This document provides information on ovarian cancer. It discusses that ovarian cancer is the most lethal gynecological malignancy, with 60% of patients presenting with advanced-stage disease and a 5-year survival rate of 38%. It then covers risk factors, symptoms, different types of ovarian tumors including epithelial tumors, germ cell tumors and sex cord-stromal tumors, staging of ovarian cancer, and assessment and treatment of the disease. Fallopian tube cancer and primary peritoneal cancer are also discussed as cancers that are closely related to ovarian cancer.

1. OVARIAN CANCER
Dr Sai Lakshmi Daayana
MBBS, MRCOG, MD (University of Manchester,
UK), Sub-specialty training in Gynaecological
Oncology (UK)
Consultant in Gynaecological Oncology
Apollo InsJtutes of Cancer
Hyderabad
Tel: 0091 7337554400

2. IntroducJon
• It is the most lethal gynecological malignancy
• 60% of paJents present with advanced-stage disease
• The overall survival rate is 38% at 5 years
In India, ovarian cancer is the third leading site of cancer
among women, trailing behind cervix and breast cancer. The
age-adjusted incidence rates of ovarian cancer vary between
5.4 and 8.0 per 100,000 populaCon in different parts of the
country.

3. Who develops Ovarian
Adenocarcinoma?
• 15% Gene(c Suscep(bility known gene(c
suscep(bility
• BRCA 1 / 2, HNPCC
• LifeJme risk up to 50% of developing Ovarian Cancer
• 85% spontaneous soma/c
muta/on
• LifeCme risk < 2% of developing Ovarian Cancer

4. Symptoms
• BloaJng
• Pelvic or abdominal pain
• Difficulty eaJng or feeling full quickly
• Urgency or urinary frequency
• Most common is abdominal enlargement

5. Symptoms
Other symptoms commonly reported
• FaJgue
• IndigesJon
• Back pain
• Pain with intercourse
• ConsJpaJon
• Menstrual irregulariJes

6. Risk Factors
• GeneJc predisposiJon
– Family history is strongest risk
• Breast-ovarian cancer syndrome
• Lynch II syndrome
– Cancer of colon, breast, endometrium and HNPCC

7. Majority of ovarian cancers are due to sporadic
mutaJons

8. Risk Factor (cont’d)
• Breast-ovarian syndrome
– Germline mutaJon in one of the breast cancer
suscepJbility genes BRCA or BRCA2
– Prevalence
• General populaJon is 1 in 300
• Ashkenazi Jewish is 2 in 100

9. Risk Factors (cont’d)
• Decrease risk:
– Pregnancy
– OCP
– Breast feeding
– Tubal ligaJon
– Hysterectomy
• Increase risk:
– InferJlity
– Endometriosis
– Peri or post
menopausal
history of
medicaJons

10. Different Types of Epithelial Ovarian Cancer by Histology

12. Ovarian Cystic Masses
USS features suggestive of malignancy:
– Irregular borders
– Internal septations
– Bilateral cysts
– Papillary projections
– Solid elements
– Ascites
– Other pelvic pathology e.g. lymphadenopathy

13. Ovarian CysJc Masses
Common benign cysts
Functional cysts (resolve spontaneously in 4-6
weeks)
Endometriomas (‘chocolate cysts’, often bilateral,
tender, immobile adnexae on VE)
Rare benign cysts
Theca-lutein cysts (overstimulation of ovaries by
excessive levels of hCG, seen in complete molar
pregnancies, usually bilateral)

14. Types of Ovarian Tumours
• Classified according to their cell of
origin:
Germ Cell
Tumours
Derived from primitive
germ cells of the embryonic
gonad
• Dysgerminoma
• Endodermal Sinus tumour
• Mature/Immature teratoma
Sex Cord Stromal
Tumours
Gonadal/stromal origin
• Granulosa cell tumours
• Sertoli-Leydig tumours
Epithelial Tumours
Derived from coelomic
epithelium
• Serous
• Mucinous
• Endometrioid
• Clear Cell
• Brenner

15. Epithelial Ovarian
Tumours (derived
from coelomic
epithelium)
Germ Cell Tumours
(primi(ve germ cells
of the embryonic
gonad)
Sex-Cord Stromal
Tumours
( gonadal /
stromal origin)
• Serous
• Mucinous
• Endometriod
• Clear cell
• Brenner
• Dysgerminoma
• Endodermal
sinus tumour
• Immature &
mature
teratoma
• Granulosa
cell tumour
• Sertoli-
Leydig cell
tumour

