Ovarian tumors

62
OVARIAN NEOPLASM OVARIAN NEOPLASM

description

 

Transcript of Ovarian tumors

Page 1: Ovarian tumors

OVARIAN NEOPLASMOVARIAN NEOPLASM

Page 2: Ovarian tumors
Page 3: Ovarian tumors

ORIGIN OF OVARIAN TUMORSORIGIN OF OVARIAN TUMORS

Page 4: Ovarian tumors

OVARIAN NEOPLASMOVARIAN NEOPLASM

►NON-NEOPLASTIC functional cystNON-NEOPLASTIC functional cyst

►PrimaryPrimary

►SecondarySecondary

Page 5: Ovarian tumors

Non-neoplasticNon-neoplastic

►Follicular cyst:Follicular cyst:- usually less than 5 cmusually less than 5 cm- Benign and a symptomaticBenign and a symptomatic- Thin wall, contain clear fluidThin wall, contain clear fluid

Page 6: Ovarian tumors

Non-neoplasticNon-neoplastic

►Corpus lutealCorpus luteal- Hemorrahgic corpus luteumHemorrahgic corpus luteum- Cyst filled with bloodCyst filled with blood- Follicular cystsFollicular cysts

Page 7: Ovarian tumors

Non-neoplasticNon-neoplastic

►Granulosa-theca lutein cystGranulosa-theca lutein cyst- in molar pregnancy or part of in molar pregnancy or part of

hyperstimulation syndromehyperstimulation syndrome- Polycystic ovaryPolycystic ovary- Endometriotic cyst Endometriotic cyst

Page 8: Ovarian tumors

Primary ovarian tumorsPrimary ovarian tumors

►EpithelialEpithelial - BenignBenign- BorderlineBorderline- MalignantMalignant

• • Germ cell tumorsGerm cell tumors

• • Sex cord (gonadal stromal) Sex cord (gonadal stromal) tumorstumors

Page 9: Ovarian tumors

Epithelial tumorsEpithelial tumors

► Serous : most commonSerous : most common► MucinousMucinous► EndometrioidEndometrioid► Clear cell(mesonephroid)Clear cell(mesonephroid)► BrennerBrenner

Page 10: Ovarian tumors

Epithelial tumorsEpithelial tumors

• • Serous:Serous:- contain clear fluidcontain clear fluid- Often bilateral. Around age of menopauseOften bilateral. Around age of menopause- Malignant type is the commonest ovarian Malignant type is the commonest ovarian

cancercancer

Page 11: Ovarian tumors

SEROUS CYT ADENOMASEROUS CYT ADENOMA

Page 12: Ovarian tumors
Page 13: Ovarian tumors

SEROUS BORDERLINE SEROUS BORDERLINE TUMORTUMOR

Page 14: Ovarian tumors
Page 15: Ovarian tumors

SEROUS CYST SEROUS CYST ADENOCARCINOMAADENOCARCINOMA

Page 16: Ovarian tumors
Page 17: Ovarian tumors

??

Page 18: Ovarian tumors

? ? ?? ? ?

Page 19: Ovarian tumors

►Mucinous:Mucinous:► large tumors. Multilocular filled with large tumors. Multilocular filled with

mucinmucin► If ruptured………pseudomyxoma If ruptured………pseudomyxoma

peritoneiperitonei

Page 20: Ovarian tumors

MUCINOUS CYST ADENOMAMUCINOUS CYST ADENOMA

Page 21: Ovarian tumors
Page 22: Ovarian tumors

MUCINOUS BORDERLINE MUCINOUS BORDERLINE TUMORTUMOR

Page 23: Ovarian tumors
Page 24: Ovarian tumors

MUCINOUS CYST MUCINOUS CYST ADENOCARCINOMAADENOCARCINOMA

Page 25: Ovarian tumors
Page 26: Ovarian tumors

? ? ?? ? ?

Page 27: Ovarian tumors

Epithelial tumorsEpithelial tumors

► Endometrioid:Endometrioid:- Few cases arise in endometriosisFew cases arise in endometriosis- 30% coexist with primary endometrial 30% coexist with primary endometrial

cancercancer- the second most common type of epithelial the second most common type of epithelial

ovarian cancerovarian cancer- occurs primarily in women who are between occurs primarily in women who are between

50 and 70 years of age.50 and 70 years of age.

