OVARIAN EPITHELIAL CANCER 1

TRANS BY: KATZUNG, BURNIE, LOS&FOUND, SLEEPYHEAD

BENIGN OVARIAL LESION  Differential Diagnosis

FUNCTIONAL CYSTS o Acute Appendicitis
 Ovary size of >5cm = pathological o Ectopic Pregnancy
 Most functional cyst are assymptomatic o Tubo-ovarian abscess
 If you are asked kung anong management ang gagamitin o Ruptured endometrioma
for benign functional cyst eto lang ang isasagot lagi: o Ovarian/ adnexal torsion
o Observed & repeat ultrasound after 2  Management
months o Ultrasonic evidence of large amount of
 If youll be asked ano ung tatlong functional benign cyst peritoneal fluid and sever pain are
eto lang ang isasagot: follicular cyst, corpus luteum indication for INTRAOPERATIVE
cyst, and theca lutein cyst. INTERVENTION
o CYSTECTOMY
A. FOLLICULAR CYSTS (increase FSH and LH) o Do you open up the patient? Sabi ni
 most common and frequent doktora YES kung may leakage ng
 Size: 2.5 or 3cm-15cm blood.
 Solitary/ multiple
C. THECA LUTEIN CYST (increase HCG)
 Mostly seen in young menstruating women
 Least common
 Associated with elevated levels of
gonadotrophins  Arise from:
o Prolonged stimulation of ovaries by
 An incidental finding only
gonadotropins
 Results from:
o Large placenta
o Dominant follicle failing to rupture
o Twins, diabetes, Rh sensitization
o Immature follicle failing to undergo
o Ovulation induction drugs
atresia
o Hypothyroidism
 Histology: Simple cyst-thin walled; unilocular;
 Size: 20-30cm; bilateral
unechoic (fluids only)
 Histology:
 Management:
o Multiloculated, thin walled, unechoic
o Observe
o Lined by theca lutein cells
o Request US after 2mos (3rd-5th day of the
cycle because this is the early  Sign and symptoms:
o Vague pressure in the pelvis
proliferative phase)
 Management:
B. CORPUS LUTEUM CYST o Observe, repeat UTZ after 2 mos.
o May resolve in 8 weeks
 most common to rupture
o If it is H mole  do suction curretage
 Aka: corpus luteum cyst hemorraghicum
 Related condition:
 Contains hemorrhages inside the cyst
o Luteoma of pregnancy
 Pathology:
o Dominant follicle  ruptures 
ENDOMETRIOMA
formation of corpus luteum  became
 Associated with endometriosis in other areas of the
vascular  increase the possibility of
pelvic cavity
hemorrhage due to its vascularity
 2/3 of women with endometriosis will have ovarian
 Size: 3-10cm
involvement
o <3cm = physiologic
o >3 cm = it’s already a cyst or pathological  One of the M/C cause of ovarian enlargement
 Develop from mature graafian follicle  May manifest as severe dysmenorrhea
 2-4days later, bleeding fills the central cavity which
OVARIAN TORSION
is later absorbed
 Contains pedicles that twists
 Signs and symptoms
o Asymptomatic (because the blood is  Can cause necrosis
reabsorbed)  Management:
o Dull, unilateral, Lower abdominal pain o Oophorectomy
(d/t small blood leakage) o If untwisted: cysterectomy
o Adnexal tenderness (via IE palpation)  Uncommon
 Peritoneal irritation d/t large o Adults- benign ovarian cyst or neoplasm
blood leakage o Children/ infant- spontaneously
 US:  Presentation:
o Thin walled; unilocular; medium level o Acute AP but an adnexal mass may be palpable
echoes (blood filled)
o Presence of ring of fire IMPORTANT TO REMEMBER: (kids, possible lumabas to)
 Most common cyst that twist: benign cystic teratoma
 Most common cyst that ruptures: Corpus luteum cyst
 OVARIAN EPITHELIAL CANCER 2
TRANS BY: KATZUNG, BURNIE, LOS&FOUND, SLEEPYHEAD

PARAOVARIAN CYST  Signs and symptoms:

