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OVARIAN NEOPLASM
ORIGIN OF OVARIAN TUMORS
OVARIAN NEOPLASM► NON-NEOPLASTIC   functional cyst► Primary► Secondary
Non-neoplastic► Follicularcyst:- usually less than 5 cm- Benign and a symptomatic- Thin wall, contain clear fluid
Non-neoplastic► Corpus   luteal- Hemorrahgic corpus luteum- Cyst filled with blood- Follicular cysts
Non-neoplastic► Granulosa-theca  lutein cyst- in molar pregnancy or part of  hyperstimulation syndrome- Polycystic ovary- ...
Primary ovarian tumors► Epithelial- Benign- Borderline- Malignant• Germ cell tumors• Sex cord (gonadal stromal) tumors
Epithelial tumors►   Serous : most common►   Mucinous►   Endometrioid►   Clear cell(mesonephroid)►    Brenner
Epithelial tumors• Serous:- contain clear fluid- Often bilateral. Around age of menopause- Malignant type is the commonest...
SEROUS CYT ADENOMA
SEROUS BORDERLINE TUMOR
SEROUS CYSTADENOCARCINOMA
?
?   ?   ?
► Mucinous:► large tumors. Multilocular filled with mucin► If ruptured………pseudomyxoma peritonei
MUCINOUS CYST ADENOMA
MUCINOUS BORDERLINE TUMOR
MUCINOUS CYSTADENOCARCINOMA
?   ?   ?
Epithelial tumors► Endometrioid:-   Few cases arise in endometriosis-   30% coexist with primary endometrial cancer-   the...
BRENNER TUMORS► usuallybenign.occur in reproductive life► They can be malignant.► May be associated with endometrial  hype...
BENIGN BRENNER TUMOR
BRENNER BORDERLINE TUMOR
BRENNER MALIGNANT TUMOR
Clear cell carcinoma► Clear cell ovarian tumors are part of the surface  epithelial tumor group of ovarian cancers,► Accou...
Germ cell tumors► Dermoid       cyst (benign cystic teratoma)-   25% of all ovarian neoplasm-   Contain tissue derived fro...
Malignant Germ cell tumors► Rare.3% of ovarian cancers► Teratoma: peak incidence in second  decade► Malignant teratoma► Im...
IMMATURE TERATOMA
CHORIOCARCINOMA► Non-gestational   choriocarcinoma► secreteHCG► May be component of solid teratoma
Malignant Germ cell tumors► Yolk-sac     (endodermal sinus)-   Highly malignant.-   Affect young age-   Partly solid.-   S...
► Dysgerminoma► Most common. Highly malignant► Usually spread by lymphatics► Very radiosensitive► Occur in young women.► M...
Sex cord tumors► Granulosa-theca       cell tumors-   Moderate to large size-   Solid, as enlarge may have cystic spaces- ...
GRANULOSA CELL TUMOR
Sex cord tumors► Androgen-     secreting tumors- Androblastoma,Sertoli-leydig,Gynandroblastoma- Cause virilization• Fibrom...
FIBROMA
THECOMA
SERTOLI-LEYDIG CELL TUMOR
Metastatic tumors► Alwaysbilateral. From mucin secreting tumors, stomach and colon (krukenberg tumors)► May   be secondary...
Metastatic ovarian   Kurkenberg   cancer                tumor
Complication of ovarian tumors► Torsion- common with dermoid/fibroma- Severe abdominal pain/vomitting► Rupture► Haemorrhag...
Physical signs► Benign:- usually mobile.unless large or complicated- Dermoid cyst anterior to bladder• Malignant:- Bilater...
FIGO StagingStage 1         Growth limited to one or                both ovariesStage 2         Growth limited to one or  ...
MANAGMENT► Surgery  :   primary   interval debulking   palliative   second look surgery► Chemotherapy
Primary surgery► Primary  cytoreduction► TAH,BSO,OMETECTOMY,WASHINGSBOWEL SURGERY► Optimal debulking: less than 2 cm resid...
Palliative surgery► Removal    of intestinal obstruction► Survival   is very poor► Quality   of life considerations
Ovarian tumors
Ovarian tumors
Ovarian tumors
Ovarian tumors
Ovarian tumors
Ovarian tumors
Ovarian tumors
Ovarian tumors
Ovarian tumors
Ovarian tumors
Ovarian tumors
Ovarian tumors
Ovarian tumors
Ovarian tumors
Ovarian tumors
Ovarian tumors
Ovarian tumors
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Ovarian tumors

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Transcript of "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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