Female Genitalia IV

Ovary

OvaryInflammationNon-neoplastic cysts

Neoplasms

OvaryInflammation

Primary inflammation is rareUsually secondary to spread from fallopian tube (tubo-ovarian abscess)

Other causes- appendicitis, diverticulitis etc

OvaryNon-neoplastic cysts

Follicular cysts - Polycystic Ovarian Syndrome (Stein-Leventhal)

Corpus luteum cysts - may cause intraperitoneal haemorrhage

Simple cysts Endometriotic cysts - haemorrhage

within endometriotic deposits; “chocolate cysts”

OvaryNeoplasms

Classification of Primary Neoplasms Surface (germinal) epithelium (approx.

65%) Germ cells (approx. 20%) Sex cord-stromal cells (approx. 10%) Miscellaneous, i.e. tumours

not specific to the ovary (approx. 5%)

Surface Epithelial Neoplasms

Classification Serous Mucinous Endometrioid Brenner Clear cell Undifferentiated

Surface Epithelial Neoplasms

Cystadenomas/cystadenocarcinomasSerous - lining resemble fallopian tube

Mucinous - resemble lining of cervixEndometrioid - resemble endometrium

Brenner - resemble urothelium

Serous Tumours 25% of all ovarian tumours 30-50% bilateral Benign ones, predominantly cystic Malignant ones, more solid Papillary projections into cyst

cavities Borderline (LMP) - features of

malignancy but no stromal invasion

Mucinous & Endometrioid Neoplasms

Mucinous Less common than serous, 10-

20% bilateral Benign, borderline, malignant Tend to grow to very large size “Pseudomyxoma peritonei”

Endometrioid Resemble endometrial

carcinoma and may coincide with it

Sex Cord-Stromal Tumours

Granulosa cell tumour

Thecoma/FibromaSertoli-Leydig cell tumour

Granulosa Cell Tumours

Occur at any age Peak incidence, postmenopausal 25-75% produce excessive

oestrogenChildren - precocious pubertyReproductive age - menstrual irregularities

Older age - p.m.b.

All potentially malignant, but Most behave benign High-grade malignant varieties occur

Thecoma/Fibromas Originate from theca cell

ThecomaSolid, firmMay produce oestrogen; a few produce androgens

Nearly always benign

FibromaSolid, invariable benignMeig’s syndrome

Sertoli-Leydig Cell Tumours

Resemble Sertoli & Leydig cells of testis

Predominantly solid Usually found in young adults About half accompanied by

excess androgen secretion - virilization

Most are of low-grade malignancy

Germ Cell Tumours Dysgerminoma Yolk sac tumour (endodermal

sinus; embryonal ca) Choriocarcinoma Teratoma

Comprise about 20% of ovarian tumours, but are most COMMON ovarian tumour in girls and young women

Germ Cell Tumours Dysgerminoma

All malignant Very radiosensitive withUp to 95% 5-yr survival

Yolk sac tumour - highly malignant; alpha-fetoprotein

Chorioca - Rare! Most are metastases from corpus

TeratomaBenign cystic teratoma (dermoid cyst)Most common GCT (up to 95% of

GCTs) Are multilocular or unilocular cystsContaining cheesy or porridge-like

sebaceous material with matted hair Sometimes cartilage, bone and/or

teeth grosslyTissues from all 3 germ cell layers but

ectodermal tissues predominate“Struma ovarii” – may be functional

Teratoma

Solid teratomasAre invariably malignantAre also known as "immature teratomas"

Malignancy due to immaturity of the tissues – usually immature neuroepithelium

Secondary (Metastatic) Tumours

Most common - stomach, colon, breast, corpus and cervix uteri

Krukenberg tumour - bilateral, solid, mucin-secreting “signet ring” cells; usually from stomach, colon, breast

Mets to ovary connote poor prognosis

Ovarian TumoursGeneral Features

USA - most fatal gynae. malignancy; kill more than ca.cx & corpus combined

Ranked 6th in women in Ja Presentation - asymptomatic, pain,

mass, signs of malignancy, hormonal changes etc

Prognosis - tumour type; grade; stage Surgical +/- radioRx, chemoRx