Ovarian Tumer Flashcards
D/D of Ovarian Mass
Functional :
1. Follicular cyst
2. Corpus luteal cyst
3. Thea luteal cyst
Inflammatory :
1. Tubo-ovarian abscess
2. Oophoritis.
Neoplastic
1. Benign
2. Malignant
Other:
1. Endometriotic cyst
2. Enlarged ovary in PCOS
3. Para-ovarian cyst
Ultrasound features of ovarian masses
Benign
Malignant
——
Internal structure:
Margins:
Echogenicity :
Content :
Vascularization :
Pouch of Douglas :
سلايد ٧
What’s the type of benign ovarian tumer ?
• Epithelial : 60%
1. Serous cystadenoma
2. Mucinous cystadenoma
3. Brenner
• Germ cell :
1. Mature cystic teratoma (Dermoid cyst)
2. Stuma ovaraii
• Sex cord- stromal :
1. Fibroma
2. Thecoma
Serous cystadenoma
- composed of cells resembling the fallopian tube lining.
- Unilocular, may have septations , with Papillary components
- Unilateral, 10-20% are bilateral
- CharacterisCc psammoma
bodies
Mucinous cystadenoma
- Composed of cells resembling the endocervical lining
- Multiloculated , unilateral 5-10% bilateral.
- Can get extremely large 7-10kg
- Round mass with smooth
capsule. - Contain clear, viscid fluid
Most common tumors of the reproductive age group (50% of all)
Benign Germ cell Ovarian Tumors
DERMOID CYST (mature cyst teratoma)
• Most common ovarian tumor in young age
• Peak incidence 20 years
• 90% of germ cell tumors
• 10% are bilateral
> 15 % present with acute torsion Its contents may be the derivatives of 3 embryonic cell layers:
1. Ectoderm: skin, hair, teeth & nervous tissue
2. Mesoderm: cartilage, bone, and muscles
3. Endoderm: thyroid, stomach, & intestinal tissue
STUMA OVARII
consists only of the active thyroid tissue
Treatment of Benign Germ cell tumors
• Cystectomy. to preserve ovarian function. Careful evaluation of the opposite adnexa should be
performed, as dermoid cysts can occur bilaterally in 10–15% of cases.
• Oophorectomy: If an ovarian cystectomy cannot be done, then an oophorectomy is performed, but conservative management should always be accepted before an oophorectomy is done.
• Follow-up is on an annual basis.
Benign sex cord-stromal Ovarian Tumors
• These are solid tumors
• Composed of stromal cells
• Present in post-menopausal women
OVARIAN FIBROMA
Meig’s syndrome consists of pleural effusion, ascites & ovarian fibroma
THECOMA (theca cell)
((secrets estrogen)) cause :
1. post-menopausal bleeding
2. associated with ca endometrium
What is the type of Malignant Ovarian Tumors
Epithelial 90% :
1. Serous cystadenocarcinoma
2. Mucinous cystadenocarcinoma
3. Endometrioid ca
4. Clear cell carcinoma
5. Undifferentiated.
Germ cell 5% :
1. Malignant teratoma
2. Dysgerminoma
3. Endodermal sinus tumor
4. Choriocarcinoma
5. Gonadoblastoma
Sex cord- stromal 3-5%:
1. Granulosa cell
2. Theca cell
3. Sertoli-leydig cell
4. Gyandroblastoma
Mucinous cystadenocarcinoma
Pseudomyxoma peritoneii’ a thick, jelly-like ascites with mucinous tumor deposits throughout the abdominal cavity.
Borderline ovarian tumors (BOTs)
- Variant of epithelial ovarian cancers
- Tumors of low malignant potential
- Well-differentiated with nuclear pleomorphism and cellular atypia but doesn’t invade the basement membrane
- Behaves much less aggressively and prognosis is very
favorable - 10% of malignant ovarian tumors.
- Presents at a younger age, at approximately 48 years
- Staging by using the FIGO
- > 75% of presentaCons are at stage1
Malignant germ cell tumors (5%)
- Unilateral (except for dysgerminoma).
- Young age
- Lymphatic spread
- Rapid growth
- Most are stage I and confined to the ovary at the time of diagnosis.
- increased incidence with dysgenetic gonads.
Patient with pain in the right side and there is a mass on ovary and she is down syndrome. What type of the tumor maybe she has?
Malignant germ cell tumors.