17. Epithelial Tumours (1)
• 60% of all & 90% of malignant ovarian tumours
• Cells retain their embryonic potential for
Mullerian differentiation
– Mucinous tumour (cyst wall lined by tall mucin-
secreting columnar cells like endocervix)
– Serous tumour (epithelium identical to fallopian
tube)
– Endometrioid or Clear Cell tumour (histologically
identical to endometrial adenocarcinoma)
• or Wolffian differentiation
– Brenner tumour (transitional-type epithelium)

18. Epithelial Tumours (2)
• Malignant epithelial tumours are the commonest fatal
tumours of the reproductive system
• Form pelvic masses that present late, infiltrate locally
but rarely metastasize to extra-abdominal sites
• 5 year survival rate of 30%
• Reducing mortality from ovarian cancer
– Improvement in chemotherapy
– Detection of early stage disease with screening

19. Epithelial Tumours (3)
• Borderline tumours
– Resemble benign forms macroscopically
– Microscopically show multilayering, irregular
budding, cellular atypia & mitotic activity without any
evidence of stromal invasion
• Behave benignly in the majority of patients
• Occasionally pursue an indolently malignant
course over 10 years or more

20. Epithelial Tumours (4)
• Aetiology unknown
• Majority cases are sporadic, 10-15% familial
(BRCA1 & BRCA2)
• Recurrent ovulation theory
• Exposure to exogenous ascending material
from lower genital tract
• COCP, multiparity, breast feeding & chronic
anovulation protective

21. Sex Cord Stromal Tumours
• Granulosa Cell tumours
– Most common (70%), usually unilateral (95%)
– Characterised histologically by Call-Exner bodies
– Secrete oestrogens (& inhibin = tumour marker)
• Precocious puberty in young girls (5% of cases)
• Menorrhagia or post menopausal bleeding in older women
• Can cause 2ry endometrial hyperplasia (25-50%) or adenocarcinoma
(5% of cases)
– Low grade malignancy (esp. in younger patients), can recur
after many years
• Sertoli-Leydig tumours
– Rare, usually benign
– Secrete androgens and may present with signs of virilisation
(oligomenorrhoea, breast atrophy, acne, hirsuitism, clitoromegaly, frontal
balding, deepening of voice)

22. Germ Cell Tumours (1)
• Dysgerminomas
– Most common type (50%), median age 17 yrs
– Unilateral tumours in 85%
– Lactate dehydrogenase & placental alkaline
phosphatase may be useful tumour markers
– Histologically identical to seminoma of testis
– Metastasizes early to para-aortic nodes
– Radiosensitive so overall 5yr survival rate 95%
• Endodermal Sinus Tumours
– Second most common type, median age 19 yrs
– AFP may be elevated

23. Germ Cell Tumours (2)
• Teratomas
– Mature cystic teratoma (dermoid cyst)
• Account for 15-20% all ovarian tumours
• Usually benign
• Contain elements from all 3 germ cell layers (endoderm,
mesoderm & ectoderm), e.g. hairs, cartilage, bone, teeth,
thyroid tissue, gastrointestinal, respiratory & neural tissue
• Malignant change occurs in 1%, usually in the form of
squamous cell carcinoma
– Immature teratoma
• Malignant tumours occurring in children & young adults
• AFP can be useful tumour marker
• Chemotherapy is mainstay of treatment

24. Other Ovarian Tumours
• Fibroma
– Meigs’ Syndrome (ascites & pleural effusion which
resolve after removal of the fibroma)
• Metastatic Tumours
– 7% of all ovarian malignancies
– Commonly from uterus, breast or GI tract
– Krukenberg tumour
• trans-coelomic spread of gastric adenocarcinoma
(majority) or adenocarcinoma of colon, appendix or breast
• characterised histologically by stromal mucin containing
‘signet-ring’ cells
• 80% bilateral, resemble fibroma or solid ovarian tumour
on macroscopic examination

25. Primary Peritoneal Tumour
• Accounts for up to 15% of ‘typical’ epithelial ovarian
cancer
• Clinical features
– Advanced intra-abdominal cancer on CT/MR scan with
ascites but no pelvic mass
– Can occur in oophorectomised women
– May develop in germline BRCA1 mutation carriers despite
prophylactic surgery
• Histology
– Indistinguishable from papillary serous ovarian cancer
– Normal sized ovaries
– Predominant extra-ovarian disease

