DR. ROOPAM JAIN, Professor & Head, Department of Pathology & Blood Bank

1. OVARIAN
TUMOURS
DR. ROOPAM JAIN
PROFESSOR & HEAD, PATHOLOGY

2. OVARIAN TUMOURS
• The ovary is 2nd most common site of primary malignancy in the
female genital tract
• Both benign and malignant tumours occur in the ovaries.

3. OVARIAN TUMOURS
ETIOPATHOGENESIS
• 1. Nulliparity - There is higher incidence of ovarian cancer in
unmarried women and married women with low or no parity.
• 2. Heredity - Women with hereditary breast-ovarian cancer
susceptibility have mutation in tumour suppressor BRCA genes—BRCA-1
(located on chromosome 17q) and BRCA-2 (chromosome 13q)
• 3. Complex genetic syndromes - several complex genetic syndromes
are associated with ovarian tumours:
• i) Lynch syndrome associated with increased risk of ovarian cancer
• ii) Peutz-Jeghers syndrome with ovarian sex cord-stromal tumours.
• iii) Gonadal dysgenesis with gonadoblastoma.
• iv) Nevoid basal cell carcinoma with ovarian fi bromas.

4. Classification of ovarian tumours
• Five major groups have been described:
• I. Tumours of surface epithelium (common epithelial tumours)
• II. Germ cell tumours
• III. Sex cord-stromal tumours
• IV. Miscellaneous tumours
• V. Metastatic tumours

5. OVARIAN TUMOURS
CLINICAL FEATURES
• Most benign and malignant ovarian tumours are discovered when they
grow sufficiently to cause abdominal discomfort and distension.
• Urinary tract and gastrointestinal tract symptoms are frequently
associated due to compression by the tumour.
• Ascites is common in both benign and malignant ovarian tumours.
• Menstrual irregularities may or may not be present.
• Some ovarian tumours are bilateral.
• Malignant tumours usually spread beyond the ovary to other sites before
the diagnosis is made.

6. Diagrammatic representation of general histologic criteria
to distinguish benign, borderline (atypical proliferating) &
malignant surface epithelial tumours of the ovary

7. Serous Tumours
• Serous tumours comprise the largest group constituting about 50% of all
surface ovarian tumours and 40% of malignant ovarian tumours.
• called serous tumours because of the presence of clear, watery, serous
fluid in these predominantly cystic tumours.
• About 60% of serous tumours are benign, 15% borderline and 25%
malig nant.
• Only 20% of benign tumours occur bilaterally
• Serous tumours occur most commonly in 2nd to 5th decades of life, the
malignant forms being more frequent in later life.

9. MORPHOLOGIC FEATURES
Grossly
• benign, borderline and malignant serous tumours are large (above 5
cm in diameter) and spherical masses.
• Malignant serous tumours may havesolid areas in the cystic mass.
• Exophytic as well as intracystic papillary projections may be present in
malignant tumours termed papil lary serous cystadeno carcinomas

10. MORPHOLOGIC FEATURES
Histologically
• 1. Serous cystadenoma - is characteristically lined by properly-
oriented low columnar epithelium
• 2. Borderline (atypical proliferating) serous tumour - usually has
stratification (2-3 layers) of benign serous type of epithelium.
• 3. Serous cystadenocarcinoma has multilayered malignant cells
which show loss of polarity, presence of solid sheets of anaplastic
epithelial cells and defi nite evidence of stromal invasion.

11. Papillary serous cystadenocarcinoma of the ovary
Microscopic features include stratification of low columnar epithelium lining
the inner surface of the cyst and a few psammoma bodies.
The stroma shows invasion by clusters of anaplastic tumour cells

12. Mucinous Tumours
• less common than serous tumours and constitute about 30% of all
ovarian tumours.
• Over 80% are benign, 10-15% are borderline (atypical proliferating) and
5% are malignant.
• These predominantly cystic tumours contain mucin.
• In mucinous tumours associated with mucinous ascites (i.e.
pseudomyxoma peritonei)
• Mucinous tumours occur principally between 2nd and 5th decades of life.
• Mucinous cystadenocarcinoma usually develops in women above the age
of 40 years.

13. Mucinous Tumours MORPHOLOGIC
FEATURES Grossly
• mucinous tumours are much larger than serous tumours.
• They are smooth-surfaced cysts with characteristic multiloculations
containing thick and viscid gelatinous fluid (Fig.

14. Mucinous Tumours

15. Mucinous Tumours MORPHOLOGIC
FEATURES Histologically
• 1. Mucinous cystadenoma
• 2. Borderline (atypical proliferating) mucinous tumour
• 3. Mucinous cystadenocarcinoma

16. Mucinous Tumours
Mucinous cystadenoma of the ovary.
The cyst wall and the septa are lined by a single layer of tall columnar
mucin-secreting epithelium with basally-placed nuclei and large apical
mucinous vacuoles

17. Brenner Tumour
• Brenner tumours are uncommon and comprise about 2% of all ovarian
tumours.
• Th ey are characteristically solid ovarian tumours.
• Less than 10% of Brenner tumours are bilateral.
• Most Brenner tumours are benign.

18. II. GERM CELL TUMOURS
• Ovarian germ cell tumours arising from germ cells which produce the
female gametes (i.e. ova) account for about 15- 20% of all ovarian
neoplasms.
• The neoplastic germ cells may follow one of the several lines of
differentiation as shown in Fig.
• Nearly 95% of them are benign and occur chiefly in young females,
• vast majority of them being benign cystic teratomas (dermoid cysts).

