1. Ovarian cysts and tumors can be non-neoplastic cysts, functional cysts, or neoplastic tumors arising from the surface epithelium, sex cord-stromal tissue, or germ cells. 2. The most common ovarian neoplasms are serous cystadenomas, which can be benign, borderline, or malignant. Serous cystadenocarcinomas make up the majority of malignant ovarian tumors. 3. Mucinous cystadenomas are also common but less likely to be malignant. Brenner tumors arise from transitional cell epithelium and are usually benign.

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Ovarian
Cysts and Tumors

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Ovaries
 The most important medical problems
in ovaries are the neoplasms
 Death from ovarian cancers is more
than that of cervix and uterus together
 Silent growth of ovarian tumors is the
rule ,which make them so dangerous

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Ovarian
Cysts and Tumors
 Non neoplastic cysts are common but
they are not serious problems
 Primary inflammation of ovaries is rare
 Salpingitis of fallopian tubes frequently
causes periovarian reaction (salpingo-
Oophoritis)
 Frequently ,the ovaries affected by
endometriosis.

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Non-Neoplastic and Functional
Cysts of ovary
 Non Neoplastic Cyst are more common than
the neoplastic ones
 Follicular and Luteal cysts are most probably
physiologic
 Follicular cyst is due to distension of
unruptured graafian follicle
 Corpus luteum cyst results from hemorrhage
into a persistent mature corpus luteum.

7.  Theca lutein cyst is lined by luteinized
theca cells and results from
gonadotrophin stimulation.
 Chocolate cyst is a blood containing
cyst resulting from endometriosis with
hemorrhage. The ovary is the most
frequent site of endometriosis
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Polycystic Ovaries
Stein-Leventhal Syndrome
 Young women ,and usually in girls after
menarche.
-Oligomenorrhea
-hirsutism
-infertility
-Obesity

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Polycystic Ovaries
Stein-Leventhal Syndrome
 Secondary to excessive production of
estrogens and androgens, mainly
androgens
 The ovaries are usually twice normal in
size ,gray-white with smooth outer
surface
 Studded with sub cortical cysts 0.5 to
1.5 cm in diameter.

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Polycystic Ovaries
Stein-Leventhal Syndrome
 Histologically ,thickened fibrosed outer
tunica
 Multiple cysts lined by granulosa cells
 Absence of corpora lutea
 Cortical stromal fibrosis
 High level of LH and low FSH

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Figure 22-36 Polycystic ovarian disease and cortical stromal hyperplasia. A, The ovarian cortex reveals numerous clear cysts. B, Sectioning of the cortex reveals several
subcortical cystic follicles. C, Cystic follicles seen in a low-power microphotograph. D, Cortical stromal hyperplasia manifests as diffuse stromal proliferation with
symmetrical enlargement of the ovary.
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© 2007 Elsevier

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Figure 22-36 Polycystic ovarian disease and cortical stromal hyperplasia. A, The ovarian cortex reveals numerous clear cysts. B, Sectioning of the cortex reveals several
subcortical cystic follicles. C, Cystic follicles seen in a low-power microphotograph. D, Cortical stromal hyperplasia manifests as diffuse stromal proliferation with
symmetrical enlargement of the ovary.
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© 2007 Elsevier

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Ovarian Tumors
 Fifth most common cancer in the USA
 Fifth leading cause of cancer death in
women
 Diversity of pathologic entities because
of the three cell types make up the
normal ovary

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Ovarian Tumors classification
 Primary tumor, three cell types :
1- the surface epithelium tumors
2- Germ cells tumors
3- Stromal /sex cord cells tumors
 Secondary or metastatic tumors

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Figure 22-37 Derivation of various ovarian neoplasms and some data on their frequency and age distribution.
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Classification of Ovarian Tumors,
Surface Epithelial Tumors
 :
-Serous Tumors : Benign ,Borderline,And
malignant
-Mucinous T. : Benign ,Borderline , and
malignant
-Endometrioid T. : Benign, Borderline, and
malignant
-Transitional cell T. :
Brenner tumors, Benign ,Borderline ,and
malignant
-Undifferentiated Carcinoma

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Classification of Ovarian Tumors,
Sex Cord-Stromal tumors
- -Granulosa Cell tuomr
- -Thecoma –Fibroma
- -Sertoli-Leydig cell tumor
- -Gynandroblastoma
- -Unclassified

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Classification of Ovarian
Tumors, Germ Cell Tumors
- -Dysgerminoma
- -Yolk Sac Tumor
- -Embryonal Carcinoma
- -Choriocarcinoma
- -Teratoma : Mature, Immature
- -Polyembryoma

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Ovarian Tumors
Surface Epithelium Origin
 Neoplasms of surface epithelium
account for the great majority of all
primary ovarian tumors.

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Ovarian Tumors ,
Surface Epithelium Origin
 65 – 70 % of overall tumors
 90 % of malignant tumors
 Age 20+
 Traditionally divided into Benign
,Malignant ,and Borderline in
malignancy
 Can be strictly epithelial (serous
,Mucinous)

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Ovarian Tumors ,
Surface Epithelium Origin
 Can have stromal component
(Cystadenofibroma ,
Brenner tumor )

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Ovarian Tumors ,
Surface Epithelium Origin
 The intermediate ,or the borderline
tumors are referred as tumors of low
malignant potential
 These appear to be low grade cancers
with limited invasive potential
 They have better prognosis

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Serous Tumors
 The most frequent ovarian tumor
 Age is 30 -40
 May be solid ,usually cystic
 Cystadenoma or Cystadenofibroma
 65% benign ,15% low malignant
potential , and 25% malignant
 65 % of all ovarian cancers