26. Assessment of the Disease
• Symptoms / Physical Exam / Tumor Marker
• Imaging (CT scan)
• Laparoscopic Assessment

27. FIGO Staging of Ovarian Cancer
I Limited to ovaries
Ia One ovary
Ib Both ovaries
Ic Stage Ia or Ib + ascites, tumour on ovarian surfaces or
ruptured capsule
II Pelvic extension
IIa To uterus or tubes
IIb To other pelvic tissues
IIc IIa or IIb + ascites or +ve peritoneal washings
III Peritoneal implants or +ve retroperitoneal LNs
IIIa Microscopic seedlings on peritoneal surfaces, -ve LNs
IIIb Tumour implants each <2cm diameter, -ve LNs
IIIc Tumour implants >2cm or +ve LNs
IV Distant metastases
If pleural effusion, must have +ve cytology

28. Stages of Ovarian Cancer

29. What is Primary Peritoneal Cancer
(PPC)?
Primary peritoneal cancer (PPC) is a rare cancer
of the peritoneum. It is very similar to the most
common type of ovarian cancer called epithelial
ovarian cancer. This is because the peritoneum
and ovary have the same embryological origin.

30. It is important for women to know that it is possible to have
primary peritoneal cancer even if a woman’s ovaries have
been removed.
PPC can occur anywhere in the abdominal cavity and affect
the surface of any organ contained within it. It differs from
ovarian cancer because the ovaries in PPC are usually only
minimally affected with cancer.
Primary Peritoneal Cancer

31. Fallopian Tube Cancer (FTC)
Cancers of the fallopian tube are also relaCvely rare and very
closely related to cancers of the ovary and PPC. They share
many commonaliJes and emerging data is even suggesJng
that many of the previously felt to be ovarian cancers may
indeed have been FTC.
CLASSIC SYMPTOM:
As the fallopian tube swells with cancer, it produces fluid,
similar to ascites, that can “leak” back into the uterus and
lead to a watery vaginal discharge, the classic presentaCon of
FTC when associated with an adnexal mass.

32. Ovarian Epithelial, Fallopian Tube, and Primary
Peritoneal Cancer
Regardless of the site of origin, the hallmark of these cancers
is their early peritoneal spread of metastases.
The inclusion of FTC and PPC within the ovarian epithelial
cancer designaJon is generally accepted on the basis of a
common Müllerian epithelium derivaJon and similar
management of these three neoplasms.

33. Mucinous carcinoma
MC rarely bilateral
Usually present as Stage Ia
Grade 1 or 2 treated by surgical resection and no
adjuvant chemotherapy
Recurrent or metastatic MC associated with poor
prognosis
Unusual sites for mets (lung/bone)
Mucinous carcinoma (show reduced mucin cf
borderline mucinous tumours)
Most of “intestinal type”
“endocervical (Mullarian type)” rare

34. Distinction between primary ovarian
carcinoma and metastases to the ovary (1)
Feature Primary Metastatic
Laterality Unilateral Bilateral
Size Max diameter > 12 cm Max diameter < 10 cm
Extensive intra-
abdominal spread
Unlikely More likely
Multinodular growth
pattern with intervening
normal parenchyma
Not usual Characteristic
Surface involvement Not usual (other than
background
endometriosis)
Characteristic
Hilar involvement Absent/not typical Typical
Extensive vascular
invasion
Not usual Favours metastasis
Singh, N; 2014

35. Distinction between primary ovarian
carcinoma and metastases to the ovary (2)
Feature Primary Metastatic
Patterns specifically
favouring primary or
metastatic carcinoma
Associated benign,
borderline and malignant
appearing areas
Beware phenomenon of
“maturation of ovarian
metastases – may result
in similar gradation of
features
Complex papillary
architecture
Signet ring carcinoma
Association with
background changes
such as endometriosis,
Brenner tumour, mature
cystic teratoma, Sertoli-
Leydig cell tumour,
adenofibroma
Pseudomyxoma
peritoneii or ovarii;
Colloid carcinoma;
Infiltrative pattern of
small glands with
desmoplastic reaction;
Single cell infiltrate
Singh, N; 2014

36. Difference between Ovarian and
PPC
Advanced Ovarian and PPC mimic each other.
However, if there is peritoneal involvement and the
ovaries are measuring less than 5cm each, it is
defined as PPC and not ovarian cancer.