Malignant germ cell tumours
• Tumour markers
• Dysgerminoma ➙ LDH, Placental alk
phosphatase
• Endodermal sinus tumor ➙ alpha-
fetoprotein
• Choriocarcinoma ➙ (bHCG)
Treatment of Malignant germ cell tumors
- A unilateral salpingo-oophorectomy and surgical staging (peritoneal and diaphragmatic biopsies, peritoneal cytology, pelvic and paraAortic
lymphadenectomy, and omentectomy) - postoperative chemotherapy (Vinblastine, Bleomycin, and cisplatin).
((( ALL pt ))). - Follow-up (( every three months )).
Malignant Sex cord-Stromal Ovarian Tumors. What’s the type and what’s the characteristic?
- Granulosa cell tumer
• Low-grade malignancy
• Reproductive age (5% prepubertal)
• Produce estrogens Asso with : endometrial carcinoma 5% endometrial hyperplasia 25-50% - Sertoli-Leydig Tumour :
• Low-grade malignancy
• 75% <40 years
• Produce androgens : Asso with 70-85% - clinical virilization
Sex-cord stromal tumors (5%)
What’s the hormonal produce ?
• Granulosa cell tumor ➨ Estrogen
• Sertoli cell tumor ➨ Estrogen
• Leydig cell tumor ➨ Antrogens
Sex-cord stromal tumors
How are you gonna treat it?
Surgical removal
Secondary or Metastatic Ovarian Tumours:
- ovaries may get enlarger than primary malignancy
- H/P shows the primary picture
- From the Genital tract
- From extragenital tract organs
Krukenberg tumor:
• secondary ovarian tumor from metastatic spread of gastric carcinoma • Uniform enlargement
• Bilateral involvement Characteristic mucin-secreting signet-ring cell appearance.
Ovarian Cancer Risk Factors
- 50 years of age or older
- Familial factors:
A • Family history of breast, ovarian, or colon cancer 3x baseline risk.
B • Personal history of breast or colon cancer
C • Familial cancer syndrome (10%) :
- BRCA (breast cancer) gene mutation
- hereditary non-polyposis colon cancer.
[[ Other potential risk factors ]]
• Early menarche (younger than 12 years of age)
• Late menopause (older than 52 years of age)
• Nulliparity
• First pregnancy at older than 30 years of age
• Infertility , endometriosis
• (fertility Rx does not increase risk)
• Hormone replacement therapy
BRCA1
chromosome 17
BRCA2
chromosome 13
A tumor suppressor gene
produces a protein for
DNA repair» predispose to the development of breast and ovarian cancer
Hereditary nonpolyposis colorectal cancer
• Also known as “Lynch syndrome”
• 12% risk of developing ovarian cancers.
• A hereditary cancer syndrome caused by a mutation in mismatch repair genes. Individuals have a signifcantly higher risk of developing colorectal, gastric, ovarian, and endometrial cancer.
Protective factors
Surgical interven :
• Bilateral salpingo-oophorectomy.
• Hysterectomy.
• Tubal ligation.
Hormonal factors :
• Oral contraceptives.
• breast-feeding.
• Parity.
Presentation S&S
• Can be asymptomatic
• Incidentally found on routine pelvic examination or imaging
• Early symptoms are nonspecifc
• Changes in urination (e.g., frequency or urgency)
• Bloating/abdominal distention
• Early satiety
• Nonspecifc pelvic pain
• Abnormal bleeding
• Postmenopausal bleeding
• Rectal bleeding
• Adnexal mass
• Para neoplastic syndromes
Clinical examination
Pelvic/abdominal mass (fxed/mobile); ascites; omental mass; pleural effusion ; supraclavicular lymph nodes.
Tumour markers:
• CA125
• Carcinoembryonic antigen(CEA): raised in colorectal cancers, normal in ovarian CA
• AFP, hCG, LDH, inhibin, and oestradiol
What’s the investigation of the ovarian cancer?
- Haematological tests: FBC, U&E, LFTs.
- Tumour markers:
• CA125
• Carcinoembryonic antigen (CEA): raised in colorectal cancers, normal in ovarian CA
• AFP, hCG, LDH, inhibin, and oestradiol - Image :
• Abdominal/pelvic USS: the presence of pelvic mass and ascites
• CXR: pleural ecusion or lung metastases
• CT abdomen/pelvis: the extent of metastasis
• MRI abdomen/pelvis : to assess the origin & the extent of metastasis
Surgical staging of primary ovarian cancer:
mid-line sub umbilical suprapubic exploratory laparotomy:
- Exploration of the pelvic and peritoneal cavity
- Aspiration of (ascites) or
perform peritoneal washings for Cytology. - infracolic omentectomy.
- Pelvic and paraAortic lymph node sampling
- Resection of any visible enlarged nodules or masses.
