This document provides an overview of diseases of the ovary, including both non-neoplastic and neoplastic lesions. It discusses common non-neoplastic conditions like follicular cysts and polycystic ovarian disease. It also covers the various types of ovarian tumors, including surface epithelial tumors (serous, mucinous, endometrioid), germ cell tumors, and sex cord-stromal tumors. For each type, it describes the gross and microscopic appearance as well as examples of histopathology slides. Metastatic tumors to the ovaries are also briefly discussed.

1. DISEASES OF THE OVARY
By
Dr.Varughese George

2. Learning Objectives
• At the end of this session, you should know
about
• Non-neoplastic lesions of the ovaries.
• Neoplastic lesions of the ovaries.

3. Normal Structure of the Ovary

4. Manifestations of ovarian diseases:
- Pelvic pain
- Menstrual irregularities ( abnormal pattern of ovarian
hormone secretion).
- Infertility; failure of ovulation (Stein-Leventhal).
- Ovarian mass : either non-neoplastic (cysts) or neoplastic
(cystic or solid).
OVARIAN DISEASES

5. • INFLAMMATORY - OOPHORITIS:
- Inflammation of the ovaries is always secondary to
salpingitis or peritonitis.
- If chronic & bilateral leading to extensive fibrosis &
infertility.

6. NON-NEOPLASTIC OVARIAN
CYSTS
Follicular and Luteal cysts: Common, 1-8 cm in
diameter. They are lined by follicular
(granulosa) cells or luteinized cells.
Asymptomatic, but may rupture, causing
peritoneal reaction & pain.
Chocolate cysts: Blood-filled cysts, due to
endometriosis of the ovaries.

7. Polycystic Ovarian Disease(Stein-Leventhal Syndrome)
(PCOD)
It is important cause of infertility. There is excessive production
of androgens, increase conversion of androgens to estrogen,
insulin resistance, and inappropriate gonadotrophin production by
the pituitary.
Morphology: Ovaries are large, white, many subcortical follicular
cysts(0.5-1 cm.) in diameter, and covered by thickened fibrosed
outer tunica. No corpora lutea (= no ovulation).
Manifestations: Young females with Oligomenorrhea, infertility,
obesity & hirsuitism.

9. Ovarian Endometriotic Cyst
Microscopy
• Foci of endometrial glands and
stroma seen.
• Old/New haemorrhages and
haemosiderin-laden
macrophages
• Surrounding zone of
inflammation and fibrosis

15. POLYCYSTIC OVARY

16. OVARIAN TUMORS
- Common forms of neoplasia in women.
- 80-90% of ovarian tumors are benign.
- Most ovarian tumors occur between 20-45 years.
- Ovarian cancer is second MC malignancy of the female genital tract
(after endometrial cancer).
- Most ovarian tumors are derived from surface epithelium, and “CA-
125” is the tumor marker for surface epithelial tumors of the ovary.
- Malignant ovarian tumors present at a late stage, thus are associated
with high mortality rate.
- Known risk factors are nulliparity, family history, and specific
inherited mutations (BRCAI & BRCAII) genes.

17. Tumour types-- a basic classification
Site of origin Types Frequency Age group
Surface epithelial
tumours
1.Serous
2.Mucinous
3.Endometroid
4.Clear cell
5.Brenner
60%-70% 20 years and greater
Germ cell 1.Teratoma
2.Dysgerminoma
3.Endodermal Sinus(Yolk Sac
Tumour)
4.Choriocarcinoma
15%-20% 0 to 25 years and
greater
Sex cord stromal
tumours
1.Granulosa Theca cell
tumours
2.Sertoli-Leydig cell tumours
3.Gynandroblastoma
5%-10% All ages
Miscellaneous 1.Lipid cell tumour
2.Gonadoblastoma
Variable variable
Metastasis Krukenberg tumours 5% variable

18. Serous Ovarian Tumours
GROSS APPEARANCE
• Serous tumours of benign,
borderline and malignant
• type are large and spherical
masses.
• Cut section of benign tumours is
unilocular while larger cysts are
multilocular with daughter loculi
in their walls containing clear
watery fluid.
• Malignant serous tumours have
solid areas in the cystic mass and
may contain exophytic as well as
intracystic papillary
• projections
Papillary serous cystadenoma of the ovary.
Cut surface shows a large unilocular cyst
containing numerous papillary structures
projecting into it (arrow).

24. SEROUS CYSTADENOMA OVARY
MICROSCOPIC APPEARANCE
• The cyst is lined by properly-
oriented low columnar
epithelium.
• The lining cells may be ciliated
and resemble tubal epithelium
Papillary serous cystadenoma of the ovary.
Microscopic features include single layer of
low columnar, at places ciliated, epithelium
lining with pronounced papillary pattern.

25. PAPILLARY SEROUS
CYSTADENOCARCINOMA OVARY
MICROSCOPIC APPEARANCE
• Lining of the cyst is by multilayered
malignant cells having features
such as loss of polarity, presence of
solid sheets of anaplastic epithelial
cells.
• There is definite evidence of
stromal invasion by malignant cells.
• Papillae formations are more
frequent in malignant variety and
may be associated with psammoma
bodies

28. Mucinous Ovarian Tumours
GROSS APPEARANCE
• Mucinous tumours are larger
than serous type.
• They are smooth-surfaced cysts
with characteristic
multiloculations containing thick
and viscid gelatinous fluid.
• Benign tumours have thin wall
and septa which are translucent
while malignant variety has
thickened areas.
Mucinous cystadenoma of the ovary.
Cut surface shows a large,
multiloculated cyst without papillae.
The loculi contain gelatinous material.

