Ovarian Cancer

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Ovarian Cancer

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Ovarian Cancer

  1. 1. Oncological Gynaecopathology Tumors of the ovary Marc van de Vijver
  2. 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. 3. Epithelial tumors • serous • mucinous • endometrioïd • clearcell • transitional cell • undifferentiated • mixed epithelial
  4. 4. For each type of epithelial tumor: • benign • “borderline” • malignant
  5. 5. Case OV1 • Age: 70 years. • Unilateral ovarian tumor, diam. 17 cm.
  6. 6. Differential diagnosis?
  7. 7. Differential diagnosis • Endometrioid adenocarcinoma of the ovary • Metastasis of adenocarcinoma • Mucinous adenocarcinoma
  8. 8. Keratin 7
  9. 9. CEA
  10. 10. Estrogen receptor
  11. 11. Diagnosis • Endometrioid adenocarcinoma, grade 1
  12. 12. Case OV2 • Age: 57 yrs. • Peritoneal metastases; clinically most consistent with primary ovarian carcinoma.
  13. 13. Differential diagnosis?
  14. 14. Differential diagnosis • Clear cell carcinoma
  15. 15. Case OV3 • Age: 66 yrs • Bilateral multicystic ovarian tumors, diam. 12 cm.
  16. 16. Differential diagnosis?
  17. 17. Differential diagnosis • Metastasis of colon carcinoma • Mucinous carcinoma of the ovary • Endometrioid carcinoma of the ovary • Metastasis of adenocarcinoma (other than colon)
  18. 18. Immunohistochemistry • Keratin 7: negative • Keratin 20: positive • CEA: strongly positive • CA125: weakly positive
  19. 19. Diagnosis • Metastasis of colon carcinoma • (patient was known to have had primary colon carcinoma)
  20. 20. Case OV4 • Age: 59 yrs • Debulking for tumor of the peritoneum, consistent with primary ovarian carcinoma
  21. 21. Differential diagnosis?
  22. 22. Differential diagnosis • Endometrioid adenocarcinoma • Endometrioid borderline tumor • Metastasis of adenocarcinoma to the ovary (for example: from primary endometrial carcinoma)
  23. 23. Diagnosis • Endometrioid adenocarcinoma
  24. 24. Case OV5 • Age: 58 yrs • Resection of 10 cm cystic mass of left ovary
  25. 25. Differential diagnosis?
  26. 26. Differential diagnosis • Benign teratoma • Immature teratoma • Carcinoma ex teratoma
  27. 27. Diagnosis • Benign teratoma/dermoid cyst
  28. 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. 29. Case OV6 • Age: 53 yrs. • Left ovary: multicystic tumor, diam. 14 cm.
  30. 30. Differential diagnosis?
  31. 31. Differential diagnosis • Mucinous dissection/disseminated adenomucinosis • Mucinous borderline tumor • Mucinous cystadenoma • Metastasis of adenocarcinoma to the ovary
  32. 32. disseminated peritoneal adenomucinosis originates in the appendix
  33. 33. Diagnosis • disseminated peritoneal adenomucinosis
  34. 34. Case OV7 • Age: 46 yrs • History: – 5 yrs back: ovarian tumor resected • Liver metastasis
  35. 35. Differential diagnosis?
  36. 36. Differential diagnosis • Granulosacell tumor • (Undifferentiated) carcinoma
  37. 37. Diagnosis • Granulosacell tumor
  38. 38. Case OV8 • Age: 44 yrs • History: at age 40 resection of left ovary • Resection cystic tumor of right ovary
  39. 39. Differential diagnosis?
  40. 40. Differential diagnosis • Serous papillary borderline tumor • Serous papillary cystadenoma • Serous papillary adenocarcinoma
  41. 41. Fallopian tube Borderline tumor
  42. 42. Diagnosis • Serous papillary borderline tumor
  43. 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. 44. Case OV9 • Age: 35 yrs • Unilateral, partly cystic tumor right ovary, diameter 7 cm.
  45. 45. Differential diagnosis?
  46. 46. Diifferential diagnosis Tumor type? • Endometrioid • Serous papillary • Mucinous
  47. 47. Endometrioid tumor • Benign • Borderline • Malignant
  48. 48. Diagnosis • Appearance of complex hyperplasia with atypia: • Endometrioid borderline tumor
  49. 49. Endometrioid borderline tumor • Very rare • Often misdiagnosed, mainly as carcinoma! • Outcome: very good (100% survival, no metastases)
  50. 50. Case OV10 • Age: 38 yrs • Unilateral multicystic ovarian tumor • Diameter 14 cm.
  51. 51. Differential diagnosis?
  52. 52. Differential diagnosis • Mucinous cystadenoma • Mucinous borderline tumor • Is the tumor adequately sampled with two sections?
  53. 53. Diagnosis • Mucinous borderline tumor
  54. 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. 55. Case OV11 • Age: 33 yrs • Unilateral solid ovarian tumor • Diameter 7 cm.
  56. 56. Differential diagnosis?
  57. 57. Differential diagnosis • Sertoli-Leydigcell tumor • Metastasis adenocarcinoma
  58. 58. Diagnosis • Sertoli-Leydigcell tumor
  59. 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. 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. 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

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