Ovarian Cancer

1. Oncological Gynaecopathology
Tumors of the ovary
Marc van de Vijver

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. Epithelial tumors
• serous
• mucinous
• endometrioïd
• clearcell
• transitional cell
• undifferentiated
• mixed epithelial

4. For each type of epithelial tumor:
• benign
• “borderline”
• malignant

5. Case OV1
• Age: 70 years.
• Unilateral ovarian tumor, diam. 17 cm.

9. Differential diagnosis?

10. Differential diagnosis
• Endometrioid adenocarcinoma of the ovary
• Metastasis of adenocarcinoma
• Mucinous adenocarcinoma

11. Keratin 7

12. CEA

13. Estrogen
receptor

14. Diagnosis
• Endometrioid adenocarcinoma, grade 1

15. Case OV2
• Age: 57 yrs.
• Peritoneal metastases; clinically most
consistent with primary ovarian carcinoma.

19. Differential diagnosis?

20. Differential diagnosis
• Clear cell carcinoma

21. Case OV3
• Age: 66 yrs
• Bilateral multicystic ovarian tumors, diam.
12 cm.

25. Differential diagnosis?

26. Differential diagnosis
• Metastasis of colon carcinoma
• Mucinous carcinoma of the ovary
• Endometrioid carcinoma of the ovary
• Metastasis of adenocarcinoma (other than
colon)

27. Immunohistochemistry
• Keratin 7: negative
• Keratin 20: positive
• CEA: strongly positive
• CA125: weakly positive

28. Diagnosis
• Metastasis of colon carcinoma
• (patient was known to have had primary
colon carcinoma)

29. Case OV4
• Age: 59 yrs
• Debulking for tumor of the peritoneum,
consistent with primary ovarian carcinoma

33. Differential diagnosis?

34. Differential diagnosis
• Endometrioid adenocarcinoma
• Endometrioid borderline tumor
• Metastasis of adenocarcinoma to the ovary
(for example: from primary endometrial
carcinoma)

35. Diagnosis
• Endometrioid adenocarcinoma

36. Case OV5
• Age: 58 yrs
• Resection of 10 cm cystic mass of left ovary

40. Differential diagnosis?

41. Differential diagnosis
• Benign teratoma
• Immature teratoma
• Carcinoma ex teratoma

42. Diagnosis
• Benign teratoma/dermoid cyst

43. 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

46. Case OV6
• Age: 53 yrs.
• Left ovary: multicystic tumor, diam. 14 cm.

50. Differential diagnosis?

51. Differential diagnosis
• Mucinous dissection/disseminated
adenomucinosis
• Mucinous borderline tumor
• Mucinous cystadenoma
• Metastasis of adenocarcinoma to the ovary

52. disseminated peritoneal adenomucinosis
originates in the appendix

55. Diagnosis
• disseminated peritoneal adenomucinosis

56. Case OV7
• Age: 46 yrs
• History:
– 5 yrs back: ovarian tumor resected
• Liver metastasis

59. Differential diagnosis?

60. Differential diagnosis
• Granulosacell tumor
• (Undifferentiated) carcinoma

61. Diagnosis
• Granulosacell tumor

62. Case OV8
• Age: 44 yrs
• History: at age 40 resection of left ovary
• Resection cystic tumor of right ovary

66. Differential diagnosis?

67. Differential diagnosis
• Serous papillary borderline tumor
• Serous papillary cystadenoma
• Serous papillary adenocarcinoma

70. Fallopian tube
Borderline tumor

71. Diagnosis
• Serous papillary borderline tumor

72. 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

73. Case OV9
• Age: 35 yrs
• Unilateral, partly cystic tumor right ovary,
diameter 7 cm.

77. Differential diagnosis?

78. Diifferential diagnosis
Tumor type?
• Endometrioid
• Serous papillary
• Mucinous

79. Endometrioid tumor
• Benign
• Borderline
• Malignant

80. Diagnosis
• Appearance of complex hyperplasia with
atypia:
• Endometrioid borderline tumor

81. Endometrioid borderline tumor
• Very rare
• Often misdiagnosed, mainly as carcinoma!
• Outcome: very good (100% survival, no
metastases)

82. Case OV10
• Age: 38 yrs
• Unilateral multicystic ovarian tumor
• Diameter 14 cm.

87. Differential diagnosis?

88. Differential diagnosis
• Mucinous cystadenoma
• Mucinous borderline tumor
• Is the tumor adequately sampled with two
sections?

89. Diagnosis
• Mucinous borderline tumor

90. 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)

91. Case OV11
• Age: 33 yrs
• Unilateral solid ovarian tumor
• Diameter 7 cm.

96. Differential diagnosis?

97. Differential diagnosis
• Sertoli-Leydigcell tumor
• Metastasis adenocarcinoma

98. Diagnosis
• Sertoli-Leydigcell tumor

99. 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.)

104. 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

105. 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