Page 28: Ovarian tumors
Page 29: Ovarian tumors
Page 30: Ovarian tumors

BRENNER TUMORSBRENNER TUMORS

►usually benign.occur in reproductive usually benign.occur in reproductive lifelife

►They can be malignant.They can be malignant.►May be associated with endometrial May be associated with endometrial

hyperplasiahyperplasia►May coexist with mucinous May coexist with mucinous

cystadenomacystadenoma

Page 31: Ovarian tumors

BENIGN BRENNER TUMORBENIGN BRENNER TUMOR

Page 32: Ovarian tumors
Page 33: Ovarian tumors

BRENNER BORDERLINE BRENNER BORDERLINE TUMORTUMOR

Page 34: Ovarian tumors

BRENNER MALIGNANT BRENNER MALIGNANT TUMORTUMOR

Page 35: Ovarian tumors

Clear cell carcinomaClear cell carcinoma

► Clear cell ovarian tumors are part of the surface Clear cell ovarian tumors are part of the surface epithelial tumor group of ovarian cancers, epithelial tumor group of ovarian cancers,

► Accounting for 6% of these cancers.Accounting for 6% of these cancers.► Polypoid masses that protrude into the cyst.Polypoid masses that protrude into the cyst.► On microscopic examination, composed of cells On microscopic examination, composed of cells

with clear cytoplasm (that contains glycogen) with clear cytoplasm (that contains glycogen) ►Hob nail cells. Hob nail cells. ► The pattern may be glandular, papillary or solid.The pattern may be glandular, papillary or solid.

Page 36: Ovarian tumors
Page 37: Ovarian tumors
Page 38: Ovarian tumors

Germ cell tumorsGerm cell tumors

►Dermoid cyst (benign cystic teratomaDermoid cyst (benign cystic teratoma))- 25% of all ovarian neoplasm25% of all ovarian neoplasm- Contain tissue derived from two or more Contain tissue derived from two or more

germ cell layersgerm cell layers- Unilocular cyst. May contain teeth, bone , Unilocular cyst. May contain teeth, bone ,

cartilage, nerves, hair, thyroid,.. Tissuescartilage, nerves, hair, thyroid,.. Tissues- Almost always benign. Malignant changes Almost always benign. Malignant changes

may occur in any componentmay occur in any component- Occur at any age.peak is 20-30 years.Occur at any age.peak is 20-30 years.- Bilateral in 20%Bilateral in 20%

Page 39: Ovarian tumors
Page 40: Ovarian tumors
Page 41: Ovarian tumors

Malignant Germ cell tumorsMalignant Germ cell tumors

►Rare. 3% of ovarian cancersRare. 3% of ovarian cancers►TeratomaTeratoma: peak incidence in second : peak incidence in second

decadedecade►Malignant teratomaMalignant teratoma►Immature teratomaImmature teratoma

Page 42: Ovarian tumors

IMMATURE TERATOMAIMMATURE TERATOMA

Page 43: Ovarian tumors

CHORIOCARCINOMACHORIOCARCINOMA

►Non-gestational choriocarcinomaNon-gestational choriocarcinoma►secrete HCGsecrete HCG►May be component of solid teratomaMay be component of solid teratoma

Page 44: Ovarian tumors
Page 45: Ovarian tumors

Malignant Germ cell tumorsMalignant Germ cell tumors

► Yolk-sac (endodermal sinus)Yolk-sac (endodermal sinus)

- Highly malignant. Highly malignant.

- Affect young ageAffect young age

- Partly solid. Partly solid.

- Secrete alpha feto-proteinSecrete alpha feto-protein

Page 46: Ovarian tumors
Page 47: Ovarian tumors

►DysgerminomaDysgerminoma►Most common. Highly malignantMost common. Highly malignant►Usually spread by lymphaticsUsually spread by lymphatics►Very radiosensitiveVery radiosensitive►Occur in young women. Occur in young women. ►May arise in gonadal dysgenesisMay arise in gonadal dysgenesis

