Ovary

1
Ovary

• Dr. Amitabha Basu MD

2
Topic

• Normal ovary
• Polycystic ovary
• Tumors of the ovary

3
Normal ovary gross
4
Micro
Th) Theca (MG) Membrana granulosa (CR) Corona
radiata (ZP) Zona pellucida (CL) Corpus luteum
5
Polycystic ovarian disease

• Definition
• Morphology
• Clinical features

6
Def Multiple cystic follicles in the ovary.
7
Pathophysiology

• Excessive secretion of estrogen and androgen.
• High LH
• Low FSH
• LH/FSH Ratio high

8
Clinical features/complications

1. Oligomenorrhoea (Polycystic ovarian disease with
   oligomenorrhea is known as Stein-Leventhal
   syndrome)
2. Hirsuitism
3. Infertility
4. Endometrial Hyperplasia.

9
Tumors of the Ovary

1. Serous tumors
2. Mucinous tumors
3. Dysgerminoma
4. Teratoma
5. Granulosa-theca cell tumor
6. Sertoli Leydig cell tumor
7. Metastasic tumor

1. Classification
2. Subtypes
3. Age Incidence
4. Etiopathogenesis

10
Classification
11
Classification

• Tumor arising form the surface epithelium
• Tumor arising form the germ cells
• Tumor arising form Sex-cord stroma surface
  epithelium
• Metastasic tumor

12
Tumor arising form the surface epithelium
13
Origin Germ cells
Frequency 15-20
Proportion of malignant ovarian tumor. 3-5
Age group 0-25 years
Types Teratoma Dysgerminoma Endodermal sinus tumor Choriocarcinoma
14
Tumor arising from sex cord stroma
Frequency 5-10
Proportion of malignant ovarian tumor. 2-3
Age group All age
Types Fibroma Granulosa-theca cell tumor Sertoli Leydig cell tumor
15
Metastasic tumor
Frequency 5
Proportion of malignant ovarian tumor. 5
Age group All age
Example Krukenberg tumor
16
Etiopathogenesis

• Multiparty
• Family history

• Genes
• BRCA 1 AND BRCA 2
• ( IN HEREDITARY OVARIAN CANCER)
• ERB B2
• K-RAS
• TP53

17
Serous tumor Types

1. Benign
2. Borderline
3. Malignant

Note All surface epithelial tumors can be
divided in these three types
18
Features of Serous tumor

• Common ovarian tumor.
• Mostly benign.
• Cysts are lined by single Ciliated columnar
  epithelium.
• Cyst contain serous fluid.
• Bilateral (25)
• Usually Small.

19
Microscopy of serus tumor Cysts are lined by
single Ciliated columnar epithelium
20
Borderline Serous Tumor

• Between benign cyst adenomas and malignant
  cystadenocarcinomas lies the grey zone of
  "borderline" lesions that are not clearly
  malignant, but are treated as though they could
  be.

21
Malignant serous Tumor Papillary serous
cystadenocarcinomas note papillary areas.
22
Microscopy Papillary process and cellular
crowding and Psammoma body (not seen)
23
Psammomma body in serous tumors( malignant)
24
Spread of the tumor

• These neoplasms characteristically spread by
  "seeding" along peritoneal surfaces.
• Marker for Surface epithelial tumors CA 125

25
Features of Mucinous tumor

• Not common ( 10), Large
• Cysts are lined by single layer Mucin secreting
  columnar epithelium.
• Cyst contain Mucinous gelatinous fluid if
  rupture produce Pseudomyxoma peritonei.

26
Histology Multilocular cysts lined by a single
layer of benign mucinous columnar epithelium.
27
Compare Serous and mucinous tumors
28
Teratoma

• Types
• Dermoid cyst
• Immature malignant Teratoma
• Struma Ovarii.

29
Types

• Benign Teratoma ( Mature usually cystic)
• Malignant Teratoma( Immature usually solid)
• Monodermal Teratoma ( carcinoid Tumor, struma
  ovarii)

30
Benign Teratoma ( Mature)of ovary

• It is also called Dermoid cyst. ( because it
  contains dermal appendages).

31
Dermoid cyst Mature cystic Teratoma
32
(No Transcript)
33
Immature Malignant Teratoma

• Mean age 18 years
• Features bulky, solid
• Histology Tissue containing immature neural
  tissue with neuroepithelial differentiation.

34
Dysgerminoma

• Etiopathogenesis Occur with gonadal dygenesis.
• Radiosensitive tumor 80 cure
• Unilateral

35
Grey white homogenous
36
Mimic Seminoma histology !
37
Granulosa-theca cell tumor

• Age Post menopause but any age
• Unilateral
• Diagnostic point Presence of call Exner body in
  Histology.
• Function Secrete estrogen promote endometrial,
  breast carcinoma.

38
Presence of call Exner body
39
Sertoli Leydig cell tumor

• Age all age
• Unilateral
• Point for identification Gross Yellow brown,
  solid. Micro Pink Sertoli Leydig cells.
• Clinical effect Masculinizing ( defeminizing).

40
Gross Yellow brown, solid.
41
(No Transcript)
42
Struma ovarii

• In this tumor the Teratoma contain predominantly
  thyroid tissue.

43
Struma ovarii produce Hyperthyroidism
44
Metastasic tumor

• Age older age
• Primary Tumor Breast, lung, GIT
• Big bilateral mass
• Example Tumor name Krukenberg tumor

45
Krukenberg tumor

1. Primary tumor Gastric adenocarcinoma
2. Route of metastasis Seeding through body
   cavity.
3. Bilateral always.
4. Histology contain signet ring cells.

46
Gross
47
Nice to Know this Tumor Thecoma-fibroma

• Any age
• Unilateral
• Produce Meigs syndrome( ovarian tumor with
  ascites and Hydrothorax)

48
Review

• Endometriosis ( clinical features)
• Endometrial Hyperplasia . Etiology with C/F
• Dermoid cyst Gross identification.
• Leiomyoma identification and c/f
• Carcinoma in situ
• Granulosa theca cell tumor.

49
Review

• Metastasic tumors
• Ectopic pregnancy
• Genes for Ovarian cancers.
• Clear cell carcinoma
• Vaginitis
• Lichen sclerosus
• Polycystic ovary
• Gonorrhea infection (PID)
• Anovulatory cycle and other Causes of DUB

50
Thank you!