Ovarian tumors

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Ovarian tumors

  1. 1. OVARIAN NEOPLASM
  2. 2. ORIGIN OF OVARIAN TUMORS
  3. 3. OVARIAN NEOPLASM► NON-NEOPLASTIC functional cyst► Primary► Secondary
  4. 4. Non-neoplastic► Follicularcyst:- usually less than 5 cm- Benign and a symptomatic- Thin wall, contain clear fluid
  5. 5. Non-neoplastic► Corpus luteal- Hemorrahgic corpus luteum- Cyst filled with blood- Follicular cysts
  6. 6. Non-neoplastic► Granulosa-theca lutein cyst- in molar pregnancy or part of hyperstimulation syndrome- Polycystic ovary- Endometriotic cyst
  7. 7. Primary ovarian tumors► Epithelial- Benign- Borderline- Malignant• Germ cell tumors• Sex cord (gonadal stromal) tumors
  8. 8. Epithelial tumors► Serous : most common► Mucinous► Endometrioid► Clear cell(mesonephroid)► Brenner
  9. 9. Epithelial tumors• Serous:- contain clear fluid- Often bilateral. Around age of menopause- Malignant type is the commonest ovarian cancer
  10. 10. SEROUS CYT ADENOMA
  11. 11. SEROUS BORDERLINE TUMOR
  12. 12. SEROUS CYSTADENOCARCINOMA
  13. 13. ?
  14. 14. ? ? ?
  15. 15. ► Mucinous:► large tumors. Multilocular filled with mucin► If ruptured………pseudomyxoma peritonei
  16. 16. MUCINOUS CYST ADENOMA
  17. 17. MUCINOUS BORDERLINE TUMOR
  18. 18. MUCINOUS CYSTADENOCARCINOMA
  19. 19. ? ? ?
  20. 20. Epithelial tumors► Endometrioid:- Few cases arise in endometriosis- 30% coexist with primary endometrial cancer- the second most common type of epithelial ovarian cancer- occurs primarily in women who are between 50 and 70 years of age.
  21. 21. BRENNER TUMORS► usuallybenign.occur in reproductive life► They can be malignant.► May be associated with endometrial hyperplasia► May coexist with mucinous cystadenoma
  22. 22. BENIGN BRENNER TUMOR
  23. 23. BRENNER BORDERLINE TUMOR
  24. 24. BRENNER MALIGNANT TUMOR
  25. 25. Clear cell carcinoma► Clear cell ovarian tumors are part of the surface epithelial tumor group of ovarian cancers,► Accounting for 6% of these cancers.► Polypoid masses that protrude into the cyst.► On microscopic examination, composed of cells with clear cytoplasm (that contains glycogen)► Hob nail cells.► The pattern may be glandular, papillary or solid.
  26. 26. Germ cell tumors► Dermoid cyst (benign cystic teratoma)- 25% of all ovarian neoplasm- Contain tissue derived from two or more germ cell layers- Unilocular cyst. May contain teeth, bone , cartilage, nerves, hair, thyroid,.. Tissues- Almost always benign. Malignant changes may occur in any component- Occur at any age.peak is 20-30 years.- Bilateral in 20%
  27. 27. Malignant Germ cell tumors► Rare.3% of ovarian cancers► Teratoma: peak incidence in second decade► Malignant teratoma► Immature teratoma
  28. 28. IMMATURE TERATOMA
  29. 29. CHORIOCARCINOMA► Non-gestational choriocarcinoma► secreteHCG► May be component of solid teratoma
  30. 30. Malignant Germ cell tumors► Yolk-sac (endodermal sinus)- Highly malignant.- Affect young age- Partly solid.- Secrete alpha feto-protein
  31. 31. ► Dysgerminoma► Most common. Highly malignant► Usually spread by lymphatics► Very radiosensitive► Occur in young women.► May arise in gonadal dysgenesis
  32. 32. Sex cord tumors► Granulosa-theca cell tumors- Moderate to large size- Solid, as enlarge may have cystic spaces- Yellow tinge on cut surface- Thecoma is benign,but granulosa cell is malignant- Occur at any age .50% postmenopausal- Secret estrogen- Usually stage 1. Late recurrence
  33. 33. GRANULOSA CELL TUMOR
  34. 34. Sex cord tumors► Androgen- secreting tumors- Androblastoma,Sertoli-leydig,Gynandroblastoma- Cause virilization• Fibroma- solid tumor- May be associated with meigs’ syndrome- Tend to have long pedicle
  35. 35. FIBROMA
  36. 36. THECOMA
  37. 37. SERTOLI-LEYDIG CELL TUMOR
  38. 38. Metastatic tumors► Alwaysbilateral. From mucin secreting tumors, stomach and colon (krukenberg tumors)► May be secondary to breast
  39. 39. Metastatic ovarian Kurkenberg cancer tumor
  40. 40. Complication of ovarian tumors► Torsion- common with dermoid/fibroma- Severe abdominal pain/vomitting► Rupture► Haemorrhage► Impaction► infection
  41. 41. Physical signs► Benign:- usually mobile.unless large or complicated- Dermoid cyst anterior to bladder• Malignant:- Bilateral- Ascites- Hard deposit in pelvis- Leg edema- Signs of bowel obstruction of ureteric obstruction
  42. 42. FIGO StagingStage 1 Growth limited to one or both ovariesStage 2 Growth limited to one or both ovaries with pelvic extensionStage 3 Tumor involving one/both ovaries with peritoneal implants outside pelvis/positive retroperitoneal or inguinalStage 4 nodes involving one or Growth both ovaries with distant metastasis
  43. 43. MANAGMENT► Surgery : primary interval debulking palliative second look surgery► Chemotherapy
  44. 44. Primary surgery► Primary cytoreduction► TAH,BSO,OMETECTOMY,WASHINGSBOWEL SURGERY► Optimal debulking: less than 2 cm residual tumors► Staging once histology is available► If confined to ovary and young age… conservative surgery
  45. 45. Palliative surgery► Removal of intestinal obstruction► Survival is very poor► Quality of life considerations
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