patho sheet 6th of Dr faisal - Karmel Qasem

Lecture nob.6 ( pathology ) – last lecture ;]

Today we are going to talk about neoplastic tumors of the ovary, in last lecture we've talked about non-neoplastic tumors of ovary.

We introduced in last lecture the term "cystic" which mean – tumor like condition-
In fact we have 3 kinds of these cysts;
1. follicular cyst , which differ than the cystic follicular that its size is more than 2-3 cm. it might secretes estrogen

2. Corpus lutem cyst which secrets progesterone.
Within 2 month, these follicular cyst and corpus lutem cyst are totally benign and should regress; otherwise you should consider them neoplastic

3. polycystic ( stein-leventhal syndrome)

- affect both ovaries (bilateral)
- Particularly, it's benign
- Fibroids and seclortcis material are found and this prevent ovulation
- It may result in prevention of puberty, amenorrhea, and infertility.
- Treatment; in past they were used wedge restriction but nowadays they don’t use this surgery anymore, instead of it they use medical treatment and its effective =]


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One of the most important topics in ovary is the tumor whether it's benign or malignant,
And whenever you discover the malignant, it will be far advance than you expected.
Remarks;
1. Death rate of ovarian (6%) is much more than incidence rate.
2. Causes of ovarian tumor, not all of them are well-known, although they are pin pointing nowadays to genetic influence there are other factors such as
1- nulliparity ( unmarried women and married women whom don’t have child yet ) , that’s because in every 2 month , 1 ovary will produce ova , in other words the cortex and epithelial will be traumatized and this result in different injuries .
2- Family history; any women if her mother or grand ma was affected, there will be marginal increase.
** Some said that oral contraceptives may protect in a way or another from ovarian cancer.

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Ovarian cancer

- They are 25-30 major categories but we are going to depend on WHO classification, in which we have 3 major classes.


A. surface epithelial tumor
B. sex cord-stromal tumors
C. germ cell tumor
D. Others



A. surface epithelial tumor
- Most common
- It's responsible for (60-70%) of all cases

1) Serous tumor
- Most common of all surface epithelial tumors
- Serous material is secreted by this tumor and it has papillary formation
- There are 3 sub-types;

First: benign (cystic) = serous cystic adenoma
- It enlarges from few cm to several; it contains watery secretions plus warts inside (papillary projection)
- It has smooth surface from inside and outside.

Second; malignant = serous cystic adenocacinoma
- It has all the features of malignant (poor differentiated, high n/c)
- It invades/ dips within underlying ovarian tissue.
- It has irregular structure AND SOLID.
** We have marker (ca125) which found in blood and urine, it is not characteristic but almost always present with this tumor. It has disadvantages in which it is not sensitive or specific, that’s mean, it might be +ve for other tumor or gives you false +ve/-ve.



Third: borderline
- It is not moderate differentiated
- It is very characteristic pathological term, meaning; malignant but this malignancy is not having destructive/necrotic invasion to underlying ovary.
- So it differs from the pure malignancy

2) Mucinous tumor.
- Less common than serous
- There are 3 types [benign-borderline-malignant]
- There are 3 main characteristic:
Multi-cystic / secretion is mucous / it has large size, in which (40-50% larger than serous cyst)
** Behavior of mucinous tumor is less aggressive than serous.
** Sometimes you might find mucous secretion in peritoneal adhere to it, and this is really dangerous, it could lead to obstruction to many organs, result in complication and death … this condition is called (psdeudomyxoma peritoneal)
** It might result in overlap between two tumor, mucinous adenocacinoma and appendix tumor.

3) Endometroid tumor
- Almost malignant
- This tumor is very similar to endometrial cancer.
- arise from surface epithelial ovarian converge.

4) Brenner tumor
- It is benign.
- It is very similar to transitional epithelial of the urinary tract


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B) Sex cord-stromal tumors (10-15%)

1) Granulusa cell tumor
- Potentially malignant.
- Vast majority secretes estrogen
- There are 2 subtypes:

First: affect adult in their middle age ( post- menopausal women)
-It secrets estrogen lead to
a- hyperplasic
B-endometrium cancer
c- Ductal carcinoma of Brest

Second; affect young children (6-7) years which called "Juvenile"
- It is rare
- Secretion of estrogen leads to precocious puberty.

*** Remark ***
If we find pure granloma cells, thus there is no secretion of estrogen; on the other hand, if we found theca cells with granloma cells, there will be estrogen ….

2) Theca cells tumor
- Benign especially if it is pure theca cells.
- Insidious are less than granloma cells
- it secrets estrogen.

3) Fibroma
- Benign – arise from fibroblast
- It is a solid mass – enlarge in size

***Remark***
it might associated with pleural effusion and this condition is called (megi-syndrome), once you remove the fibroid, the pleural effusion will disappears.

4) Others


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C) Germ cell tumor
1) Teratoma – benign
- Marked by a tissue of 3 germ layers (endoderm, ectoderm, and mesoderm)
- cyst might contain hair, skin .eye tissue, brain tissue and many others!!!
- It has 3 types;

First; majority of them are benign cystic = dermoid cyst
- It contains 3 germ layers and affects young people
.
Second; malignant = teratoma carcinoma
- They are less in number.
- Tendency is older age.
- You might found either undifferentiated cell or/and nerve/ brain tissue.

Third; monaderm (endocrine)
- It is specialized.
- One tissue predominate on others tissue and it is differentiated in structure and function.
- Example ; thyroid tissue in ovary (struma ovarii )

2) Dysgermioma; meaning it is atypical.
- It is very similar to testicular seminoma tumor even in histological and behavior aspect.
- Very radio sensitive
- consider as malignant tumor
- affect mainly adolescence

3) Yolk sac tumor
- Very malignant tumor
- found in younger age
- It is consider as alfa-feto protein secretor.






Tumor – metastatic to ovaries

- They are primarily coming' from Brest, lung. G.I tract.
- In case we found (adeno carcinoma) in the ovary, we must find out the reasons, it might come from GI ( stomach) in a condition called Krukenberg tumor.

[[[Krukenberg tumor A Krukenberg tumor is a type of ovarian tumor which starts in another area of the body and migrates to the ovaries. Around five to six percent of ovarian cancers present as Krukenberg tumors, and the prognosis for patients with this type of tumor are not good. Because Krukenberg tumors are secondary metastases, rather than primary tumors, identifying one means that a patient has an underlying primary cancer which may have spread to other areas of the body, which would complicate treatment considerably. ]]]










Done by; Karmel Qasem
Pathology
Last lecture for Dr .faisel...
Nob. 6
Date; 22-4-2011