37. Ovarian Cancer

38. How do we treat Ovarian Cancer?
• Current Approach -- Surgery and Chemotherapy
• Primary Tumor Reduc/ve Surgery (PDS)
– Surgery à Chemotherapy
• Neoadjuvant Chemotherapy (NACT)
– Chemotherapy àSurgery àChemotherapy
• Goal of Surgery àremove all visible disease
• Goal of Chemotherapy àkill all cancer cells

39. Ovarian Cancer
Most likely borderline. Malignant tumours do not usually get to
this size without extensive metastasis.

40. Preoperative Imaging – Infiltration of the
Falciform Ligament
Tumour
in
fissure

41. Preoperative Imaging – Small
Bowel Involvment
Serosal
Involvement
Mesenteric
Infiltration

42. Preoperative Imaging – Infiltration
of Porta hepatis
Porta
Infiltration

43. Preoperative Imaging – Extra –
Abdominal Disease
Pericardial
Infiltration

44. Diffuse carcinomatosis infiltrating
the SB mesentery

45. Opera(ve assessment – The role of
laparoscopy in advanced ovarian cancer
• Avoids unnecessary
laparotomy in cases more
suitable for neoadjuvant
chemotherapy
• Neo-adjuvant
chemotherapy followed by
debulking surgery is a valid
opJon
Unresectable disease with
bowel serosal involvement

46. AnJcipated “Radicalness” of the Surgery
• Procedures may include:
• ResecJon of Pelvic tumor including uterus
ovaries and fallopian tubes,
• omentectomy
• selecJve lymph node removal,
• bowel resecJon,
• removal of peritoneal implants, including
diaphragm,
• splenectomy, appendectomy

47. Neoadjuvant Chemotherapy (NACT)
– Chemotherapy given before surgery (usually 3
cycles)
– NACT not inferior to Primary Tumor ReducJve
Surgery
– NACT significantly improved the completeness of
surgery with less residual disease at Jme of surgery
– Less post-operaJve morbidity and mortality with
NACT
– Increased rate of Blood Transfusions

48. OpJmal cyto-reducJon – Ovarian cancer
Defined as:
þ No visible disease at the end of surgery – 2014 (GOG
104, 172)
Largest residual tumor nodule measuring 1 cm or less – 2008
Largest residual tumor nodule measuring 1.5 cm or less -
1975

49. Advanced ovarian cancer – ≥Stage 3c
Neo-adjuvant chemotherapy
Interval debulking surgery
Primary surgery
Adjuvant chemotherapy
§ EORTC
§ CHORUS
2 important trials
show equal survival
and reduced
morbidity in neo-
adjuvant chemo
§ Standard surgery
§ Radical surgery
§ Ultra radical surgery

50. Women who benefit most from Neo-
Adjuvant ChemoTherapy
• Extensive Stage IIIC that is too extensive for opJmal
surgical resecJon by imaging or laparoscopic scoring
– Stage IV disease (Complete ResecJon <10%)
– Performance status too poor to undergo aqempt at
major surgery, parJcularly extensive surgery
– No access to experience Gynecologic Oncology
surgical team

51. Standard of Care (SOC) Chemotherapy
CarboplaJn
Taxol (Paclitaxel)
• Intravenous
• Every 3 weeks (before surgery and / or start within 6 weeks
arer surgery)
• for 6 treatments (@ 18 weeks)
• Well tolerated
– (nausea, bone marrow suppression, hair loss,
peripheral neuropathy, faJgue)

52. Recurrent Ovarian Cancer is a Chronic Disease Process
• For most women who are diagnosed with
ovarian cancer, the cancer will recur and the
cancer becomes a chronic disease.
– Over 70% of all women diagnosed with ovarian cancer
will have recurrent disease.
• Good news is that women are living longer with beSer
quality of life with recurrent ovarian cancer.
– Beqer control of the cancer with newer treatment
opJons

53. Treatment of Recurrent Cancer
• Timing of Recurrence
• PlaJnum Resistance vs PlaJnum SensiJvity
• Prior Chemotherapy Treatments
• Goal is Quality of Life and Longevity
• Treatment OpJons
• Chemotherapy
• Surgery (selecJve cases)
• New Treatment OpJons such as biologic therapies

54. DefiniJons of Disease State
• Cure (completely eradicate all cancer cells)
• Recurrent Ovarian Cancer
– Asymptoma(c
– Biochemical
– Measurable Disease
• Arer Treatment
» Complete Response
» ParJal Response
» Stable Disease
» Progression

