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Ovarian Cancer
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Ovarian Cancer

Ovarian Cancer

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Ovarian Cancer Presentation Transcript

  • 1. Oncological Gynaecopathology Tumors of the ovary Marc van de Vijver
  • 2. Main types of ovarian tumors • 1. Surface epithelial-stromal tumors • 2. Germcell tumors • 3. Sex cord-stromal tumors • 4. Metastatic tumors • 5. Miscelaneous
  • 3. Epithelial tumors • serous • mucinous • endometrioïd • clearcell • transitional cell • undifferentiated • mixed epithelial
  • 4. For each type of epithelial tumor: • benign • “borderline” • malignant
  • 5. Case OV1 • Age: 70 years. • Unilateral ovarian tumor, diam. 17 cm.
  • 6. Differential diagnosis?
  • 7. Differential diagnosis • Endometrioid adenocarcinoma of the ovary • Metastasis of adenocarcinoma • Mucinous adenocarcinoma
  • 8. Keratin 7
  • 9. CEA
  • 10. Estrogen receptor
  • 11. Diagnosis • Endometrioid adenocarcinoma, grade 1
  • 12. Case OV2 • Age: 57 yrs. • Peritoneal metastases; clinically most consistent with primary ovarian carcinoma.
  • 13. Differential diagnosis?
  • 14. Differential diagnosis • Clear cell carcinoma
  • 15. Case OV3 • Age: 66 yrs • Bilateral multicystic ovarian tumors, diam. 12 cm.
  • 16. Differential diagnosis?
  • 17. Differential diagnosis • Metastasis of colon carcinoma • Mucinous carcinoma of the ovary • Endometrioid carcinoma of the ovary • Metastasis of adenocarcinoma (other than colon)
  • 18. Immunohistochemistry • Keratin 7: negative • Keratin 20: positive • CEA: strongly positive • CA125: weakly positive
  • 19. Diagnosis • Metastasis of colon carcinoma • (patient was known to have had primary colon carcinoma)
  • 20. Case OV4 • Age: 59 yrs • Debulking for tumor of the peritoneum, consistent with primary ovarian carcinoma
  • 21. Differential diagnosis?
  • 22. Differential diagnosis • Endometrioid adenocarcinoma • Endometrioid borderline tumor • Metastasis of adenocarcinoma to the ovary (for example: from primary endometrial carcinoma)
  • 23. Diagnosis • Endometrioid adenocarcinoma
  • 24. Case OV5 • Age: 58 yrs • Resection of 10 cm cystic mass of left ovary
  • 25. Differential diagnosis?
  • 26. Differential diagnosis • Benign teratoma • Immature teratoma • Carcinoma ex teratoma
  • 27. Diagnosis • Benign teratoma/dermoid cyst
  • 28. Germ cell tumors of the ovary • 30% of all ovarian tumors • Dermoid cysts: 70% • Malignant: 3% – Dysgerminoma – Yolk sac tumor – Immature teratoma – Malignancy in dermoid cyst – Rare types
  • 29. Case OV6 • Age: 53 yrs. • Left ovary: multicystic tumor, diam. 14 cm.
  • 30. Differential diagnosis?
  • 31. Differential diagnosis • Mucinous dissection/disseminated adenomucinosis • Mucinous borderline tumor • Mucinous cystadenoma • Metastasis of adenocarcinoma to the ovary
  • 32. disseminated peritoneal adenomucinosis originates in the appendix
  • 33. Diagnosis • disseminated peritoneal adenomucinosis
  • 34. Case OV7 • Age: 46 yrs • History: – 5 yrs back: ovarian tumor resected • Liver metastasis
  • 35. Differential diagnosis?
  • 36. Differential diagnosis • Granulosacell tumor • (Undifferentiated) carcinoma
  • 37. Diagnosis • Granulosacell tumor
  • 38. Case OV8 • Age: 44 yrs • History: at age 40 resection of left ovary • Resection cystic tumor of right ovary
  • 39. Differential diagnosis?
  • 40. Differential diagnosis • Serous papillary borderline tumor • Serous papillary cystadenoma • Serous papillary adenocarcinoma
  • 41. Fallopian tube Borderline tumor
  • 42. Diagnosis • Serous papillary borderline tumor
  • 43. Serous papillary borderline tumor • Frequently bilateral (30%) • Often associated with peritoneal implants • Favorable clinical course, also when Peritoneal implants or lymph node localization is present • Invasive peritoneal implants associated with progression to invasive serous carcinoma
  • 44. Case OV9 • Age: 35 yrs • Unilateral, partly cystic tumor right ovary, diameter 7 cm.
  • 45. Differential diagnosis?
  • 46. Diifferential diagnosis Tumor type? • Endometrioid • Serous papillary • Mucinous
  • 47. Endometrioid tumor • Benign • Borderline • Malignant
  • 48. Diagnosis • Appearance of complex hyperplasia with atypia: • Endometrioid borderline tumor
  • 49. Endometrioid borderline tumor • Very rare • Often misdiagnosed, mainly as carcinoma! • Outcome: very good (100% survival, no metastases)
  • 50. Case OV10 • Age: 38 yrs • Unilateral multicystic ovarian tumor • Diameter 14 cm.
  • 51. Differential diagnosis?
  • 52. Differential diagnosis • Mucinous cystadenoma • Mucinous borderline tumor • Is the tumor adequately sampled with two sections?
  • 53. Diagnosis • Mucinous borderline tumor
  • 54. Mucinous borderline tumor • Always stage I; 100% survival • Cases that go bad: mostly misdiagnosis: – Inadequate sampling, diagnosis of invasive carcinoma missed – Mucinous dissection missed (pseudomyxoma peritonei)
  • 55. Case OV11 • Age: 33 yrs • Unilateral solid ovarian tumor • Diameter 7 cm.
  • 56. Differential diagnosis?
  • 57. Differential diagnosis • Sertoli-Leydigcell tumor • Metastasis adenocarcinoma
  • 58. Diagnosis • Sertoli-Leydigcell tumor
  • 59. OV12 • 32-jarige P0 • Opname met sinds 2 weken bestaande progressieve cognitieve en gedragsveranderingen. • Na opname in het zhs. achteruitgang en ontstaan van insulten • Resectie van cysteuze tumor uit het abdomen (gewicht 800 gram; diameter 19cm.)
  • 60. A patient with bilateral immature ovarian teratoma presenting with paraneoplastic encephalitis Anne M. van Altena, Geertruida J. Wijnberg, Eva Kolwijck, Joanne A. de Hullu and Leon F.A.G. Massuger Gynecologic Oncology (2008) 108: 445-448
  • 61. DD matuur vs immatuur teratoom • 1% van de teratomen is immatuur • Immatuur teratoom bevat immature of embryonale structuren (meestal neuronaal) – gradering Blaustein: – Graad 1: geringe foci van immatuur weefsel; geringe mitose-activiteit – Graad 2: matige hoeveelheid immatuur weefsel; matige mitose-activiteit – Graad 3: grote hoeveelheid immatuur weefsel; hoge mitose-activiteit