Introduction to ovarian tumors, Epidemiology, Classification of ovarian tumor, Pathogenesis of epithelial ovarian tumors, Serous tumors of the ovaries, definition, pathogenesis, gross and microscopic pathology, Mucinous tumors of ovaries, definition, pathogenesis, gross and microscopic pathology, Teratoma of the ovaries,definition, pathogenesis, gross and microscopic pathology, Dysgerminma,definition, pathogenesis, gross and microscopic pathology

1. Dr. Sizan Thapa
MBBS,MD

2. Introduction To Ovarian Tumors
• Mostly benign and occur in young females (20-45 y)
• Borderline tumors (tumors of intermediate malignancies) -
seen in slightly older women
• Malignant tumors - 45-65 yrs
• Ovarian cancers : 3% of all the female tumors and eighth
most common diagnosis and cause of cancer death in
women world wide
• High grade serous carcinoma - most common histological
type

3. Classification of Ovarian Tumors
• Surface epithelial- stroma tumors
– Serous tumors
• Benign (Cystadenoma, Cystadenofibroma
• Borderline (Serous borderline tumor)
• Malignant (Low and high grade serous Adenocarcinoma)
– Mucinous tumors, endocervical like and intestinal type
• Benign (Cystadenoma, cystadenofibroma)
• Borderline (Mucinous borderline tumor)
• Malignant (Mucinous adenocarcinoma)

4. – Endometroid tumor
• Benign (Cystadenoma, cystadenofibroma)
• Borderline (Endometroid borderline tumor)
• Malignant (Endometroid adenocarcinoma)
– Clear cell tumor
• Benign
• Borderline
• Malignant (Clear cell adenocarcinoma)

5. – Transitional cell tumor
• Benign Brenner tumor
• Brenner tumor of borderline malignancy
• Malignant Brenner tumor
– Epithelial- stromal tumor
• Adenosarcoma
• Malignant mixed Mullerian tumor

6. • Sex cord-stromal Tumor
– Granulosa tumor
– Fibroma
– Fibrothecoma
– Thecoma
– Sertoli-leydig cell tumor
– Steroid (lipid) cell tumor

7. • Germ cell tumors
– Teratoma
• Mature
• Immature
• Solid
• Cystic (Dermoid Cyst)
– Monodermal (eg. Struma ovarii, carcinoid)
– Dygerminoma
– Yolk sac tumor
– Mixed germ cell tumor

8. • Metastatic tumor from non-ovarian primary
– Colonic, appediceal
– Gastric
– Pancreaticobilliary
– Breast

9. EPITHELIAL TUMORS
• Three most common types : serous, mucinous and
endometroid
• Subclassification: benign, borderline and malignant
• Based on clinicopathological and molecular studies: 2
types
• Type I : Low grade; Associated with borderline tumor or
endometriosis
• Type II : High grade serous carcinoma arising from STIC

10. Serous Tumor
Definition
• Group of cystic ovarian epithelial neoplasms with
neoplastic cells resembling the tubal epithelium
• Most common ovarian tumor (30%)
• 50% of ovarian epithelial tumors
• 30 % of serous tumors : malignant
• Benign/ borderline : age 20-45
• Malignant later in life; young adults in familial cases

11. Pathogenesis
• Risk factors for benign and borderline : Unclear
• Risk factors (malignant serous tumor)
– Nulliparity
– Family history
– Heritable mutations (BRCA1 and BRCA2)
– Higher frequency in low parity
• Reduced risk in women 40-59 y; oral contraceptives and
tubal ligation

12. • Low grade - Serous
borderline tumor
• High grade - Insitu lesions
in fallopian tube (STIC) or
serous inclusion cysts in
ovary

13. • Mutational profiles : distinct regardless of origin
• Low grade : Mutation of KRAS, BRAF or ERBB2
oncogenes, and wild type TP53 genes
• High grade :
– High frequency of TP53 muation
– absent KRAS and BRAF mutation
– Genomic imbalance : amplification of oncogenes(PIK3CA) and
deletion of tumor supressor genes (RB)

14. Morphology
• Gross features
– Cystadenoma: Smooth outer and inner surfaces, may be
septate; filled with serous fluid; Cystadenofibroma - cyst with
variable amout of solid areas
– Serous borderline tumor: large (>5cm); may be intracystic;
Increased papillary projections (30% bilateral)
– Malignant serous tumor: Bilateral; large solid or papillary
growth; tumor irregularity; nodularity of the capsule