55. DefiniCon of Longevity
• Overall Survival
• Time from diagnosis to death
• Progression Free Interval/ Survival
– Interval between Treatment Response to Evidence of
Progression
• How is Progression defined?
– Biochemical - CA125
– Imaging -- CT / PET
– Physical Exam
– Increased Symptoms

56. Strong evidence points
to fallopian tube
origins of high-grade
serous ovarian cancers

57. Risk-reducing salpingectomy as a new and safe
strategy to prevent ovarian cancer
Indica(ons:
• BRCA1/2 carriers
• Women with strong family h/o breast and ovarian cancers
• Women undergoing hysterectomy with ovarian
conservaJon for benign causes or sterilisaJon procedure

58. In high-risk women: “this raises the possibility
of altering the risk-reducing surgery approach,
specifically, by removing the fallopian tubes
first, while a woman is sCll premenopausal, and
then removing the ovaries at the Cme of onset
of menopause”.

59. Ovarian Cancer Screening
It is premature to recommend screening for
early detecCon of ovarian cancer. Despite this
high-powered study (UKCTOCS), there is no
strong scienCfic foundaCon for ovarian cancer
screening.

60. 54 yr old woman presents to her GP with reduced appeJte,
increased saJety, crampy abdominal pain. She was diagnosed a
year ago with IBS. Serum ca125 is 62 IU/ml. What is the most
appropriate management?
1. Colonoscopy
2. CT scan
3. USS of abdomen and pelvis
4. Trail of mebeverine and lifestyle modificaJon
5. Urgent referral to gynaecology clinic as suspected cancer
6. Pelvic USS and pipelle biopsy

61. 54 yr old woman presents to her GP with reduced appeJte,
increased saJety, crampy abdominal pain. She was diagnosed a
year ago with IBS. Serum ca125 is 62 IU/ml. What is the most
appropriate management?
1. Colonoscopy
2. CT scan
3. USS of abdomen and pelvis
4. Trail of mebeverine and lifestyle modificaJon
5. Urgent referral to gynaecology clinic as suspected cancer
6. Pelvic USS and pipelle biopsy

62. 62 yr old presents with SOB. She is found to be having a large
ler pleural effusive and a large volume ascites. Ascites shows
high protein content. What is the most likely diagnosis?
1. CCF
2. Ovarian malignancy
3. Cervical cancer
4. Meigs syndrome
5. Cirrhosis of liver

63. 62 yr old presents with SOB. She is found to be having a large
ler pleural effusive and a large volume ascites. Ascites shows
high protein content. What is the most likely diagnosis?
1. CCF
2. Ovarian malignancy
3. Cervical cancer
4. Meigs syndrome
5. Cirrhosis of liver

64. 63 yr old lady presents with an abdominal mass and
weight loss, diagnosed with ovarian tumour. The most
common ovarian tumour in this woman would be:
1. Epithelial tumour
2. Stromal tumour
3. Germ call tumur
4. Sex cord tumour
5. TrophoblasJc tumour

65. 63 yr old lady presents with an abdominal mass and
weight loss, diagnosed with ovarian tumour. The most
common ovarian tumour in this woman would be:
1. Epithelial tumour
2. Stromal tumour
3. Germ call tumur
4. Sex cord tumour
5. TrophoblasJc tumour

66. • A 66 year old women underwent a staging laparotomy, TAH, BSO and
omentectomy for ovarian cancer. What is the most likely diagnosis?
Click Here For
Answer
Serous cystadenocarcinoma
Endometrioid adenocarcinoma
Mucinous cystadenocarcinoma
Clear cell cystadenocarcinoma
Transitional cell carcinoma

67. • A 66 year old women underwent a staging laparotomy, TAH, BSO and
omentectomy for ovarian cancer. What is the most likely diagnosis?
Click Here For
Answer
Serous cystadenocarcinoma
Endometrioid adenocarcinoma
Mucinous cystadenocarcinoma
Clear cell cystadenocarcinoma
Transitional cell carcinoma

68. • A 66 year old women underwent a staging laparotomy, TAH, BSO and
omentectomy for ovarian cancer. What is the most important risk
factor for the development of ovarian cancer?
Click Here For
Answer
Infertility
Oestrogen replacement therapy
Diet / obesity
Family history
Talcum powder (perineal application)

