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Ovarian Tumours

1. EPITHELIAL TUMOURS
A. Serous tumours
Benign
o Usually cystic
o Thin-walled
o Usually unilocular
o 3-30 cm
o Clear, straw coloured fluid

Malignant (serous cystadenocarcinoma)


o Usually large
o Partially cystic and solid
o Fluid tends to be blood-stained
o Tumour marker CA-125

B. Mucinous tumours
Benign
o Usually cystic
o 15-30 cm (huge)
o Thick, parchment-like wall
o Multilocular
o Clear mucoid material
o Epithelium similar to endocervix
o Contains goblet cells, occasionally PANETH CELLS

Mucinous adenocarcinoma
o Usually partially or wholly solid
o Areas of necrosis and haemorrhage
o Mucoid material

Pseudomyxoma peritonei associated with


o Benign or borderline mucinous tumour
o Mucoid material fills the peritoneal cavity
o Associated neoplasm of appendix or intestine

C. Endometrioid
Benign form is rare
Most are Malignant
o May be solid, partially cystic or wholly cystic
o Most are well-differentiated
o Resembles endometrial adenocarcinoma

D. Brenner
Benign
o Majority
o Small, solid
Malignant
o May appear as pure transitional cell carcinoma

E. Clear-cell tumours
Benign form is very rare
Adenocarcinoma
o Large, most are cystic, multilocular
o Mucoid material
o Large deeply-staining nuclei protruding into the lumen (HOBNAIL
NUCLEI)

2. SEX CORD STROMAL TUMOURS


A. Granulosa cell
Usually solid, hard or rubbery
Cut surface is white, yellow or gray
Mean size 12cm in diameter
Slow-growing
CALL-EXNER BODIES (granulosa cells arranged around small spaces
containing nuclear fragments)
75% produce oestrogen
o Precocious puberty, abnormal uterine bleeding or even
postmenopausal bleeding
Potentially malignant although slow growing
Recurrence or metastases tend to occur late (after 5 years, even after 20
years)
Long-term survival 50-60%
Tumour marker Inhibin

B. Thecoma
Usually solid
Especially in postmenopausal women
Produce oestrogen (rarely androgens)
Benign

C. Fibroma
Ascites, Pleural Effusion, Benign Ovarian Tumour (Meigs Syndrome)
Benign

D. Androgen-producing
Androblastoma Sertoli-Leydig
Gynandroblastoma
o Cause virilisation
o Benign (mostly)
o Solid
o Tend to occur in young girls/women (10-35)

3. GERM CELL TUMOURS


A. Teratoma/Teratocarcinoma/Borderline
Embryonic lines especially ectodermal (hair, sebum)
Majority are mature/cystic
10-20% of all ovarian tumours
Most occur in the 2nd - 3rd decade (90%)
Most are asymptomatic
Rule of 10s 10cm diameter; 10% bilateral; 10% recurrence; 10% (-20%)
of all ovarian tumours
BUT only 1% malignant (squamous cell)
Usually unilocular, Rokintansy tubercle (hillock)
Lined by squamous epithelium

Monophyletic teratomas differentiate into one line


o Such as stroma ovarii (thyroid tissue)
o Pelvic hyperthyroidism

Tumour marker Alpha-Fetoprotein

B. Dysgerminoma
Young women (10-30 years)
Identical to seminomas in males
Radiosensitive
Usually solid, ~12cm in diameter
Malignant

C. Choriocarcinomas
Tumour Marker: -hCG.
Responds poorly to chemotherapy, unlike Gestational Trophoblastic Disease.
Malignant.
Primary ovarian malignancy.
Not choriocarcinoma secondary to molar pregnancy

D. Yolk sac tumour (endodermal sinus)


Rare
Secretes alpha-fetoprotein
Young girls (4-20 years)
Highly aggressive

Many of these germ cell tumours co-exist!

4. OTHERS
A. Kruckenberg
Signet-sign
Bilateral, solid
From adenocarcinoma in stomach/GIT

B. Secondaries
Spread from breast, endometrium, fallopian tubes

NB Many epithelial ovarian tumours may be secondaries from distal ends


of the fallopian tubes such as clear cell (highly aggressive)

Accidents to Ovarian Cysts


o Rupture
o Torsion
o Haemorrhage
o Malignant change
Acute severe abdominal pain, nausea, vomiting, acute abdomen

FEATURES
o Malignant cyst/tumour
Usually solid/partially soilid
Larger in size
Bilateral
Straw-coloured ascites
Excrescences (irregular surface)
Omental/peritoneal deposits
Usually multilocular

TREATMENT
o Benign: cystectomy/unilateral salpingo-oophorectomy

o Malignant
Debulking (TAH + BSO + omentectomy + removal of tumour)
Post-operative chemotherapy (Cis-platin + Paclitaxel)

NB: irradiation has a minor role except with dysgerminoma

o Tumour markers
CA-125 Serous (malignant)
Alpha-fetoprotein - Teratoma
-hCG - Choriocarcinoma
Inhibin - Granulosa

o Concept second-look laparoscopy vs laparotomy

o RMI where/who should do surgery

o Prognosis generally poor due to late presentation/diagnosis

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