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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
 cystic follicles:Innocent lesions originate from
unruptured follicles or in follicles that have
ruptured and sealed. Usually they are small 1
– 1.5 cm ,and filled by clear fluid

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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
 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.
Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 28 April 2008 01:14 PM)
© 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.
Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 28 April 2008 01:14 PM)
© 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
 Three cell types :
 1- the surface epithelium tumors
 2- Germ cells tumors
 3- Stromal /sex cord cells tumors

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Figure 22-37 Derivation of various ovarian neoplasms and some data on their frequency and age distribution.
Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 28 April 2008 01:14 PM)
© 2007 Elsevier

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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).
Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 28 April 2008 01:14 PM)
© 2007 Elsevier

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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).
Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 28 April 2008 01:14 PM)
© 2007 Elsevier

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Figure 22-40 Papillary serous cystadenoma revealing stromal papillae with a columnar epithelium.
Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 28 April 2008 01:14 PM)
© 2007 Elsevier

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Figure 22-41 Borderline serous cystadenoma exhibiting increased architectural complexity and epithelial cell stratification.
Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 28 April 2008 01:14 PM)
© 2007 Elsevier

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Figure 22-42 Papillary serous cystadenocarcinoma of the ovary with invasion of underlying stroma.
Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 28 April 2008 01:14 PM)
© 2007 Elsevier

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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.
Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 28 April 2008 01:14 PM)
© 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.)
Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 28 April 2008 01:14 PM)
© 2007 Elsevier

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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.
Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 28 April 2008 01:14 PM)
© 2007 Elsevier

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Figure 22-49 Benign cystic teratoma. Low-power view of skin (top), beneath which there is brain tissue (bottom).
Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 28 April 2008 01:14 PM)
© 2007 Elsevier

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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.
Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 28 April 2008 01:14 PM)
© 2007 Elsevier

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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
 Older ages
 Mostly Bilateral
 Primaries are Breast ,lung, and G.I.T.
(Krukenberg Tumors)

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