Prof. Mohammad Emam

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Sex Cord And Metastatic Ovarian Tumours

• BY
• Prof. Mohammad Emam
• Prof. of OB GYN.
• Mansoura Faculty of Medicine
• EGYPT

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Classification of OV tumours

• Pathologic behavior
• Non neoplastic
• Neoplastic
• (benign,malign, borderline).
• Morphology(cystic,solid).
• Histogenesis.

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Ovarian tumours

• Neoplastic
• Epithelial T
• Germ cell T.
• Sex cord T
• others( Metastatic.)

Non neoplastic Lutein cysts. Endometrial
cysts ( follicular hematoma
endometriosis). Inflammatory Watered
inclusion cyst cystic C.L. Pcos
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SEX CORD-STROMAL TUMORS( SCTS)
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SEX CORD-STROMAL TUMORS

• SCTS are 15 of all malignant ovarian neoplasm
• The vast majority of these tumors are of low
  malignant potential or benign.
• Long term prognosis is good.
• Excessive estrogen production influences end
  organ responses.
• Endometrial and breast cancer must be
  remembered.

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SEX CORD-STROMAL TUMORSCLASSIFICATION
1-GRANULOSA-STROMAL
2-SERTOLI-STROMAL
3-STEROID CELL

• Granulosa cell tumor
• Adult
• Juvenile
• Thecoma-fibroma
• Thecoma
• Fibroma,sarcoma
• Sclerosing stromal tumor

• Sertoli cell
• Leydig cell
• Sertoli- Leydig

• Stromal luteoma
• Leydig cell
• Hilus cell
• Leydig cell
• Other

4-SEX CORD TUMOR WITH ANULAR TUBULES
5-UNCLASSIFIED
6-GYNANDROBLASTOMA
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Granulosa Cell Tumor
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Gonadal Stromal tumours
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Metastatic Tumors of Ovary
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METASTATIC TUMOR FROM BREAST CANCER
both ovaries replaced by pale, rather nodular
tumor, with breast cancer cells arranged in long
lines perpendicular to the surface of the ovarian
cortex
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METASTATIC TUMOR FROM GASTRIC CANCER (Krukenberg )
gastric carcinoma of the fundus, with secondary
ovarian tumor (Mucus-secreting signet-ring cells)
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Krukenberg Tumor
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Endometrioid Ca
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complications of benign ov Tumours

• torsion
• hemorrhage
• rupture
• infection
• incarceration
• malignant change
• complications during pregnancy

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Diagnostic tools

• History
• Exam (including rectal)
• Investigations-
• TVS masses and mass characteristics
• Tumor markers CA-125, LPA (plasma
  lysophosphatidic acid)
• CT assess spread to LN, pelvic and abdominal
  structures
• MRI best for distinguishing malignant from
  benign tumors

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Clinical picture of benign ov tumors

• Symptoms
• functioning tumors
• nonfunctioning tumors
• swelling
• pressure symptoms
• pain
• menstrual disturbances
• ovarian cachexia
• Signs
• small ov tumors
• large ov tumors
• DD
• from other pelvic swellings
• from other abdominal swellings

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Clinical picture cancer ovary

• Benign ovarian Tumours The following suggest
  malignancy
• agemostly postmenopausal
• pain chronic and persistent
• rapid course
• bilaterality
• Solidity ( variegated consistency )
• fixity
• metastases nodules in DP, lymph nodes
• ascitis
• edema LL
• cachexia

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Treatment

• Depends on
• Staging
• Tumor type
• Age
• Desire for future fertility
• Include surgery, chemotherapy and/or radiation
  therapy

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Surgery for ov. cancer

• Conservative surgery unilateral adnexectomy
  indicated
• stage Ia intact capsule, negative peritoneal
  washing, free omentum,
• well differentiated T,
• young patient with low parity
• Complete surgeryTAH/BSO omentectomylymphadenect
  omy
• other cases of stage Ia
• Stage Ib,c

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Surgery for ov. Cancer cont

• Cytoreductive surgery for all other stages
• optimum cytoreduction leaving no macroscopic
  lesion or one less than 1.5 cm.
• consist of TAH/BSO omentectomylymphadenectomyma
  y be bowel resection anastmosis.
• Second look surgery after chemotherapy

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Surgical treatment

• Primary debulking and cytoreduction may include
• Bilateral salpingo-oopherectomy
• Hysterectomy
• Lymphadenectomy (Para-aortic, inguinal)
• Omentectomy
• brushing of diaphragm
• Examination of liver

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Chemotherapy radiotherapy for ov cancer

• Chemotherapy
• adjuvant to surgery to improve prognosis in early
  stages
• induce remission in advanced cases
• agents alkylating agents,platinum single drug
  and multible drug regimens

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Chemotherapy radiotherapy for ov cancer cont

• Radiotherapy
• has less place in modern practice, replaced by
  chemotherapy
• was given for cases with small residual lesions
  (lt 2 cm)
• forms are
• radioactive isotope intraperitoneal 32P ,
• external-beam radiotherapy

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Chemotherapy and Radiation

• Usually 6 cycles of chemotherapy
• Cisplatin (or Carboplatin) plus Paclitaxel most
  commonly used combination therapy
• XRT

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Thank you
Prof. DR. MOHAMMAD EMAM
Telfax 0020502319922 0020502312299 Email.
mae335_at_hotmail.com www.ivfmifc.com