69. • A 66 year old women underwent a staging laparotomy, TAH, BSO and
omentectomy for ovarian cancer. What is the most important risk
factor for the development of ovarian cancer?
Click Here For
Answer
Infertility
Oestrogen replacement therapy
Diet / obesity
Family history
Talcum powder (perineal application)

70. • A 42 year old accountant underwent a staging laparotomy, TAH, BSO
and omentectomy for a poorly-differentiated serous
cystadenocarcinoma. The operation note stated that “optimal”
cytoreduction was obtained. The accepted definition of “optimal”
encompasses patients in whom there remain no tumour nodules
greater than:
Click Here For
Answer
1.5cm in diameter
0.2cm in diameter
0.5cm in diameter
0.7cm in diameter
1.0cm in diameter

71. • A 42 year old accountant underwent a staging laparotomy, TAH, BSO
and omentectomy for a poorly-differentiated serous
cystadenocarcinoma. The operation note stated that “optimal”
cytoreduction was obtained. The accepted definition of “optimal”
encompasses patients in whom there remain no tumour nodules
greater than:
Click Here For
Answer
1.5cm in diameter
0.2cm in diameter
0.5cm in diameter
0.7cm in diameter
1.0cm in diameter

72. • A 40 year old woman underwent a staging laparotomy, TAH, BSO and
omentectomy for stage IIIB clear cell carcinoma of the ovary. What is
the most appropriate management?
Click Here For
Answer
Observation with serial Ca125
Adjuvant chemotherapy with 6 cycles of carboplatin
Adjuvant chemotherapy with 8 cycles of carboplatin
Adjuvant chemotherapy with 6 cycles of carboplatin / paclitaxel
Adjuvant chemotherapy with 8 cycles of carboplatin / paclitaxel

73. • A 40 year old woman underwent a staging laparotomy, TAH, BSO and
omentectomy for stage IIIB clear cell carcinoma of the ovary. What is
the most appropriate management?
Click Here For
Answer
Observation with serial Ca125
Adjuvant chemotherapy with 6 cycles of carboplatin
Adjuvant chemotherapy with 8 cycles of carboplatin
Adjuvant chemotherapy with 6 cycles of carboplatin / paclitaxel
Adjuvant chemotherapy with 8 cycles of carboplatin / paclitaxel

74. EMQ
Which ovarian neoplasm best matches
the following pathological reports?
1. Macroscopically, there are hairs,
teeth and pieces of bone within a
large, thick-walled cyst
2. Microscopically, the partly solid cyst
is lined with columnar cells
identical to those seen lining the
endocervix
3. Microscopically, there are mucin-
containing ‘signet-ring’ cells
scattered in a fibrous stroma
4. Call-Exner bodies are seen
microscopically
5. Microscopically, there is cellular
atypia & mitotic activity but stromal
invasion can not be convincingly
seen
• Borderline ovarian tumour
• Clear cell ovarian tumour
• Dysgerminoma
• Endodermal sinus tumour
• Endometrioid adenocarcinoma of
the ovary
• Granulosa cell tumour
• Immature teratoma
• Krukenberg tumour
• Mature cystic teratoma
• Mucinous adenocarcinoma of the
ovary
• Mucinous adenoma of the ovary
• Sertoli-Leydig tumour
• Serous adenocarcinoma of the
ovary
• Serous adenoma of the ovary

75. EMQ
Which ovarian neoplasm best matches
the following pathological reports?
1. Macroscopically, there are hairs,
teeth and pieces of bone within a
large, thick-walled cyst
2. Microscopically, the partly solid cyst
is lined with columnar cells
identical to those seen lining the
endocervix
3. Microscopically, there are mucin-
containing ‘signet-ring’ cells
scattered in a fibrous stroma
4. Call-Exner bodies are seen
microscopically
5. Microscopically, there is cellular
atypia & mitotic activity but stromal
invasion can not be convincingly
seen
• Borderline ovarian tumour
• Clear cell ovarian tumour
• Dysgerminoma
• Endodermal sinus tumour
• Endometrioid adenocarcinoma of
the ovary
• Granulosa cell tumour
• Immature teratoma
• Krukenberg tumour
• Mature cystic teratoma
• Mucinous adenocarcinoma of the
ovary
• Mucinous adenoma of the ovary
• Sertoli-Leydig tumour
• Serous adenocarcinoma of the
ovary
• Serous adenoma of the ovary