Benign Ovarian Tumors

Anatomy and Histology

Gross findings

- paired pelvic organs- attached by

mesovarium to posterior broad ligament, by utero-ovarian ligament to the uterine cornu, and by the infundibulopelvic ligament to the lateral pelvic walls

- ovoid, weighs 5-8 g- approximately

measures 3-5 x 1.5-3 x 0.6-1.5 cm

- smooth external surface of prepubertal ovary becomes convoluted and scarred with age

Microscopic findings

The ovarian surface epithelium • single layer of columnar cells overlies the ovarian stroma

Corpus Luteum

Corpora Albicantia

Derivation of various ovarian neoplasm

Origin Surface Epithelial Stromal Cell tumors

Germ cell tumors Sex Cord-Stromal tumors

Metastasis to Ovaries

Over all frequency 65-70% 15-20% 5-10% 5%Proportion of Malignant ovarian tumor

90% 3-5% 2-3% 5%

Age group affected 20+ years 0-25+ years All ages VariableTypes -Serous tumor

-Mucinous tumor -Endometrioid tumor -Clear cell tumor -Brenner tumor -Squamous cell tumors

- Teratoma -Dysgerminoma -Endodermal sinus tumor -Choriocarcinoma

-Fibroma -Granulosa-theca cell tumor -Sertoli-Leydig cell tumor

Surface Epithelial-stromal Cell Tumors

• Serous Cystadenoma

Gross Findings:

• could be unilocular or multilocular

• enlarged and filled with clear watery fluid

• smooth and glistening surface

Serous Cystadenoma

• thin walled

• multiloculated

Serous Cystadenoma

• single layer of columnar cells covering the stroma

Serous Cystadenoma

• The lining epithelium is cuboidal with a darkly stained nuclei. The stroma contains fibroblast and collagen

Serous Cystadenoma

• the cells have dark nuclei with an eosinophilic, ciliated cytoplasm

Serous Adenofibroma

• glands are lined by a single epithelial layer within a dense fibrous stroma

Serous Cystadenofibroma

• polypoid projections have broad fibrous or edematous cores lined by a single layer of epithelium

• Mucinous Cystadenoma

Gross findings:

• typically multiloculated

• the serosal saurface is thick, smooth and opaque

Mucinous Cystadenoma

• cysts contain thick mucinous material

• locules usually are small and multiple

Mucinous Cystadenoma

Microscopic findings:• single layer of tall columnar cells with clear

cytoplasm

Mucinous Cystadenoma

• the nuclei is small, basal and hyperchromatic

• Mucinous Adenofibroma

• dense fibrous stroma containing benign mucinous glands

Comparison of Mucinous and Serous Cystadenoma

Endometrioid Adenofibroma

• tubular and cystic glands surrounded by a fibrous stroma

Transitional (Brenner) Cell tumor

Clinical Features• 1–2% of all ovarian neoplasms1• Average age at presentation ≈50 years:

– 71% >40 years• Sometimes signs of hyperestrinism, such as

postmenopausal uterine bleeding from endometrial hyperplasia2

• Slow rate of growth• Rarely ascites

Pathogenesis• Most favor origin from surface ovarian

epithelium or cysts derived from them through a process of metaplasia:3 – supported by continuity demonstrated

between epithelial nests of Brenner tumor and ovarian surface

Transitional Cell (Brenner) Tumor

• large tumor involving the right ovary

• gross neoplasm is similar to fibrothecoma

• mostly are well circumscribed

• firm, rubbery

• slightly bosselated serosal surface

• coexist with mucinous cystadenoma

Brenner Tumor

• nest of transitional cells embedded in a fibrous stroma

Brenner Tumor

• The cells have very distinct margins. • The nuclei are oval with definite micronucleoli. • There is no pleomorphism or mitotic activity

Germ cell tumor

Mature cystic teratoma• Almost 20% of all ovarian neoplasms:• Most common ovarian tumor in childhood1• 88% unilateral• Symptoms:

– relate to mass– occasionally:

• hemolytic anemia, virilization, • May coexist with:

mucinous cystadenoma

Brenner tumor

fibrothecoma

• Teratoma •

multiloculated

• sebaceous material

• hair• teeth

Mature Cystic Teratoma

• keratinized surface of stratified squamous epithelium with hair follicle

Mature Cystic Teratoma

• keratin overlying a squamous epithelium, beneath the epithelium are benign sebaceous glands

Sex cord stromal cell tumor

FibromaClinical Features• Common• Usually unilateral• Almost invariably after puberty1• Sometimes in young women with basal cell nevus (Gorlin's)

syndrome• Benign• May be ascites:

– especially if large– sometimes with right-sided pleural effusion (Meigs'

syndrome): disappears on removal of tumor

Fibroma

Gross Findings: • Solid

• lobulated

• uniformly white

• avarage diameter is 6 cm

Fibroma

• Ovarian fibroma showing closely packed spindle stromal cells arranged in a feather stitched or storiform pattern of growth

Thecoma

Clinical Features• After menopause in 65% of cases• Typically estrogenic manifestations• Some may be androgenic:

– particularly those containing steroid cells• Nearly always benign• A few malignant examples

Thecoma

Cut surface of thecoma showing a predominance of yellow areas alternating with whitish foci

Thecoma

Granulosa Cell tumor

Clinical Features• Two distinct types:

– adult– juvenile:

• more aggressive than adult• more likely to produce distant metastases

Adult Granulosa Cell Tumor

- Usually childbearing age – 75% have hyperestrinism, which may result in:

• isosexual precocious puberty in children1• metrorrhagia in adults, including postmenopausal2

– Some cases clinically hormonally inactive– A few androgenic3,4 Elevated serum inhibin and follicle regulatory proteins

Juvenile Granulosa Cell Tumor– ≈80% during first two decades of life– Usually presents with isosexual precocity– Occasionally associated with: – enchondromatosis (Ollier's disease)5– Maffucci's syndrome6

Granulosa Cell tumor

• encapsulated• smooth, lobulated

• folds or grooves in nuclei result in coffee bean appearance