Page 48: Ovarian tumors
Page 49: Ovarian tumors

Sex cord tumorsSex cord tumors

►Granulosa-theca cell tumorsGranulosa-theca cell tumors- Moderate to large sizeModerate to large size- Solid, as enlarge may have cystic spacesSolid, as enlarge may have cystic spaces- Yellow tinge on cut surfaceYellow tinge on cut surface- Thecoma is benign,but granulosa cell is Thecoma is benign,but granulosa cell is

malignantmalignant- Occur at any age .50% postmenopausalOccur at any age .50% postmenopausal- Secret estrogenSecret estrogen- Usually stage 1. Late recurrenceUsually stage 1. Late recurrence

Page 50: Ovarian tumors

GRANULOSA CELL TUMORGRANULOSA CELL TUMOR

Page 51: Ovarian tumors

Sex cord tumorsSex cord tumors

►Androgen- secreting tumorsAndrogen- secreting tumors- Androblastoma,Sertoli-leydig,Androblastoma,Sertoli-leydig,

GynandroblastomaGynandroblastoma- Cause virilizationCause virilization

• • FibromaFibroma- solid tumorsolid tumor- May be associated with meigs’ syndromeMay be associated with meigs’ syndrome- Tend to have long pedicleTend to have long pedicle

Page 52: Ovarian tumors

FIBROMAFIBROMA

Page 53: Ovarian tumors

THECOMATHECOMA

Page 54: Ovarian tumors

SERTOLI-LEYDIG CELL SERTOLI-LEYDIG CELL TUMORTUMOR

Page 55: Ovarian tumors

Metastatic tumorsMetastatic tumors

►Always bilateral. From mucin secreting Always bilateral. From mucin secreting tumors, stomach and colon tumors, stomach and colon (krukenberg tumors)(krukenberg tumors)

►May be secondary to breastMay be secondary to breast

Page 56: Ovarian tumors

Metastatic ovarian Metastatic ovarian KurkenbergKurkenberg

cancer tumor cancer tumor

Page 57: Ovarian tumors

Complication of ovarian Complication of ovarian tumorstumors

►TorsionTorsion- common with dermoid/fibromacommon with dermoid/fibroma- Severe abdominal pain/vomittingSevere abdominal pain/vomitting►RuptureRupture►HaemorrhageHaemorrhage► ImpactionImpaction► infectioninfection

Page 58: Ovarian tumors

Physical signsPhysical signs

► Benign:Benign:- usually mobile.unless large or complicatedusually mobile.unless large or complicated- Dermoid cyst anterior to bladderDermoid cyst anterior to bladder• • Malignant:Malignant:- BilateralBilateral- AscitesAscites- Hard deposit in pelvisHard deposit in pelvis- Leg edemaLeg edema- Signs of bowel obstruction of ureteric Signs of bowel obstruction of ureteric

obstructionobstruction

Page 59: Ovarian tumors

FIGO StagingFIGO Staging

Stage 1Stage 1 Growth limited to one or Growth limited to one or both ovariesboth ovaries

Stage 2Stage 2 Growth limited to one or Growth limited to one or both ovaries with pelvic both ovaries with pelvic extensionextension

Stage 3Stage 3 Tumor involving Tumor involving one/both ovaries with one/both ovaries with peritoneal implants peritoneal implants outside pelvis/positive outside pelvis/positive retroperitoneal or retroperitoneal or inguinal nodes inguinal nodes

Stage 4Stage 4 Growth involving one or Growth involving one or both ovaries with distant both ovaries with distant metastasismetastasis

Page 60: Ovarian tumors

MANAGMENTMANAGMENT

►Surgery :Surgery :

primaryprimary

interval debulkinginterval debulking

palliativepalliative

second look surgerysecond look surgery

►ChemotherapyChemotherapy

Page 61: Ovarian tumors

Primary surgeryPrimary surgery

►Primary cytoreductionPrimary cytoreduction►TAH,BSO,OMETECTOMY,WASHINGSTAH,BSO,OMETECTOMY,WASHINGSBOWEL SURGERYBOWEL SURGERY►Optimal debulking: less than 2 cm Optimal debulking: less than 2 cm

residual tumorsresidual tumors►Staging once histology is availableStaging once histology is available► If confined to ovary and young age… If confined to ovary and young age…

conservative surgeryconservative surgery

Page 62: Ovarian tumors

Palliative surgeryPalliative surgery

►Removal of intestinal obstructionRemoval of intestinal obstruction

►Survival is very poorSurvival is very poor

►Quality of life considerationsQuality of life considerations