Morphology and diagnosis of Ovarian Tumors • Clinical Features of Ovarian Tumors Early-stage ovarian cancer rarely causes any symptoms. Advanced-stage ovarian cancer may cause few and nonspecific symptoms that are often mistaken for more common benign conditions, such as constipation or irritable bowel. Bloating; abdominal distention or discomfort Pressure effects on the bladder and rectum Constipation Vaginal bleeding Indigestion and acid reflux Shortness of breath Tiredness Weight loss Early satiety ------prepared by med_students0-----

1. ‫الرحــيم‬ ‫الرحمن‬ ‫هللا‬ ‫بــسم‬
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Ovarian Tumors

2. :Objectives
• Morphology and diagnosis of Ovarian Tumors
• Clinical Features of Ovarian Tumors
.
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3. •
Classification of ovarian tumors
a)Describe the Morphology and diagnosis.
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4. Surface derived tumors
• Overall most common ovarian tumors.
• Four groups:
1. Serous tumors
• Benign: serous cystadenoma
• Malignant: serous cystadenocarcinoma
2. Mucinous tumors*
• Benign: mucinous cystadenoma
• Malignant: mucinous cystadenocarcinoma
3. Endometrioid tumors
• Benign and malignant
4. Brenner tumor
formation of
tubular glands, similar to those of the endometrium
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5. • Serous tumors are the most common of the ovarian epithelial tumors.
• About 60% are benign, 15% are of low malignant potential, and 25% are malignant.
• Benign lesions are usually encountered in patients between 30 and 40 years of age.
• malignant serous tumors are more commonly seen between 45 and 65 years of age
.
Serous tumors
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6. •MC benign ovarian tumor.
•Most serous tumors are large, spherical to ovoid, cystic structures
up to 30 to 40 cm in diameter.
About 25% of the benign tumors are bilateral.
•Cystic tumor cyst filled with serous fluid
•papillary projections
•benign tumors contain a single
layer of tall columnar epithelial cells that line the cyst
or cysts.
•Serous cystadenoma
6

7. •Is the MC malignant tumor of the ovary.
•surface of the cystadenocarcinoma has nodular irregularities
representing areas in which the tumor has penetrated into
the serosa and cyst is opened to reveal a large,
bulky tumor mass.
•Often bilateral
•Accounts for 50% of ovarian cancers
•Cystic tumor with solid areas.
•Areas of hemorrhage and necrosis
•Papillary structures.
•Psammoma bodies.
7
•Serous cystadenocarcinoma
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8. •only 10% of mucinous tumors are malignant;
another 10% are of low malignant potential, and 80% are
benign.
•Compared with serous tumors, mucinous tumors are
much less likely to be bilateral(about 30% of cases)
•.
Mucinous Tumors
The prognosis for patients with invasive serous cystadenocarcinoma is poor,.
If the tumor appears confined to
the ovary, frank carcinomas have a 5-year survival rate of about 70%,
of low malignant potential are associated with nearly 100% survival
cancers that have penetrated the capsule the 10-year survival rate is less than1 5
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9. •Large multiloculated tumors and large
•Cysts lined by Mucus secreting cells (similar to endocervix)
•Cysts filled with mucinous material ( thick and gelatinous)
.
•Less often bilateral.
9
•Mucinous cystadenoma

10. •Multi-loculated cystic tumor
Malignant tumors are characterized by the presence of architectural complexity, including
solid areas of growth, cellular stratification, cytologic atypia,
and stromal invasion
contain neoplastic glands lined by tall columnar, mucin-producing cells.
•Can result in Pseudomyxoma peritonei ( the accumulation mucinous material in
the peritoneal cavity)
•Due to Rupture of cysts or intra-peritoneal spread.
•Multiple peritoneal implants  produce large quantities of intra-peritoneal
mucinous material.
•Mucinous cystadenocarcinoma
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11. Germ cell tumors
• Are similar to germ cell tumors in men (testis).
• Account for most ovarian tumors occurring in women younger than 20 years
• Arise from
• totipotent germ cells
• Types:
1. Teratomas (originate from germ cells)
2. Dysgerminoma
3. Yolk sac (endodermal sinus) tumor
4. Choriocarcinoma
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12. Mature teratoma
Micrograph of a teratoma showing tissue from all
three germ layers: mesoderm (immature
cartilage endoderm (gastrointestinal glands) -
and ectoderm (epidermis ).
teratoma will contain no organs but rather one or more
tissues normally found in organs such as
the brain, thyroid, liver, and lung.
90% of these germ cell neoplasms are benign.

