NEOPLASTIC DISEASES OF OVARY Dr. Cayabyab

1. NEOPLASTIC DISEASES OF OVARYDr. Cayabyab Ovarian neoplasm � 2nd most malignant in female genital tract Classification of ovarian neoplasm 1. epithelial stromal 65% 2. Germ Cell tumors 20 -25 % 3. Sex Cord Stroma 6% 4. Lipid cell tumor <0.1% 5. Gonadoblastoma <0.1% Others: soft tissue, unclassified, metastatic, tumor- like

2. 1. Epithelial stromal tumor cell types a. serous � most common b. mucinous c. endometroid d. clear cell e. Brenner Epithelial can be categorized as benign (adenoma) malignant(adenocarcinoma) intermediate- borderline/tumors of low malignant potential

3. Associations of increasing or decreasing risks of ovarian epithelial carcinoma Increases Decreases 1. age breastfeeding 2. diet OCP 3. family history pregnancy 4. industrialized tubal lig/hyst country conserve ovary 5. infertility 6. nulliparity,ovulation ovulatory drugs/talc?

4. Benign conditions in which Ca -125 is increased: 1. endometriosis 2. peritoneal inflammation 3. Leiomyoma 4. pregnancy 5. hemorrhagic ovarian cyst 6. liver disease Ca-125 is the tumor marker in ovarian neoplasm

5. Staging of ovarian Ca Stage 1- growth limited to ovaries 1A � one ovary no ascites capsule intact 1B � both ovaries no ascites 1C � either 1A or 1B capsule ruptured ascites + / peritoneal washing +

6. Stage 11 � one or both ovaries with pelvic extensions 11A � mets to uterus/ tubes 11B - mets to pelvic tissues 11C � either 11A/11B capsules ruptured +ascites + peritoneal washings

7. Stage 111 � one or both ovaries with peritoneal implants outside the pelvis + retroperitoneal/inguinal nodes superficial liver mets limited to true pelvis histologically proven malignant extension to small bowel or omentum 111 A- limited to true pelvis /microscopic seeding 111 B � one or both ovaris with implants none exceeding 2 cm, nodes negative 111C � abdominal implants more than 2cm (+) retroperitoneal/inguinal nodes

8. Stage 1V � one or both ovaries with distant mets if pleural effusion present there must be (+) cytology 1VA � parenchymal liver mets

9. Diagnosis: Pelvic exam- palpation of a mass USG � usually incidental Dx frequently made after the disease had spread beyond the ovary Pt manifest ascites vague abdominal discomfort swollen abdomen first sign confirmatory dx � histopath after the ovarian tissue was removed surgery. others: CT scan , CA -125

10. Staging of ovarian ca is based on the result of operative exploration. Spread � extension lymphatic Management � Explore lap childbearing � preserve one ovary chemotherapy Prognosis: depends on Stage Grade cell type amount of residual tissue

11. 2. Germ Cell tumors - second most frequent 1. Dysgerminoma a.endodermal sinus tumor b. embryonal ca c. polyembryoma d.choriocarcinoma e. teratomas immature mature - solid/cystic

12. Mature dermoid cyst ( mature cystic teratoma) dermoid cyst with malignant transformation Monodermal and highly specialized struma ovarii � thyroid tissue carcinoid � GIT tissue sruma ovarii/carcinoid Others Mixed forms

13. Mature � Teratomas has 3 layers of developing embryo Ectoderm Mesoderm Endoderm has XX karyotype Benign cystic teratomas (Dermoids) most common germ cell tumor more on reproductive years usually unilateral

14. Immature teratomas � malignant Dysgerminoma- has primitive germ cells with stroma infiltrated with lymphocytes radiosensitive usually bilateral Endodermal sinus tumor � (yolk sac tumor has Schiller duval bodies secretes alpha feto protein common in young patients

15. Gonadoblastomas � with germ cell and sex cord stromal elements Granulosa theca cell tumors � with granulosa cells has Call Exner bodies pt may manifest vaginal bleeding more in older patiets Thecomas/ fibromas thecomas � benign � solid in menopause

16. Fibromas � can have large ovarian tumor with asictes/ pleural effusion hydrothorax(Meig�s syndrome) regress upon removal of tumor Metastatic- tumors Krukenburg�s tumor tumors from GIT