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OVARY 2

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OVARY 2

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  1. OVARY 2 • Neoplasms of the Ovary • Epithelial, Sex Cord-Stromal, and Germ Cell

  2. 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

  3. 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

  4. Epithelial Tumors General Consideration: Peri and Postmenopausal Women Mean age of Cancer Diagnosis approx. 52 years LMP 4-10 years younger

  5. Benign • Borderline (Low Malignant Potential) • Malignant

  6. Serous Tumors • LMP • 9-15% of serous neoplasms • cystic and papillary • 14-40% bilateral • 20-40% beyond ovaries at diagnosis • excellent prognosis

  7. Serous LMP

  8. Serous Tumors • Malignant • Large 15cm or more • Papillary, Cystic, Solid • 35-50% bilateral • poor prognosis

  9. Serous Tumors

  10. Variants • Surface tumor • Surface Serous Carcinoma of the Peritoneum • Psammocarcinoma

  11. Implants • Invasive • Noninvasive • Epithelial • Desmoplastic

  12. Mucinous • LMP • less common than Serous LMP • Intestinal Type • Endocervical/ Muellerian Type • Better prognosis than Serous

  13. Mucinous • Malignant • 10% bilateral • usually confined to ovary and (-) surface • 66% 5yr Stage I • 59% 10 yr • Pseudomyxoma peritonei

  14. Mucinous Tumors

  15. Endometrioid • LMP

  16. 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

  17. Endometrioid Tumors

  18. Clear Cell • Nearly all are Ca • 5-11% of Ovarian Ca • 10% Hypercalcemia • usually >15 cm • Cystic and Solid • 3% bilateral • Endometriosis

  19. Clear Cell Carcinoma

  20. Brenner Tumor

  21. Transitional Cell • LMP • > 8-10 cm • Cystic or Semicystic • Resemble LG Papillary TCC • Usually Benign Clinical Course

  22. Transitional Cell • Malignant • Malignant Brenner vs. TCC • rare • elderly women • Unilateral and Cystic

  23. Undifferentiated Carcinoma • Poor Prognosis

  24. 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

  25. Misc. • Small Cell Carcinoma of Hypercalcemic Type • Small Cell Carcinoma Carcinoma of Pulmonary Type • Squamous Cell Carcinoma

  26. Sex Cord-Stromal Tumors • Ovarian Differentiation • Testicular Differentiation

  27. Granulosa Cell Tumor • Adult Type • Juvenile Type • <5% before puberty

  28. 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

  29. Juvenile Granulosa Cell Tumor • Grossly similar to Adult Form • Neoplastic Granulosa Cells scattered among which are varying numbers of follicles.

  30. Granulosa Cell Tumor

  31. Adult Granulosa Cell Tumor

  32. Germ Cell Tumors • 30% Ovarian Tumors • 95% Dermoid Cysts • 3% Ovarian Ca • 2/3 of Ca in first 2 decades

  33. 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)

  34. Mature Germ Cell Tumor (Reproductive Years) • Most common • Mature Somatic Tissue

  35. Benign Cystic Teratoma giving rise to malignancy (Postmenopausal) • Squamous Cell Carcinoma • Carcinoid • Malignant Thyroid Cancer

  36. Dysgerminoma • Most Common Germ Cell Tumor • 100% 5yr survival St I • Radio and Chemosensitive • Solid, 15cm • Primordial Germ Cells Fibrous Stroma w/ Lymphocytes

  37. Dysgerminoma

  38. Yolk Sac (Endodermal Sinus) Tumor • AFP • Rapidly growing highly malignant • Chemotx • 80% 5yr survival St I • 25% rupture • hemorrhage, necrosis • Schiller-Duvall bodies

  39. Yolk Sac Tumor

  40. Embryonal • Very Rare • mean age 15 • HCG, AFP • 15 cm • Anaplastic large Cells

  41. Choriocarcinoma • Very rare • < 20 yr • HCG

  42. Teratomas • Immature • 18cm, solid • immature tissue • neuroectodermal • neuroepithelial rosettes

  43. Immature Teratoma

  44. Metastatic Tumors • Krukenberg Tumor