OVARIAN NEOPLASMS

1. Ovarian Neoplasms
Dr.T.Arivazhagan
Post graduate
Department of Pathology

4. Germ cell
•A germ cell is any biological cell that gives rise to the
gametes of an organism that reproduce sexually
•So GCT presumed to derived from the pathogenic
transformation of ovarian germ cell

5. Germ cell tumors
• Constitute 15% to 20% of all ovarian tumor
• Composed of a number of histologically different tumor types
• Derived from the primitive germ cells
• Common histogenesis
• Presence of histologically different neoplastic elements with in the
same tumor
• 3% have malignant potential

6. Classification

7. Teratoma
A teratoma is
a tumor with tissue or organ components
resembling normal derivatives of more than
one germ layer

8. Classification
1.Mature – Benign
2.Immature – Malignant
3.Monodermal – Highly specialized

9. MATURE IMMATURE MONODERMAL
Features Cystic Essentially
malignant
Specialized
Example Dermoid cyst Solid
teratoma
Struma ovarii,
carcinoid
tumor
Morphology Well
differentiated
cells
Cystic areas
with solid
areas
Thyroid tissue,
colloid
vesicles

10. Dermoid cyst
•It Contains Elements From All The Germ Layers
•Incidence - 95 % of Germ cell tumor
•Almost always lined by skin like structures
•Young women – Reproductive age groups
•Karyotype almost 46XX
•Majority arises from an ovum after first meiotic division
Ectoderm Mesoderm Endoderm
Skin, Hair, Teeth, Nails Thyroid, Bronchus,
Intestine
Bone, Smooth muscle

11. Site
1. Ovary
2. Lumbar
3. Uterovesical
4. Para sacral
5. Rectovaginal septum

12. Morphology
•Bilateral in 10% to 15%
•Characteristically UNILOCULAR CYST
•Contain hairs & sebaceous material
•Tooth structures
•Areas of calcification

16. Microscopic
•Cyst wall lined by stratified squamous epithelium
•Sebaceous glands, hair shafts
•Other skin adnexal structures
•1% undergoes malignant transformation
•Squamous cell carcinoma

20. Immature Teratomas
• Rare tumor
• Grows rapidly
• Spread either locally or distantly
• Prepuberteal age groups
• Young women
• Mean age 18 years
• Differ from benign Teratomas by – tissue resembles embryonal &
immature fetal tissues

21. Morphology
• Bulky
• Smooth external surface
• Hair, sebaceous material
• Cartilage, bone
• Along with areas of hemorrhage, necrosis

22. Microscopic
• Immature neuroepithelium
• Cartilage
• Bone
• Muscle
• Extra ovarian spread – Grading I to III based on proportion of
IMMATURE NEUROEPITHELIUM

24. Monodermal
•Specialized form
•Rare tumor
•Most common – Struma ovarii, carcinoid
•Always unilateral

27. Dysgerminoma
• Ovarian counter part of testicular seminoma
• 2% of all ovarian tumors
• Unilateral
• Malignant tumor
• 75% occurs in 2nd & 3rd decades
• Most of tumors have no endocrine function
• Mutation of OCT 3 , OCT4 ,NANOG & KIT
• Transcription factors – Maintance the pluripotency

28. Risk factors
1. Gonadal dysgenesis
2. Turner syndrome
3. Klienfelter syndrome
4. Androgen insensitivity syndrome

29. Morphology
• Small to large size
• Soft , Elastic
• Capsulated
• Cut section – Solid , Yellow white to gray pink

32. Microscopic
• Large vesicular cells
• Clear cytoplasm
• Well defined cell borders
• Centrally placed regular nuclei
• FRIED EGG APPEARANCE
• Tumor cells arranged in sheets or cords
• Separated by scanty fibrous stroma
• Lymphocytic infiltrates

37. Yolk sac tumor
• Also known as endodermal sinus tumor
• Second most common malignant germ cell tumor
• Derived from malignant germ cells
• That are differentiating along the extraembryonic yolk sac
lineage
• Tumor cell elaborate α - fetoprotein

39. Microscopic
•Characteristic – Glomerulus like structure composed of a
central blood vessel enveloped by tumor cell
Schiller duval body
•Intracellular & extra cellular hyaline droplets are present

41. Choriocarcinoma
•More commonly of placental origin
•Extraembryonic differentiation of malignant germ cell
•Prepuberteal age group
•Almost associated with other germ cell tumors
•Pure Choriocarcinoma extremely rare

42. Morphology
• Identical to the common placental lesion
• Ovarian form more aggressive
• Metastasized to the lungs,liver,bone
• Elaborate high levels of chorionic gonadotrophins
• Differentiate from placental origin
• Ovarian origin unresponsive to chemotherapy & often fatal

44. Microscopy
•Proliferation of Trophoblast
•Extensive areas of hemorrhage