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REGUB: Pathology of the Fallopian Tubes and Ovaries (ii) Ovarian Neoplasms
REGUB: Pathology of the Fallopian Tubes and Ovaries (ii) Ovarian Neoplasms
Benign
80%
in younger women (20-45)
cystadenoma
cystadenofibroma
adenofibroma
Malignant
primary
WHO classification based on tissue of origin
carcinomas (epithelial, surface)
OCP, pregnancy + breastfeeding are protective
rare in under 20s, mainly over 40s
Classification based on lining epithelium
mucinous
usually a met from GIT
appendix, colon, pancreas
bilat
nodular surface
pseudomyxoma peritoneii or ovarii = dx (gelatinous fluid collection, peritoneii esp a/w appendices tumours)
use IHC: usually CK 20+, CK 7 -ve
occur in middle life
25% of ovarian tumours (based on old literature)
80% are benign or borderline
endometrioid adenocarc
20%
tubular glands resembling endometriosis
arise from endometriosis (pain + infertility)
up to 1-3 have simultaneous tumours in endometrium
identical to endometrioid tumours of the uterus
characteristic squamous morules
clear cell
clear cells + hobnail cells
can be a/w endometriosis
poor prognosis
pattern of tubular, solid, cystic
brenner (transitional cell)
like bladder
may have micro cyst
often a mucinous element
BENIGN - but can be hormone producing (e.g. oestrogen) + cause endometrial pathology
cystadenofibroma
serous
1/3 of ovarian tumours
25% = malignant
originate from fallopian tube
simple
Mullerian (endocervix)
intestinal (GI mucosa)
non-specific symptoms
pevlic/abdo pain/discomfort
GI symptoms
mestruation disturbances
abdo distension
standard tx usually surgery - if not: platinum + taxmen chemo
70%
germ cell tumours
sex cord stromal tumours
rarer types exist
secondary (mets)
suspect if: both ovaries enlarged, surface involvement, mucinous tumours
older women women (40-65)
common
not detected until late - advanced @ presentation
risk factors
nulliparous (never given birth)
family hx
genetics (BRCA1/2, Her2, P53, Lynch type 2)
large solid growth
necrosis, haemorrhage
microscopic findings
papillary projections (or micropapillae)
psammoma bodies (calcification, usually in low grade serous carc)
other features of neoplasia
invasion
survival based on grade + stage (involvement of peritoneum, true met or implant?)
Histology used to predict behaviour
benign - no malignant potential
malignant - potential to met
borderline - low malignant potential - NO STROMAL INVASION
Borderline
architectural complexity
cytologic malignancy microscopically but no destructive stromal invasion
5yr survival > 95%
recurrence in 5-12% esp where implants are seen (peritoneal disease outside ovary, not considered a true met)
atypical prolif