low grade • - high grade • endometrioid • clear cell • mucinous

  9. Benignepithelialtumors • canbelarge (especiallymucinoustumors – theworld´sbiggest tumor weighted 136 kilos) • symptoms and signsusuallynonspecific: • - pelvicpain • - discomfort • - anasymptomaticpelvic mass • up to 25% oftumorsbilateral

  10. Borderlinetumors • increasedepithelialproliferation • do not display invasion • usuallybehave in a benignfashion • but behaviorcanbemalignant • clinicalfeaturessimilar to thoseforbenigntumors

  11. Borderline tumor vs. carcinoma

  12. Ovarian cancer • about 30% ofallcancersofthefemalegenitaltract • incidence rates are highestin the economically advanced countries (most frequent cause ofdeathdue to gynecologicalcancer) • epithelialcarcinomasaccount for 90% of these cancers in North America andWestern Europe • in some Asian countries, including Japan,germ cell tumours account for a significant proportion (20%) ofovarian malignancies

  13. Ovariancancer Risk factors Protectivefactors increased parity oral contraceptive use surgicallyinduced: - hysterectomy - tuballigation - bilateralsalpingo-oophorectomy • age • reproductivefactors • - early menarche, latemenopause • highsocioeconomic status • - lower fertility • BRCA1/2 mutation (5-10% hereditary)

  14. Incidence and mortality Czech Republic 2006

  15. Classificationofovariancarcinomas (WHO) surfaceepithelial-stromal (98%) endometrioid (10%) carcinosarcoma low grade serous (<5%) uncertainhistogenesis high grade serous (70%) undifferentiated mucinous (3%) small cell, lung type unspecified clear cell (10%) small cell, hypercalcemic type malignantBrenner tumor squamous cell large cell neuroendocrinne urothelial arisingfromteratoma(dermoid cyst) adenoidcystic adenocarcinoma hepatoid othertypesofcarcinoma

  16. Prognosticfactors • histologic subtype • histologic grade • stage • advancedcancer: • - macroscopic absence ofresidual tumor afterprimarysurgery

  17. about 8 % ofallovariantumors composedof: granulosacells thecacells fibroblastsofstromalorigin Sertolicells Leydigcells singly or in variouscombinations Sex cord-stromaltumors granulosa cell tumor (adultorjuveniletype) thecoma fibroma fibrosarcoma Sertoli cell tumor Leydig cell tumor

  18. Germ cell tumors • different tumor typesderivedfromthe primitive germcellsoftheembryonicgonad • represents: • -about 30% ofallovariantumors (up to 95 % are maturecysticteratomas) • - about 3 % ofallovariancancers (western world) • - up to 20 % ofallovariancancers (Asia)