First gyne - pathology

1. OVARIES

2. Objectives
• Classification of ovarian tumors
• Figo staging
• Precancerous lesions
• Pseudo-neoplastic lesions

3. Ovarian
Tumours

4. Surface epithelial tumors
• Origin
• 1-old theory
• arise from celomic epithelium and then
differentiates along mullerian line
• 2-recent theory
• Arise from the fimbria of the tube
• Clear cell /endometroid arise from
endometriosis

5. Ovarian
Tumours
Transformation of coelomic
epithelium.
It evolves into serous (tubal),
endometrioid (endometrial), and
mucinous (cervical) epithelia.
Manifestations:
Abdominal pain and enlargement.
High serum CA125 is present in
many patients.

6. Each of surface epithelial tumors
• Classified according to biological behaviour
• 1-benign
• Localized to the ovary with no risk of
metastases
• 2-borderline
• Of unknown biological behavior
• The ovarian tumor isn’t invasive or only
microinvasive
• Can remain localized or can send peritoneal
implants and LN metastases

7. • 3-Malignant
• There ovarian tumor is invasive
• Behavior depend on grade and type

8. Serous Tumors
1- Benign
• Serous cystadenoma
• cystadenofibroma
• Bilateral 20% of
cases
• Older women
• Unilocular
• Serous fluid inside
• Tubal –like epithelial
lining

9. Benign Serous Tumors

10. Benign Serous Tumors

11. Benign Serous Tumors

12. Serous Tumor with low potentiel of
malignancy ( Borderline)
• Bilateral in 30 % of cases.
• Papillae
• Epithelial stratification and atypia but no
invasion

13. Borderline Serous Tumors

14. Borderline Serous Tumors

15. Reporting of serous borderline
tumor
• 1-Microinvasion
• 2-lymphovascular invasion
• 3-Surface implants
• 4-peritoneal implants
• 5-LN implants
• 6-stage

16. Peritoneal implants
• 1-non invasive(with better prognosis)
• a-epithelial
• b-desmoplastic
• 2-invasive

17. Serous malignant Tumors
-Solid areas
-Endo-phytic and
ex0-phytic papillae
-Invasion of the stroma
-Low grade (wild type
p53)
-high grade (mutant type
p53)

18. Serous malignant Tumors

19. Serous malignant Tumors

20. Serous malignant Tumors

21. Serous malignant Tumors
Psammoma bodies

22. Serous carcinoma
• Microscopically glands and papillae
• Divided into
• 1-low grade
• 2-high grade
• They are considered 2 different tumors with
different histo-genesis

23. Low grade serous carcinoma
• 1-It arises from serous borderline tumor
• 2-less pleomorphism and mitosis
• 3-No p53 mutation(p53 is wild type)
• 4-indolent course
• 5-Chemoresistant

24. High grade serous carcinoma
• 1-arise from serous tubal intraepithelial
carcinoma
• 2-more pleomorphism and mitosis
• 3-p53 mutation(either diffuse positive or
diffuse negative)
• 4-aggressive course but chemoresponsive

25. Mucinous tumors
• 1-intestinal type(most common)
• 2-endocervical type
• Need to de differentiated from metastatic
tumors from GIT

26. • Features in favor of ovarian primary
• 1-unilateral tumors
• 2-large size more than 10cm
• 3-presence of borderline tumor
• 4-lack of surface nodularity
• 5-lack of pseudomyxoma ovarii

27. • Immunohistochemical markers help in
differentiating ovarian primary from
metastatic
• CK7
• CK20
• SATB2( marker of intestinal origin)

28. Mucinous Tumors
Mucinous Cystadenoma
• Usually unilateral
• Multilocular
• Mucoid material inside
• columnar, mucin secreting cells

29. Mucinous Cystadenoma

30. Mucinous Cystadenoma

31. • Multiple fine papillary processes
containing thin connective tissue cores
• Intestinal or endocervical type
• Celluler stratification
Mucinous Tumors with low potential of
Malignancy ( Borderline)

32. Borderline Mucinous Tumors

33. Malignant Mucinous Tumors
10% of ovarian cancer
20% bilateral

34. Malignant Mucinous Tumors

35. Endometrioid Tumors
Morphological
feature similar to
endometrial
carcinoma.
Associated with
ovarian
endometriosis

36. Clear Cell Carcinoma

37. • Diagnosed by heterogenous
pattern(tubules,cysts,&papillae)
• Sheets of clear to eosinophilic cells
• Hobnail cells

