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.
BRENNER TUMORS► usuallybenign.occur in reproductive life► They can be malignant.► May be associated with endometrial hyperplasia► May coexist with mucinous cystadenoma
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.
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%
Malignant Germ cell tumors► Rare.3% of ovarian cancers► Teratoma: peak incidence in second decade► Malignant teratoma► Immature teratoma
► Dysgerminoma► Most common. Highly malignant► Usually spread by lymphatics► Very radiosensitive► Occur in young women.► May arise in gonadal dysgenesis
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
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
Complication of ovarian tumors► Torsion- common with dermoid/fibroma- Severe abdominal pain/vomitting► Rupture► Haemorrhage► Impaction► infection
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
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
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 residual tumors► Staging once histology is available► If confined to ovary and young age… conservative surgery
Palliative surgery► Removal of intestinal obstruction► Survival is very poor► Quality of life considerations