13. Mature cystic teratoma of the ovary with hair, sebaceous
material, and thyroid tissue.
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14. Sex cord stromal tumors
• Account for small percentage of ovarian tumors.
• Women of all ages are affected
• These tumors are usually functional
• Types:
• Fibroma (Meig’s Syndrome)
• Granulosa cell tumor (estrogen)
• Sertoli leydig cell tumor (androgens)
• Thecoma
• Gonadoblastoma
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15. •
Fibroma of ovary. The ovary is conspicuously
enlarged by a firm, white, bosselated tumor.
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16. Brenner tumor
The Brenner tumor is an uncommon, solid, usually unilateral ovarian tumor
consisting of abundant stroma containing
Contain Walthard’s rests (transitional like epithelium of bladder) in fibrous stroma
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17. •
1. History
Assessment of women for their risk of ovarian cancer necessitates obtaining a
careful family history of both male and female relatives, including those relatives
without cancer
Physical Examination
Physical findings are uncommon in patients with early disease. Patients with more advanced disease
may present with ovarian or pelvic mass, ascites, pleural effusion, or abdominal mass or bowel
obstruction
Pelvic Exam: rectum and vagina simultaneously to feel for abnormal swelling and to
detect tenderness
Staging
•Stages of ovarian cancer include:
•Stage I. Cancer is found in one or both ovaries.
•Stage II. Cancer has spread to other parts of the pelvis.
•Stage III. Cancer has spread to the abdomen.
•Stage IV. Cancer is found outside the abdomen.

18. •
Tumor Markers
•. CA125 is not specific for epithelial ovarian cancer and is elevated in other benign and
malignant conditions, including menstruation; endometriosis; pelvic inflammation; liver,
renal, and lung disease;
•Although CA125 is elevated in 83% of women with epithelial ovarian cancer, it is
elevated in only 50% of those with stage I disease.
•lysophosphatidic acid.
•, tumor-associated glycoprotein 72 (TAG 72),
•macrophage colony-stimulating factor (M-CSF).
•mesothelin, human epididymis protein 4, kallikrein, and haptoglobin-alpha.
No marker is completely specific; therefore, diagnostic immunohistochemistry
testing must be used in conjunction with morphologic and clinical findings.
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19. •
Urinalysis
Urinalysis should be obtained to rule out other possible causes of abdominal or pelvic pain, such
as urinary tract infections or kidney stone.
Imaging in Ovarian Cancer
ultrasonography, chest radiography, (MRI). Positron emission tomography (PET) scanning does
not have an established role in the diagnosis of primary ovarian malignancy.
Ultrasonography is the most useful initial investigation in a patient found to have a pelvic mass.
This may define the morphology of the pelvic tumor
The primary advantage of using MRI in the evaluation of ovarian masses is the ability to employ
this modality in the characterization of tissue. The presence of fat, hemorrhage, mucin, fluid,
and solid tissue within an ovarian mass can be determined with the aid of MRI.
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20. •
Biopsy
Fine-needle aspiration (FNA) of an adnexal mass is not routinely recommended. In most cases,
this approach may only serve to delay diagnosis and treatment of ovarian cancer.
Instead,
if a clinical suggestion of ovarian cancer is present, the patient should undergo a laparotomy
for diagnosis and staging.
FNA should be performed in patients with diffuse carcinomatosis or ascites without an obvious
ovarian mass.
Mammography
The preoperative workup also should include mammography for women older than 40 years
who have not had one in the preceding 6-12 months.
This is especially important in women with estrogen-producing tumors because these may
increase the risk of breast malignancies
.

21. •B. Clinical Features
•
Early-stage ovarian cancer rarely causes any symptoms. Advanced-stage ovarian cancer may
cause few and nonspecific symptoms that are often mistaken for more common benign
conditions, such as constipation or irritable bowel.
•Bloating; abdominal distention or discomfort
•Pressure effects on the bladder and rectum
•Constipation
•Vaginal bleeding
•Indigestion and acid reflux
•Shortness of breath
•Tiredness
•Weight loss
•Early satiety
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22. Summary
•
•Stages of ovarian cancer include:
•Stage I. Cancer is found in one or both ovaries.
•Stage II. Cancer has spread to other parts of the pelvis.
•Stage III. Cancer has spread to the abdomen.
•Stage IV. Cancer is found outside the abdomen.
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23. Resources
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24. Questions

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