38. Brenner Tumors

39. Benign Brenner
• may be microscopic finding
• nests of transitional epithelium with grooved
nuclei
Borderline Brenner
• papillary structures with atypia without
stromal invasion
Malignant Brenner
• papillae with atypia and invasion

40. Germ Cell Tumors

41. • Dysgerminoma (look exactly like the testicular
seminoma), malignant.
• Teratomas (usually benign in ovary), i.e., “mature”
cystic teratoma or dermoid cyst.
• Monodermal teratoma.
• “Immature” teratomas are regarded as
malignant.
• Endodermal Sinus (Yolk Sac), malignant, Just like
testicular.
• Choriocarcinoma
Germ Cell Tumors

42. All are malignant except Mature cystic
teratoma

43. Dysgerminoma
• Children and young adult women
• 2% of ovarian tumors
• 50% of malignant germ cell tumors

44. Dysgerminoma

45. • Sheets of clear cells and stroma infiltrated by
lymphocytes(most characterstic)

46. Teratoma
• Benign tumor with differentiation along all
three germ cell layers (ectoderm, endoderm,
mesoderm).
• Usually cystic, skin structures “dermoid cyst”
• Sebaceous material, matted hear, teeth, bone…
• Malignant variant has immature tissues.

47. Teratoma

48. Teratoma

49. Teratoma

50. • Immature teratoma
• like mature teratoma but contain foci of
immature neuroepithelial tissue
• Graded according to number of foci of
immature element

51. B=granulosa d=theca interna e=theca externa
Sex-cord/stromal tumors

52. Sex-cord/stromal tumors
• Mainly benign, solid..
• May be functional (secrete hormones)
• Granulosa.
• Thecoma/Fibroma (fibrothecoma)
• Sertoli-Leydig (Androblastoma)
• Mixed differentiation (Gynandroblastoma)

53. Fibroma – thecoma
• 1% of ovarian tumors
• Peri and post menopausal, <10% before 30
years
• Ascitis ( 40%) if > 10cm
• Meig’s syndrome: ascitis +Hydrothorax : 1 %

54. • Adult Granulosa is low grade malignant tumor
with risk for late recurrence
• Jeuvenile granulosa occurs in children and
adloscent, it is an aggressive tumor

55. Sertoli-Leydig cell Tumors:
androblastoma
• 0.2% of ovarian tumors
• Young women
• < 5% before puberty, 10% >45 years
• Virilization, AUB
• Malignant potential

56. • Usually bilateral.
• Transcoelomic, blood,
retrograde lymphatic or
direct spread.
• Site of primaries uterus,
G.I.T, gall bladder, pancreas,
and lung (krukenberg tumor).
Metastatic tumors
krukenberg tumor:
shows signet ring cells
scattered fibrous stroma.
Primary present in G.I.T
mainly stomach (it may mucoid
or not).

57. • 1- Polycystic ovary (stein-
leventhal syndrome):
- Affects young women.
- Bilateral multiple small
cysts lined by cubical and
lipid containing cells.
- Produce androgen and
estrogen leading
oligomendorhea, hirsutism
and infertility.
Non neoplastic cysts of the ovary

58. 2- Follicular cysts:
They are dilatation of atretic follicles.
Bilateral multiple (may be single) filled with clear fluid.
They are lined with granulosa cells. They produce
estrogen.
Non neoplastic cysts of the ovary

59. 3- Corpus luteum cysts:
Dilatation of degenerated corpus luteum.
Usually single, large and filled with blood or serous
fluid. They are surrounded by gramulosa lutein cells.
Non neoplastic cysts of the ovary

60. • 4- Theca lutein cysts:
- Related to the action of HCG
hormone of placenta on atretic
follicles. So, they associate
vesicular mole or choriocarcinoma.
-Bilateral, multiple, large cysts lined
by luteinized theca cells.
• 5- Chocolate cysts:
- Due to ovarian endometriosis.
- Bilateral or unilateral, multiple
small or single large cyst filled with
blood.
Non neoplastic cysts of the ovary