Ovarian Disorders Overview

Ovarian Disorders

• Inflammation of the ovary (oophoritis): Oophoritis occurs when one or both ovaries become inflamed, often preceded by infection of fallopian tubes or peritoneum. It's part of chronic pelvic inflammatory disease (PID), affecting the upper genital tract (uterus, tubes, and ovaries). Females under 35 are at highest risk. It rarely develops before menstruation, during pregnancy, or after menopause. Extensive fibrosis can cause sterility.

• Non-neoplastic cysts of ovary (Follicular ovarian cysts): Very common, arising from unruptured ovarian follicles. Often multiple, can grow large (over 10cm) but are usually small (approximately 1.5 cm). The lining resembles a normal follicle (granulosa and theca cells). They rarely secrete estrogen.

• Luteal cysts: Cysts in the corpus luteum, approximately 2 cm in diameter (up to 3 cm). Usually multiple and lined by luteal cells. Secretes progesterone.

• Chocolate cyst (endometriotic cyst): A specific type of cyst.

• Germinal inclusion cyst: Cyst resulting from germinal epithelium development into ovarian stroma.

• Polycystic ovary syndrome (PCOS): A common condition in 12-21% of women of reproductive age. Up to 70% remain undiagnosed. More prevalent in obese women. Can cause infertility. Requires two of three criteria for diagnosis: oligomenorrhea/anovulation, hyperandrogenism (hirsutism, raised free androgen index/free testosterone), and polycystic ovaries on ultrasound.

Ovarian Tumors

Classification of ovarian tumors:

• Surface epithelial tumors: Serous, mucinous, Brenner, endometrioid, clear cell tumors

• Clinicopathological features of surface epithelial tumors (Serous tumors): Show a significant proportion of benign cases (60%), with malignant cases (25%), and borderline (15%).

• Serous cystadenoma: Grossly, they are small to large (up to 40cm) rounded masses with smooth walls. They're often unilateral, and unilocular, filled with clear yellowish fluid. Microscopic features include a single layer of tall columnar ciliated cells with small microscopic papillae.

• Papillary Serous cystadenocarcinoma: Grossly, they exhibit solid papillary projections invading the cyst wall. Microscopically, they have more than one layer of cells showing malignancy characteristics, and may contain psammoma bodies.

• Borderline serous tumors: Grossly similar to benign, microscopically similar to malignant without involvement of the stromal tissue.

• Mucinous tumors: Benign cases (mucinous cystadenoma = roughly 80%) and malignant (mucinous cystadenocarcinoma = roughly 5-10%), with a borderline form.

• **Mucinous cystadenoma: ** Large ovoid, lobulated, usually unilateral, multilocular, gelatinous material fills the cyst. Thick and fibrous walls. Microscopically, tall columnar cells with apical mucinous vacuolation.

• Mucinous cystadenocarcinoma: Shows atypia in cells with invasion of the capsule and the presence of solid formations.

• Endometrioid tumors: Approximately 20% of ovarian cancers, associated with ovarian endometriosis (50%). Gross characteristics show solid and cystic areas; 40% are bilateral. Microscopically, resembles endometrial adenocarcinoma.

• Brenner tumors: Mostly benign, unilateral, and occasionally cystic. Varies from smaller lesions up to large masses. Dense fibrous stroma and nests of transitional cells.

• Germ cell tumors: Teratomas (mature and immature) and dysgerminoma.

• Teratomas (mature): Mostly cystic, small, called dermoid cysts; Lined with skin, hair, and sebaceous glands. Microscopically they are composed of epidermis, hair follicles, sebaceous glands, teeth, cartilage, bone, thyroid tissue, as well as other organ tissue. Malignant change (squamous cell carcinoma) in rare cases (1%).

• Teratomas (immature): Bulky, solid tumors with necrosis and hemorrhage. Immature cells differentiating into cartilage, glands, bone, muscle, or nerves.

• Dysgerminoma: Ovarian counterpart of seminoma. Usually in childhood, teens, or twenties. Solid, fleshy, yellowish-white to gray-pink; 90% are unilateral tumours. Microscopically, large cells with clear cytoplasm in sheets with scant fibrous stroma. Lymphocytes can be present.

• Sex-cord stromal tumors: Arise from embryonic gonads or ovarian stroma. Frequently functional, secreting estrogen (granulosa or theca cell tumors) or androgen (Sertoli-Leydig cell tumor).

• Granulosa-theca cell tumor: Common in postmenopausal women. Unilateral, solid and cystic areas. Usually encapsulated. Potentially malignant (5–25%).

• Microscopically: Mixture of granulosa and theca cells. Granulosa cells in cords, sheets, or strands (rosettes). Theca cells are spindle-shaped with lipid droplets.

• Fibroma-thecomas: Usually unilateral, solid, hard tumours. Well-differentiated fibroblasts. Often associated with hydrothorax/ascites (Meigs syndrome).

• Sertoli-Leydig cell tumor: Produce androgens. Usually unilateral. Composed of Sertoli or Leydig cells.

• Metastatic tumors: Primarily from gastrointestinal tract or breast. Krukenberg tumor is a bilateral metastatic ovarian cancer typically originating in the stomach's malignant cells spread throughout the peritoneal cavity.

Complications of benign ovarian cysts

• Torsion: Twisting of a pedicle leading to hemorrhage
• Rupture: leading to acute abdomen
• Pressure effects.
• Malignant change

This quiz covers a range of ovarian disorders including oophoritis, non-neoplastic cysts, and luteal cysts. Understand the symptoms, risks, and implications of these conditions, particularly among females under 35. Test your knowledge of ovarian health and its impact on fertility.