Ovarian PathologyM.M.Gees

Polycystic ovarian diseaseClinical presentations: - young female of reproductive age. - Oligomenorrhea or secondary amenorrhea. - Hirsutism, Infertility and Obesity.This is usually in girls after menarche, secondary to excessive production of estrogen and androgens ( mostly the later) by multiple cystic follicles in the ovaries. This condition is known as Polycystic ovaries or Stein-leventhal syndrome.

Cont..Unknown etiology Lab: i. Elevated luteinizing hormone. (LH) ii. Low Follicle stimulating hormone.(FSH) iii. Elevated testosterone.Gross morphology: Bilaterally enlarged ovaries with multiple cysts. Microscopically it has multi follicle cysts.Treatment: Oral contraceptive or Provera

Ovarian Tumors

A) Suface epithelial tumorsThese neoplasms are derived from the coelomic mesothelium that covers the surface of the ovary. With repeated ovulation and scarring the surface epithelium is pulled into the cortex of the ovary, forming small epethial cysts. These can undergo metaplasia and neoplastic transformtion into epithelial tumors of various histologic types.

ContBenign lesions are usually cystic(cystadenoma) or can have accompanying stromal components (cystadenofibroma).Malignant tumors may also be cystic(cystadenocarcinoma) or solid(carcinoma).

S.E.T also have an intermediate,borderline category currently referred to as tumors of low malignant potential.E.T are the most common malignant ovarian tumors and are more in women older than 40 yrs.

cont,..Cystadenoma: - most common benign ovarian tumor. - Gross; unilocular,smooth-lined cyst. - Micro; simple serous or mucinous lining.Cystadenocarcinoma: - most common malignant ovarin tumor. - Gross: - Complex multiloculated cyst. - Nodular and solid area. - Micro: stratified serous or mucinous lining with tufting. papillary structures with psammoma bodies. stromal invasion. - Heridetary rist factors: BRCA-1: breast and ovarian cancer. lynch syndrom. Tumor marker is CA125. Spreads with seeding peritoneal cavity.

Patient with ovarian cystadenoma

Ovarian cystadenoma

Ovarian cystadenoma

Ovarian cystadenoma

Papillary cystadenocarcinoma

Papillary cystadenocarcinoma

B) Germ cell tumorsTeratoma(dermoid cyst) - vast majority (>95%) are benign. - commonly occurs in the early reproductive years. - elements from all these germ cell layers are present: Ectorderm- skin, hair, adnexa and neural tissue.Mesoderm- bone and cartilage.Endoderm- thyroid and bronchial tissue. - Gross: ovarian cyst containing hair, teeth and greasy material. - Stroma ovarii: prepondarance of thyroid tissue. - immature teratoma: histologically immature - Complication: Torsion, Ruptue, Malignant transformation(1%) usually squamous cell carcinoma (SCC).

Teratoma

Teratoma

ContDysgerminoma: - malignant germ cell tumor. - common in young adults.-Risk factors: Turner syndrom & Psuedohermophrodites.Gross and Microscopic features are similar to seminoma.Radiosensitive and good prognosis.

C) Sex cord-stromal tumorOvarian fibroma: Most common stromal tumor.Gross: firm white masses.Meigs syndrome: fibroma+ascities+pleural effusion.

Granulosa Cell tumor:Potentially malignant.Estrogen producing tumor.The clinical presentation depends on age:Prepuberalprecocious puberty.Reproductive ageirregular menses.Postmenopuasalvaginal bleeding.- Gross: yellow- white mass

Cont..Micro:Polygonal tumor cells.Formation of follicle-like structures (call-exner bodies)- Complication: endometrial hyperplasia and cancer.

Cont..Sertoli-leydig cell tumor(androblastoma):

- Androgen producing tumor. - Clinical presentation: Virilization. - Complications: Risk of female psuedohermophrodite.

METASTATIC TUMORS TO THE OVARYPrimary sites: Breast cancer. Colon cancer. Endometerial cancer. Gastric singet-ring cell cancer.