Diseases of Ovary PDF

Disorders of the ovaries BY DR. HUSAMELDIN OMER Inflammation of the ovary (oophoritis):  Oophoritis occurs when one or both ovaries become inflamed, commonly preceded by infection of the fallopian tubes or peritoneum.  It classified as part of the chronic pelvic inflammatory...

Disorders of the ovaries BY DR. HUSAMELDIN OMER Inflammation of the ovary (oophoritis):  Oophoritis occurs when one or both ovaries become inflamed, commonly preceded by infection of the fallopian tubes or peritoneum.  It classified as part of the chronic pelvic inflammatory disease (PID), which is inflammation and infection in the upper genital tract of females (uterus, tubes and ovaries).  Females under age 35 years are at the most significant risk of PID and oophoritis. It rarely occurs before the start of menstruation, during pregnancy, or after menopause.  Extensive changes with fibrosis may occur causing sterility. Non-neoplastic cysts of ovary: Follicular ovarian cysts:  Very common, arise from unruptured graafian follicles  Often multiple, can reach large sizes (above 10 cm), but usually small about 1.5 cm in diameter  Lining resembles normal follicle (granulosa and theca cell layer)  Rarely secrete estrogen. Luteal cysts:  Cystically dilated corpus luteum, about 2 cm in diameter (reach up to 3 cm)  Usually multiple, lined by luteal cells.  Secret progesterone. Chocolate cyst (endometriotic cyst). Germinal inclusion cyst: due to dipping of germinal epithelium into the ovarian stroma. Polycystic ovary syndrome (PCOS) is a common condition, present in 12–21% of women of reproductive age. Up to 70% of women with PCOS remain undiagnosed. More in obese women and may cause infertility. Two of the following three criteria are required for diagnosis  oligomenorrhea/anovulation  Hyperandrogenism (clinically reflected by the hirsutism or biochemically manifested by raised free androgen index FAI or free testosterone  polycystic ovaries on ultrasound Polycystic ovary Classification of the ovarian tumors: Surface epithelial tumors:  Serous tumors.  Mucinous tumors.  Brenner tumor.  Endometrioid.  Clear cell tumors. Germ cell tumors:  Teratoma.  Dysgeminoma.  Choricarcinoma.  Embryonal carcinoma.  Yolk sac tumor (endodermal sinus). Sex-cord stromal tumors:  Granulosa-theca cell tumor.  Sertoli-stromal cell tumor.  Gynandroblastoma. Soft tissue tumors:  Fibroma.  Angioma. Metastatic secondary tumors. Clinicopathological features of surface epithelial tumors Serous tumors:  Benign(60%).  Malignant (25%).  Borderline (15%). Serous cystadenomas: Grossly; Small or large (up to 40 cm in diameter).Rounded masses with smooth thin wall. Mostly unilateral. Unilocular, filled with clear yellowish fluid. May show papillary projections inside or outside the surface. Microscopic:  The lining epithelium is single layer of tall columnar ciliated cells.  Small microscopic papillae. Serous cystadenoma Papillary Serous cystadenocarcinoma Gross:  They have solid papillary projections, which penetrate the capsule of the cyst (papillary processes on both sides of the cyst wall).  Solid loculi may be found. Microscopic:  The lining epithelium is more than one layer, and showing the criteria of malignancy.  Psammoma bodies may be found. Borderline serous tumors:  Grossly they resemble the benign form.  Microscopically, they resemble the malignant form, without stromal invasion. Mucinous tumors:  Benign (mucinous cystadenoma): 80%  Malignant (mucinous cystadenocarcinoma): 5-10%.  Borderline. Mucinous cystadenoma:  Grossly: it may be very large ovoid or lobulated, usually unilateral and multilocular, filled with gelatinous material. The wall is thick and fibrous.  Microscopically, the tumors lined by tall columnar cells with apical mucinous vacuolation. Mucinous cystadenocarcinoma:  There is atypia of the cells and invasion of the capsule.  Presence of solid masses of the tumor. Borderline forms:  Shows the same change as the malignant but without invasion of the capsule. Complications of benign serous & mucinous cystadenoma  Torsion or twisting of the pedicle, leading to hemorrhage.  Rupture of a cyst leading to acute abdomen.  Pressure effects.  Malignant change in serous cystadenoma. Endometrioid tumors:  20% of all ovarian cancers.  50% are associated with ovarian endometriosis.  Grossly, the tumors show solid and cystic areas. 40% are bilateral.  Microscopically, the glandular structures resemble endometrial adenocarcinoma. Brenner tumors:  Mostly benign, unilateral, occasionally cystic.  Varies from small lesions up to large mass.  Formed of dense fibrous stroma and nests of transitional cells. Clinicopathological features of Germ cell tumors Teratomas: Arise from totipotent cells, capable of differentiation into the 3 germ cell layers. Types include: Mature teratomas:  Mostly cystic, small, called dermoid cysts.  Lined by skin with adnexal structures and filled with hair bearing sebaceous secretion. Microscopic:  they composed of epidermis, hair follicles, sebaceous glands & tooth structures. Cartilage, bone, thyroid tissue and other organ tissues may be found.  Malignant change (sq cell carc) may occur in 1% of cases.  Monodermal teratoma: The most common is struma ovarii (thyroid tissue), carcinoid, and combined. Immature (malignant) teratoma: Most common in adolescents and young women (mean age is 18 years). Gross: the tumor is bulky and solid with areas of necrosis and hemorrhage. Microscopic: formed of mixture of immature tissues, differentiating towards cartilage, glands, bone, muscle or nerve. Dysgerminoma (malignant):  It is the ovarian counterpart of seminoma.  Age incidence: childhood, teens or twenties.  Gross: it is a solid tumor, 90% unilateral, fleshy, yellowish-white to gray-pink in color.  Microscopic: it is composed of sheets and cords of large cells with clear cytoplasm, separated by scant fibrous stroma containing lymphocytes.  Gross and microscopic appearances of dysgerminoma Clinicopathological features of Sex cord stromal tumors:  Arise either from sex cords of the embryonic gonads or from the stroma of the ovary.  The tumors are frequently functioning, secreting estrogen (granulosa and theca tumors) or androgen (Sertoli-Leydig cell tumor). Granulosa-theca cell tumor: Common in postmenopausal women. Gross:  Unilateral.  Has solid and cystic areas.  Varies in size.  Encapsulated.  Potentially malignant (5%-25%). Microscopically, It is composed of a mixture of granulosa and theca cells. The granulosa cell component consists of small cuboidal cells growing in cords, sheets or strands, forming rosettes. The theca cell component is formed of spindle cells having lipid droplets in their cytoplasm. Fibroma-thecomas:  Common tumors.  Usually unilateral, solid, hard masses.  Composed of well differentiated fibroblasts.  40% of fibromas are associated with hydrothorax and ascites “Meigs syndrome”. Sertoli-Leydig cell (androblastoma) tumor:  Produce androgens.  Usually unilateral.  Composed of Sertoli or Leydig cells and stroma. Clinicopathological features of Metastatic tumors:  Mainly from GIT and breast tumors.  Krukenberg tumor refers to metastatic ovarian cancer (bilateral), from GIT, mostly the stomach. The malignant cells spread through the peritoneal cavity