16. • Microscopic Features
– Benign : cysts lined by
simple columnar with
retained cilia and
microscopic papillae

17. – Borderline : Increased
complexity of stromal
papillae; stratification of
epithelium; mild atypia;
no invasion

18. – Low grade serous
carcinoma :
Small nests, Glands,
papillae or complex
micropapillae and inverted
papillae; Invasion seen;
Moderate degree of
nuclear atypia

19. – High grade serous carcinoma :
- More complex growth pattern
than borderline tumors;
- Wide spread stromal
infiltration or stromal
effacement;
- Marked nuclear atypia
(pleomorphism,
multinucleation, atypical mitotic
figures);
- Necrosis;
- Psammoma bodies

20. Mucinous Tumors
Definition
• Group of ovarian epithelial tumors with neoplastic cells
resembling gastrointestinal or Mullerial type mucinous
epithelium
• 20 - 25 % of all ovarian neoplams
• Malignant mucinous carcinoma is rare (3%); majority are
benign or borderline

21. Pathogenesis
• KRAS proto-oncogene mutation in benign, borderline and
malignant mucinous tumors
• Borderline mucinous tumors arise from mucinous
cystadenomas
• Malignant mucinous carcinoma arise from borderline
mucinous tumors;
• CDK2NA and TP53 mutation present

22. Morphology
• Gross Features
– Usually unilateral
– Surface of ovary rarely involved
– Benign :
- up to 30 cm or more
- Filled with sticky gelatinous fluid

23. – Borderline
- Larger than benign
mucinous tumors (up to 50
cm)
- Multiloculated
- Solid areas may be seen
- Filled with mucinous
content

24. Malignant
- Solid and cystic
- Mucinous content
- Necrosis and hemorrhage
may be present

25. • Microscopic Features
– Benign
- Lined by tall columnar
cells with apical mucin; lack
cilia
- Gastric or intestinal type;
rarely endocervical type

26. – Borderline
- Epithelial stratification
- Tufting
- Papillary intraglandular
growth
- Low grade nuclear atypia
- Mucin in glandular lumen

27. – Malignant Mucinous carcinoma
- 2 patterns of invasion: confluent glandular (expansile) or
infiltrative/desturctive ; may coexist
- Cofluent pattern - glandular crowding with little or no
intervening stroma
- Infiltrative pattern: Irregular glands, nests and single cells
- Marked atypia

29. DYSGERMINOMA
• Primitive germ cell tumor composed of cells showing no
specific differentiation
• Ovarian counterpart of testicular seminoma
• 2% of ovarian cancers
50% of malignant ovarian germ cell tumors
• Age: 2nd and 3rd decade; may occur in childhood

30. • Pathogenesis
– may occur in gonadal dysgenesis
– Chromosome 12 abnormalities typically iso12p
– KIT mutation

31. • Gross Features
– Size : variable; very small to
large ones filling the
abdomen
– Fleshy yellow or cream
colored, lobulated

32. • Microscopic features

33. TERATOMA
• Three types
– mature
– immature
– monodermal

34. • Mature (benign) teratoma
– also known as Dermoid cyst
– Gross features
• unilateral or bilateral
• Unilocular cyst containing hair and sebaceous material
• Teeth and bones may be visible
– Microscopic Features
• Tissues from at least 2 of the 3 germ layers
• eg skin with nerves, bones or cartilage etc

35. • Immature Teratoma
– Component resemble embryonal and immature fetal tissue
– Adolescent and young girls
– Gross features
• Bulky with smooth exterior; cut sections --> solid
• may contain hair, sebaceous material, teeth bones and calcification
• Necrosis and hemorrhage

36. – Microscopic Features
• Varying amount of immature neuroepithelium, cartilage bone muscles
and other elements
• Extraovarian spread is dependent on grade
• Grading is based on the portion of the tumor that is based on immature
component

37. • Monodermal or specialized teratoma
– Rare
– Struma ovarii and carcinoid
– Sturma ovarii
• entirely composed of mature thyroid tissue
• may be functional and cause hyperthyroidism
– Carcinoid
• arise from intestinal tissue found in teratoma
• May be functional; large ones produce 5-HT to produce carcinoid synd

38. THANK YOU