19. Teratomas
• Teratomas are tumours composed of different types of tissues derived
from the three germ cell layers—ecto derm, mesoderm and endoderm,
in varying combinations.
• Teratomas are divided into 3 types:
• mature (benign),
• immature (malignant),
• and monodermal or highly specialised teratomas

20. MATURE (BENIGN) TERATOMA
• Vast majority of ovarian teratomas are benign and cystic and have
the predominant ectodermal elements, often termed clinically as
dermoid cyst.

21. Grossly,
• benign cystic teratoma or dermoid cyst is characteristically a unilo
cular cyst,
• 10-15 cm in diameter,
• usually lined by the skin and hence its name.
• On sectioning, the cyst is filled with paste-like sebaceous secretions
and desquamated keratin admixed with masses of hair.

23. Microscopically,
• the most prominent feature is the lining of the cyst wall by stratified
squamous epithelium and its adnexal structures such as sebaceous
glands, sweat glands and hair follicles (Fig).
• Though ectodermal derivatives are most prominent features, tissues of
mesodermal and endodermal origin are also commonly present.
• Various other tissue components frequently found in teratomas are
bronchus, intestinal epithelium, cartilage, bone, tooth, smooth muscle,
neural tissue, salivary gland, retina, pancreas and thyroid tissue.

24. Benign cystic teratoma.
Microscopy shows characteristic lining of the cyst wall by epidermis
and its appendages. Islands of mature cartilage are also seen.

25. Dysgerminoma
• Dysgerminoma is an ovarian counterpart of seminoma of the testes.
• Dysgerminomas comprise about 2% of all ovarian cancers.
• They occur most commonly in 2nd to 3rd decades.
• About 10% of them are bilateral.
• About 10% of patients with dysgerminoma have elevated hCG level in
the plasma.
• All dysgerminomas are malignant and are extremely radiosensitive.

26. MORPHOLOGIC FEATURES Grossly,
• dysgerminoma is a solid mass of variable size.
• Cut section of the tumour is grey-white to pink, lobulated, soft and
fleshy with foci of haemorrhages and necrosis.

27. Dysgerminoma.
The histologic appearance is identical to that of seminoma of the testis.
Masses of large uniform tumour cells are separated by scanty fibrous stroma that
is infiltrated by lymphocytes

28. Choriocarcinoma
• Choriocarcinoma in females is of 2 types—gestational & nongestational.
• Gestational choriocarcinoma of placental origin is more common

29. GRANULOSA CELL TUMOUR
• Pure granulosa cell tumours may occur at all ages.
• These tumours invade locally but occasionally may have more
aggressive and malignant behaviour.
• Recurrences after surgical removal are common.

30. Morphologic appearance
• Grossly, granulosa cell tumour is a small, solid, partly cystic and usually
unilateral tumour.
• Cut section of solid areas is yellowish-brown
• Microscopically, the granulosa cells are arranged in a variety of
patterns including micro- and macro follicular, trabecular, bands and
diffuse sheets.
• The micro follicular pattern is characterised by the presence of
characteristic rosettelike structures, Call-Exner bodies, having central
rounded pink mass surrounded by a circular row of granulosa cells (Fig.

31. Granulosa cell tumour showing uniform granulosa cells and
numerous rosette-like Call-Exner bodies containing central
amorphous pink material surrounded by granulosa cells.

32. THECOMA
• Pure thecomas are almost always benign.
• They occur more frequently in postmenopausal women.
• Thecomas are typically oestrogenic.
• Occasionally a thecoma may secrete androgen and cause virilisation

33. Sertoli-Leydig Cell Tumours
(Androblastoma, Arrhenoblastoma)
• Tumours containing Sertoli and Leydig cells in varying degree of
maturation comprise Sertoli-Leydig cell tumours, also called
androblastomas or arrhenoblastomas.
• Characteristically, they produce androgens and masculinise the patient.
• may elaborate oestrogen.
• Their peak incidence is in 2nd to 3rd decades of life

34. Gynandroblastoma
• Gynandroblastoma is an extremely rare tumour in which there is
combination of patterns of both granulosa-theca cell tumour and
Sertoli-Leydig cell tumour.
• The term gynandroblastoma stands for combination of female (gyn) and
male (andro).

35. METASTATIC TUMOURS
• About 10% of ovarian cancers are secondary carcinomas.
• Metastasis may occur by lymphatic or haemato genous route but direct
extension from adjacent organs (e.g. uterus, fallopian tube and sigmoid
colon) too occurs frequently.
• Bilaterality of the tumour is the most helpful clue to diagnosis of
metastatic tumour.
• Most common primary sites from where metastases to the ovaries are
encountered are: carcinomas of the breast, genital tract, GIT (e.g.
stomach, colon appendix, pancreas, biliary tract) and haematopoietic
malignancies

36. Krukenberg Tumour
• Krukenberg tumour is a distinctive bilateral tumour meta static to the
ovaries by transcoelomic spread.
• The tumour is generally secondary to a gastric carcinoma but other
primary sites where signet ring carcinomas occur (e.g. colon, appendix
and breast) may also pro duce Krukenberg tumour in the ovary

37. Grossly,
• Krukenberg tumour forms moderately large, rounded or kidney-shaped,
firm, multinodular masses in both ovaries.
• Cut section shows grey-white to yellow, firm, f eshy tumour and may
have areas of haemorrhage and necrosis (Fig

38. Krukenberg tumour
showing characteristic bilateral metastatic ovarian
cancer (arrow) having fi rm white appearance.

39. Microscopically,
• it is characterised by the presence of mucinfilled signet ring cells
which may lie singly or in clusters.
• It is accompanied by cellular proliferation of ovarian stroma in a
storiform pattern (Fig.

40. Krukenberg tumour
Histologic features include mucin-filled signet-ring cells
and richly cellular proliferation of the ovarian stroma.