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Female Genitalia IV. Ovary. Ovary. Inflammation Non-neoplastic cysts Neoplasms. Ovary Inflammation. Primary inflammation is rare Usually secondary to spread from fallopian tube (tubo-ovarian abscess) Other causes- appendicitis, diverticulitis etc. Ovary Non-neoplastic cysts.
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Female Genitalia IV Ovary
Ovary • Inflammation • Non-neoplastic cysts • Neoplasms
OvaryInflammation • Primary inflammation is rare • Usually secondary to spread from fallopian tube (tubo-ovarian abscess) • Other causes- appendicitis, diverticulitis etc
OvaryNon-neoplastic cysts • Follicular cysts - Polycystic Ovarian Syndrome (Stein-Leventhal) • Corpus luteum cysts - may cause intraperitoneal haemorrhage • Simple cysts • Endometriotic cysts - haemorrhage within endometriotic deposits; “chocolate cysts”
OvaryNeoplasms Classification of Primary Neoplasms • Surface (germinal) epithelium (approx. 65%) • Germ cells (approx. 20%) • Sex cord-stromal cells (approx. 10%) • Miscellaneous, i.e. tumours not specific to the ovary (approx. 5%)
Surface Epithelial NeoplasmsClassification • Serous • Mucinous • Endometrioid • Brenner • Clear cell • Undifferentiated
Surface Epithelial Neoplasms Cystadenomas/cystadenocarcinomas • Serous - lining resemble fallopian tube • Mucinous - resemble lining of cervix • Endometrioid - resemble endometrium • Brenner - resemble urothelium
Serous Tumours • 25% of all ovarian tumours • 30-50% bilateral • Benign ones, predominantly cystic • Malignant ones, more solid • Papillary projections into cyst cavities • Borderline (LMP) - features of malignancy but no stromal invasion
Mucinous & Endometrioid Neoplasms Mucinous • Less common than serous, 10-20% bilateral • Benign, borderline, malignant • Tend to grow to very large size • “Pseudomyxoma peritonei” Endometrioid • Resemble endometrial carcinoma and may coincide with it
Sex Cord-Stromal Tumours • Granulosa cell tumour • Thecoma/Fibroma • Sertoli-Leydig cell tumour
Granulosa Cell Tumours • Occur at any age • Peak incidence, postmenopausal • 25-75% produce excessive oestrogen • Children - precocious puberty • Reproductive age - menstrual irregularities • Older age - p.m.b. • All potentially malignant, but • Most behave benign • High-grade malignant varieties occur
Thecoma/Fibromas • Originate from theca cell • Thecoma • Solid, firm • May produce oestrogen; a few produce androgens • Nearly always benign • Fibroma • Solid, invariable benign • Meig’s syndrome
Sertoli-Leydig Cell Tumours • Resemble Sertoli & Leydig cells of testis • Predominantly solid • Usually found in young adults • About half accompanied by excess androgen secretion - virilization • Most are of low-grade malignancy
Germ Cell Tumours • Dysgerminoma • Yolk sac tumour (endodermal sinus; embryonal ca) • Choriocarcinoma • Teratoma Comprise about 20% of ovarian tumours, but are most COMMONovarian tumour in girls and young women
Germ Cell Tumours • Dysgerminoma • All malignant • Very radiosensitive with • Up to 95% 5-yr survival • Yolk sac tumour - highly malignant; alpha-fetoprotein • Chorioca - Rare! Most are metastases from corpus
Teratoma Benign cystic teratoma (dermoid cyst) • Most common GCT (up to 95% of GCTs) • Are multilocular or unilocular cysts • Containing cheesy or porridge-like sebaceous material with matted hair • Sometimes cartilage, bone and/or teeth grossly • Tissues from all 3 germ cell layers but ectodermaltissues predominate • “Struma ovarii” – may be functional
Teratoma Solid teratomas • Are invariably malignant • Are also known as "immature teratomas" • Malignancy due to immaturity of the tissues – usually immature neuroepithelium
Secondary (Metastatic) Tumours • Most common - stomach, colon, breast, corpus and cervix uteri • Krukenberg tumour - bilateral, solid, mucin-secreting “signet ring” cells; usually from stomach, colon, breast • Mets to ovary connote poor prognosis
Ovarian TumoursGeneral Features • USA - most fatal gynae. malignancy; kill more than ca.cx & corpus combined • Ranked 6th in women in Ja • Presentation - asymptomatic, pain, mass, signs of malignancy, hormonal changes etc • Prognosis - tumour type; grade; stage • Surgical +/- radioRx, chemoRx