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Ovary. Diseases of the ovary. nonneoplastic lesions - pelvic inflammatory disease - ovarian cysts - endometriosis ovarian tumors - epithelial ( surface epithelial-stromal ) - sex cord-stromal - germ cell - germ cell sex- cord stromal. Ovarian cysts. Nonneoplastic.
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Diseases of the ovary • nonneoplasticlesions • - pelvicinflammatorydisease • - ovariancysts • - endometriosis • ovariantumors • - epithelial (surfaceepithelial-stromal) • - sex cord-stromal • - germ cell • - germ cell sex-cordstromal
Ovarian cysts Nonneoplastic Cystic tumors epithelialtumors - cystadenoma (benign, borderline) - cystadenocarcinoma germ cell tumors - dermoid cyst • inclusion • functional • endometrioid
Nonneoplasticcysts • inclusioncysts • - inclusionsofthesurfaceepithelium • - inclusionsfromfimbrialepitehlium • functionalcysts • - follicular cyst • - corpus luteum cyst • - hemorrhagic cyst • endometrioid cyst
Classification of ovarian tumors • surfaceepithelial (epithelial-stromal) tumors • sex cord-stromaltumors • germ cell tumors • germ cell sex cord-stromaltumors
Classificationofsurfaceepithelialtumors • according to their gross features: • - cystadenoma (cystadenocarcinoma) • - cystadenofibroma • - adenofibroma (adenocarcinofibroma) • - surfacepapilloma (surfacepapillarycarcinoma) • according to theirhistogenesis
Surfaceepithelialtumors • benign • borderline • malignant • serous • - low grade • - high grade • endometrioid • clear cell • mucinous
Benignepithelialtumors • canbelarge (especiallymucinoustumors – theworld´sbiggest tumor weighted 136 kilos) • symptoms and signsusuallynonspecific: • - pelvicpain • - discomfort • - anasymptomaticpelvic mass • up to 25% oftumorsbilateral
Borderlinetumors • increasedepithelialproliferation • do not display invasion • usuallybehave in a benignfashion • but behaviorcanbemalignant • clinicalfeaturessimilar to thoseforbenigntumors
Ovarian cancer • about 30% ofallcancersofthefemalegenitaltract • incidence rates are highestin the economically advanced countries (most frequent cause ofdeathdue to gynecologicalcancer) • epithelialcarcinomasaccount for 90% of these cancers in North America andWestern Europe • in some Asian countries, including Japan,germ cell tumours account for a significant proportion (20%) ofovarian malignancies
Ovariancancer Risk factors Protectivefactors increased parity oral contraceptive use surgicallyinduced: - hysterectomy - tuballigation - bilateralsalpingo-oophorectomy • age • reproductivefactors • - early menarche, latemenopause • highsocioeconomic status • - lower fertility • BRCA1/2 mutation (5-10% hereditary)
Classificationofovariancarcinomas (WHO) surfaceepithelial-stromal (98%) endometrioid (10%) carcinosarcoma low grade serous (<5%) uncertainhistogenesis high grade serous (70%) undifferentiated mucinous (3%) small cell, lung type unspecified clear cell (10%) small cell, hypercalcemic type malignantBrenner tumor squamous cell large cell neuroendocrinne urothelial arisingfromteratoma(dermoid cyst) adenoidcystic adenocarcinoma hepatoid othertypesofcarcinoma
Prognosticfactors • histologic subtype • histologic grade • stage • advancedcancer: • - macroscopic absence ofresidual tumor afterprimarysurgery
about 8 % ofallovariantumors composedof: granulosacells thecacells fibroblastsofstromalorigin Sertolicells Leydigcells singly or in variouscombinations Sex cord-stromaltumors granulosa cell tumor (adultorjuveniletype) thecoma fibroma fibrosarcoma Sertoli cell tumor Leydig cell tumor
Germ cell tumors • different tumor typesderivedfromthe primitive germcellsoftheembryonicgonad • represents: • -about 30% ofallovariantumors (up to 95 % are maturecysticteratomas) • - about 3 % ofallovariancancers (western world) • - up to 20 % ofallovariancancers (Asia)