29. MUCINOUS CYSTADENOMA OVARY
MICROSCOPIC APPEARANCE
• The cyst is lined by a single layer
of cells having basal nuclei and
apical mucinous vacuoles,
resembling intestinal mucosa.
• There is no invasion or papillae
formation.
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.

31. ENDOMETROID TUMOURS
• 20% of all ovarian tumours.
• Majority are carcinomas, if benign forms are
present they are cyst adenofibromas.
• Distinguished from serous and mucinous
tumours by presence of tubular glands bearing
close resemblance to benign or malignant
endometrial glands.
• 30% associated with carcinoma endometrium
and 15% with endometriosis whereas 40%
involve both ovaries.

32. ENDOMETRIOD CARCINOMA
• Gross: presence of both
solid and cystic areas
• Microscopic: Tubular
glands resemble those of
typical endometrial
adenocarcinoma.

33. CLEAR CELL TUMOUR
These are uncommon and aggressive tumours.
Grossly can present in solid and or cystic pattern (figure
solid tumour with cysts and necrosis)
Microscopically: large epithelial cells with abundant clear
cytoplasm.

34. BRENNER TUMOUR
• Uncommon adenofibromas
• Epithelial components– nests of transitional cells
resembling urinary bladder.
• Most are benign,variable size(1cm to 30 cm).
• Gross—solid or cystic
• Microscopic – fibrous stroma resembling normal
ovarian stroma seperated by sharply demarcated
nests of urinary tract, with mucinous glands.

35. BRENNER TUMOUR
• Gross:A sharply
demarcated, yellow-white
fibromatous tumor
occupies a portion of the
sectioned surface of the
ovary.
Microscopically:Nests of
transitional cells, some
containing cysts, lie in a
fibromatous stroma.

36. GERM CELL TUMORS
- 15-20% of all ovarian tumors. It arises from
totipotent germ cells capable of differentiation into
the three germ layers.
- Mostly benign cystic teratomas while Other
tumours are found principally in children
and young adults.
- Homologous to germ cell tumours in male testis.

37. II. GERM CELL TUMORS:
1- Teratoma
2- Dysgerminoma (seminoma ovarii)
3- Yolk sac tumor= Endodermal sinus tumor
4- Embryonal carcinoma (MC mixed with other
types)
5- Choriocarcinoma (MC mixed with other types)

38. TERATOMAS
Mature
Benign
teratomas
Immature
Malignant
Monodermal
or highly
specialized

39. TERATOMAS
1-Mature (Benign) Teratoma: MC germ cell tumors of the ovary, cystic (dermoid
cysts), lined by skin & hairs, and filled with sebaceous secretion. There may be
mature cartilage, bone (teeth) & other structures. 10-15% are bilateral. < 1%
undergo malignant transformation (MC sq.c.c.).
2-Immature (Malignant) Teratoma: Rare , solid, bulky, with areas of hemorrhage
and necrosis. It contains embryonic elements of the three germ layers. Age:
adolescent & young women. Grading is based on the amount of immature
neuroepithelium. It causes wide spread extraovarian metatases depending on the
degree of the immaturity of the including tissues.
3- Monodermal (Specialized )Teratomas: differentiate along the line of single
tissue.
Examples:- Strauma ovarii is MC (mature thyroid tissue) – Carcinoid tumor.

40. Benign Cystic Teratoma Ovary
GROSS APPEARANCE
• Benign cystic teratoma is
characteristically a unilocular cyst,
10-15 cm in diameter.
• On sectioning, the cyst is filled with
paste-like sebaceous secretions and
desquamated keratin admixed with
masses of hair.
• The cyst wall is thin and opaque
grey-white.
• The cyst wall also shows a solid
prominence where tissue elements
such as tooth, bone, cartilage and
other odd tissues are present
Benign cystic teratoma (dermoid cyst) of
the ovary. Cut surface shows a large
unilocular cyst containing hair, pultaceous
material and bony tissue.

44. Benign Cystic Teratoma Ovary
MICROSCOPIC APPEARANCE
• Viewing a benign cystic teratoma in
different microscopic fields reveals a
variety of mature differentiated tissues,
producing kaleidoscopic appearance.
• Ectodermal derivatives are most
prominent. The lining of the cyst wall is by
stratified squamous epithelium and its
adnexal structures such as sebaceous
glands, sweat glands and hair follicles.
• Tissues of mesodermal and endodermal
origin are commonly present and include
bronchus, intestinal epithelium, cartilage,
bone, smooth muscle, neural tissue,
salivary gland, retina, pancreas and
thyroid tissue

47. DYSGERMINOMA
• GROSS: Small nodules to
very large size.Cut
surface: yellow white to
gray pink appearance
and are soft and fleshy.
• Microscopic:large vesicular
cells, clear cytoplasm and
well defined boundaries and
centrally placed regular
nuclei.cells in sheets or cords
seperated by scant fibrous
stroma, which has mature
lymphocytes.

48. III. SEX CORD-STROMAL TUMORS:
• 1- Granulosa-Theca cell tumor: secrete
estrogen
• 2- Sertoli-Leydig cell tumor: secrete androgens
• 3- Fibroma: associated with Meig’s syndrome
• 4- Sex cord stromal tumor with annual tubules
• 5- Gynandroblastoma
• 6- Steroid (Lipid)cell tumors

49. METASTATIC TUMOR
- Very common,
- The primary tumors is from abdominal and breast
tumors.
A bilateral metastatic ovarian carcinoma, composed of
mucin-producing signet ring cells, metastasizing from
GIT, mostly from the stomach, it may produce
pseudomyxoma peritonei like well differentiated
appendicial tumors.
Krukenberg tumor

51. HISTOPATHOLOGY OF KRUKENBERG TUMOR
Numerous signet ring cells are present in a highly fibrous stroma, either
individually or in small nests.