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Serous Tumors
 Most are large ,spherical to ovoid ,cystic
structures
 5 – 10 cm and might be 30-40 cm
 25% of benign tumors are bilateral
 The surface of the benign is smooth
and glistening .In contrast to the
malignant forms ,the surface is nodular
and irregular

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Serous Tumors
 Cystic spaces are filled by serous fluide
 Papillary formation is very important and
need to be sampled well
 Histologically the benign tumors are lined by
a single layer of tall columnar epithelium
 Papillary formation can be seen in both the
benign and the malignant ones

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Serous Tumors
 Psammoma bodies could be seen
 Between the clearly benign and the
solid malignant tumors we can see the
tumors of low malignant potential
 LMP tumors may seed the peritoneum,
the implants of tumors are non
invasive. Sometimes may behave as
invasive peritoneal implants

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Serous Tumors
 The prognosis of LMP tumors is
determined mainly by the nature of the
peritoneal implants
 Prognosis of invasive Serous
cystadenocarcinoma after surgery
,chemotherapy ,and radiation is poor
and depend on stage
 70% 5 –year survival for the tumors
confined to the ovary

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Serous Tumors
 5 year survival f0r LMP is 100% ,
 Malignant Tumors with capsular
invasion ,survival for 10 years is 13%
 LMP with capsular invasion the 10 year
survival is 80%.

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Figure 22-39 A, Borderline serous cystadenoma opened to display a cyst cavity lined by delicate papillary tumor growths. B, Cystadenocarcinoma. The cyst is opened to
reveal a large, bulky tumor mass. C, Another borderline tumor growing on the ovarian surface (lower).
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Figure 22-39 A, Borderline serous cystadenoma opened to display a cyst cavity lined by delicate papillary tumor growths. B, Cystadenocarcinoma. The cyst is opened to
reveal a large, bulky tumor mass. C, Another borderline tumor growing on the ovarian surface (lower).
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© 2007 Elsevier

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Figure 22-40 Papillary serous cystadenoma revealing stromal papillae with a columnar epithelium.
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© 2007 Elsevier

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Figure 22-41 Borderline serous cystadenoma exhibiting increased architectural complexity and epithelial cell stratification.
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Figure 22-42 Papillary serous cystadenocarcinoma of the ovary with invasion of underlying stroma.
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Mucinous Tumors
 Epithelium is consists of mucin-
producing cells
 Less likely to be malignant
 10% of ovarian cancers
 80% of them benign
 10% LMP
 10% malignant

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Figure 22-44 A, A mucinous cystadenoma with its multicystic appearance and delicate septa. Note the presence of glistening mucin within the cysts. B, Columnar cell
lining of mucinous cystadenoma.
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© 2007 Elsevier

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Brenner Tumor
 Transitional cell epithelium
 Most are benign

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Figure 22-46 A, Brenner tumor (right) associated with a benign cystic teratoma (left). B, Histologic detail of characteristic epithelial nests within the ovarian stroma.
(Courtesy of Dr. M. Nucci, Brigham and Women's Hospital, Boston, MA.)
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Sex Cord Tumors,
Granulosa Cell Tumor
 Most postmenopausal ,could be any age
 Unilateral
 Solid and cystic
 Tiny to large in size
 Produce estrogen
 Malignant behaviour in 5-25%

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Sex Cord Tumors,
Thecoma-Fibroma
 Any age
 Unilateral
 Solid gray to yellow
 Rarely malignant

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Sex Cord Tumors
Sertoli - Leydig
 All ages
 Unilateral Gray to yellow
 Produce androgens
 Uncommonly malignant

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Germ Cell Tumors
Dysgerminoma
 2nd and 3rd decades
 Unilateral
 Counterpart to Seminoma
 Solid ,gray to yellow
 All malignant
 PLAP positive

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Embryonal carcinoma
 2nd and 3rd decade
 Solid
 Aggressive
 CD 30 positive.

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Germ Cell Tumors
Teratoma
 15-20 % of Ovarian tumors
 Majority in the first 2 decades
 The younger the patient ,the greater
the likelihood of malignancy
 Over 90% are benign cystic ,mature
teratomas
 Immature teratomas are malignant and
are rare.

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Figure 22-48 Opened mature cystic teratoma (dermoid cyst) of the ovary. Hair (bottom) and a mixture of tissues are evident.
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Figure 22-49 Benign cystic teratoma. Low-power view of skin (top), beneath which there is brain tissue (bottom).
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Endodermal Sinus (Yolk Sac)
Tumor
 the tumor is rich in α-fetoprotein and α1-antitrypsin.
 Its characteristic histologic feature is a glomerulus-
like structure composed of a central blood vessel
enveloped by germ cells within a space lined by germ
cells (Schiller-Duval body)
 stained for α-fetoprotein by immunoperoxidase
techniques
 Most patients are children or young women
presenting with abdominal pain and a rapidly
developing pelvic mass. The tumors usually appear to
involve a single ovary but grow rapidly and
aggressively.

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Figure 22-52 A Schiller-Duval body in yolk sac carcinoma.
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Choriocarcinoma
 More commonly of placental origin, the
choriocarcinoma, similar to the
 Most ovarian choriocarcinomas exist in combination
with other germ cell tumors, and pure
choriocarcinomas are extremely rare.
 are aggressive tumors that generally have
metastasized widely through the bloodstream to the
lungs, liver, bone, and other viscera by the time of
diagnosis.
 high levels of chorionic gonadotropins that are
sometimes helpful in establishing the diagnosis or
detecting recurrences.

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Ovarian Tumors
Metastatic Carcinoma
 Accounts for approximately 5% of
ovarian tumors
 Older ages
 Mostly Bilateral
 Primaries are Breast ,lung, and G.I.T.
(Krukenberg Tumors)

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