 Classify and describe the etiopathogenesis,

pathology, morphology, clinical course,

spread and complication of ovarian tumours
 Common neoplasms

 80% are benign – young (20-45)

 20% are Malignant - older (>40)

 6% of all cancers in women.

 50% deaths due to late detection.

 Less clear than other

 Nulliparity

 Gonadal Dysgenesis

 Family History

 Ovarian cancer genes

◦ BRCA1 (17q12) & BRCA2(13q12)
Tumors of ovary
 Coelomic mesothelium.
◦ Serous(tubal), Mucinous (Cervix) & endo

 Most common primary neoplasms

 90% of malignant tumors of ovary

 Morphologically
◦ Cystic – Cystadenomas
◦ Solid/cystic – Cystadenofibromas
◦ Solid - adenofibromas
 Frequently bilateral (30-66%).
 75% benign/bord., 25% malignant.
 One or few cysts, papillary/solid.
 Tall columnar ciliated epithelium.
 Papillary, solid, hemorrhage, necrosis or

adhesions – malignancy.
 Extension to peritoneum – bad prog.
 Serous tumours of ovary

Benign Borderline tumour Malignant

Benign Borderline tumour Malignant
Serous cystadenocarcinoma
 KRAS mutation is a consistent feature

 Less common 25%, very large.

 Rarely malignant - 15%.

 Multiloculated, many small cysts.

 Tall columnar, apical mucin.

Goblet

Endocervical
 Pseudomyxoma peritonei.
◦ Extensive mucinous ascites
◦ Cystic epithelial implants on peritoneal surfaces
◦ Adhesions
◦ Frequent involvement of the ovaries
 It was thought it is due to primary mucinous
ovarian neoplasm but later it is confirmed
that it is due to non ovarian primary like
appendix.
 15-20% cases coexists with endometriosis
 Benign
 Boderline
 Malignant
 15-30% are associated with endometrial

carcinomas
 Contains neoplastic epitlelial cells resembling
urothelium and are usually benign

 10% of ovarian tumours

 Also referred as Brenners tumour

 Most often detected incidentally

 Teratoma –
◦ Benign cystic teratoma / mature teratoma (dermoid
cysts)
◦ Monodermal teratoma – struma ovarii, carcinoid
◦ Immature teratoma

 Dysgerminoma

 Yolk sac tumor

 Mixed germ cell tumor

Rokitansky's
protuberance
 Struma ovarii
◦ Composed of mature thyroid tissue
◦ May cause hyperthyroidism

 Carcinoid
◦ Intestinal tissue in teratoma may become funtional
and produce 5 hydroxytryptamine
◦ It must be differentiated from metastatic carcinoid
Immature teratoma
 It is ovarian counterpart of testicular
seminoma

 Accounts for 2% of ovarian cancers and

roughly 50% of all malignant ovarian tumours

 Occurs in patients with gonadal dysgenesis

 Most have no endocrine function

Dysgerminoma ovary
 Rank 2nd most common malignant tumour of
germ cell origin

 The tumour cells produce α-fetoprotein.

 Most patient are children or young adult

 Granulosa cell tumour

 Fibromas, thecomas and fibrothecomas

 Sertoli-leydig cell tumour

 Steroid cell tumours

 Composed of cells resembling granulosa cells
of a developing ovarian follicle

 Broadly divided as
◦ Adult type
◦ Juvenile type

 5% of all ovarian tumours

 Clinical importance
◦ Elobrate large amounts of estrogen
◦ May behave like low grade malignancies

 Precocious puberty

 Proliferative breast disease

 Endometrial hyperplasia and endometrial

carcinomas

 Elevated levels of inhibin

 Tumour composed of fibroblasts – fibromas

 Tumour composed of plump spindle cells

with lipid droplets – thecomas

 Mixture of both – fibrothecomas

 Meigs syndrome
◦ Ovarian tumour (fibroma)
◦ Ascites
◦ hydrothorax
 Liver
Krukenberg tumour
Stomach primary
Krukenberg tumour
 Torsion
 Malignancy/ mets
 Hyperthyroid or carcinoid symptoms
 Endometrial hyperplasia
 Masculinizing symptoms