 Remnant of mesonephric duct o Asymptomatic
 Cyst outside the ovary o Vague and non-specific
o Irregular menses
ADNEXAL MASS o (+) pelvic mass –urinary frequency and
 Ovary >5cm is usaually abnormal constipation
 If OVARIAN MASS is 5-8cm o acute pain d/t rupture or torsion-unusual
o Common to Premenopausal age group  Advance stages symptoms:
o Usually Unilocular. Anechoic o abdominal distention
o This is a functional cyst o pelvic/ abdominal pain
 If OVARIAN MASS is >8cm  diagnosis:
o Multilocular
o Partially solid DIAGNOSIS
o usually neoplastic  Final Dx is made by HISTOPATHOLOGICAL
EXAMINATION of the mass
 if Purely cystic mass  BENIGN
 if Complex or Solid MALIGNANT Laboratory Test before the Operation
 Hematologic/ biochemical assessment
---------------------------------------------------------------------------------  Chest xray
OVARIAN CANCER  IVP
 Leading cause of death for gynecologic malignancies WHO Classification: Frequency
 2nd most common gynecologic Cancer CLASS Approximate Frequency (%)
 Mortality rate is higher than cervical and endometrial Epithelial stromal tumors 65
CA combined Germ Cell Tumors 20-25
 In the Philippines Sex-Cord Stromal Tumors 6
o 11th cause of death Lipid (lipoid) cell tumors <0.1
o 4th in women Gonadoblastoma <0.1
 Epithelial type are the killers!!!!
 Survival age: 30-35 CLASS
 Stage 1 cases are rare Epithelial stromal tumors Coelomic epithelium
 Reasons for late diagnosis: Germ Cell Tumors Embryologic layers; tumors of
o No screening test or it is costly young women
o Risk factors are not defined Sex-Cord Stromal Tumors Constituents of the ovary or
o Unknown etiology testes; hormonally inactive
o Absence of identifiable precursor lesion Lipid (lipoid) cell tumors Resembles adrenal glands
 Most cases are seen in postmenopausal cases Gonadoblastoma Dysgenetic gonads; Y
 Risk factors: chromosome present
o Ovulation (most common)
 Late menarche & late menopause
 Nulliparity & late child bearing
o Clomiphene citrate for > 1 year
o High animal fat BORDERLINE TUMORS
o Talcum powder on perineum  Aka: tumors of low malignant potential
 Reduced risks:  Malignant Tumors that behave in a benign fashion
o OCP use for >10 years (but it can cause  Confined to the ovary for long time
cervical cancer)  Age: premenopausal women
o Breast feeding  Non-invasive: young age
o Pregnancy  Invasive: old age
o High fiber diet  Criteria:
 Screening: o Thick capsule (2cm) due to papillary
o US- encouraging but specificity limited formation and pseudostratification
 Remember that, HINDI LAHAT NG o Nuclear atypia and increase mitotic activity
MAY SOLID AREA MALIGNANT. o (-) of stromal invasion
o Tumor markers: o Cystic
 CA 125 indicates:  Survival rate is high
 PID  Recurrences is rare
 TB of the pelvis
 BRCA GENE  Management:
 FAMILY HISTORY o Unilateral OOPHORECTOMY
 Lynch II associated cancers: o Peritoneal cytology
o Breast cancer o postoperative irradiation and chemotherapy for
o Ovarian cancer higher stages
o Colon cancer o if stage 1a- observe only
 OVARIAN EPITHELIAL CANCER 3
TRANS BY: KATZUNG, BURNIE, LOS&FOUND, SLEEPYHEAD

EPITHELIAL OVARIAN CANCER 5. BRENNER TUMORS

 2/3 are epithelial tumors  Resembles the transitional epithelium of bladder
 Categorized as: and Walthard nests of the ovary
o Adenoma –benign  BENIGN IN NATURE!!!
o Adenocarcinoma- malignant  Solid in nature
o Borderline tumor- tumor of low malignant  Eto ung sinasabi kanina na HINDI LAHAT NG SOLID
potential MALIGNANT! Eto SOLID pero HINDI MALIGNANT.
 Prefix / suffix used:
o Papillary-with papillae PATTERN OF SPREAD:
o Cyst- with cystic structures(cystadenoma)  EXFOLIATION OF CELLS
o Fibroma- when ovarian stroma predominated o Most common
exception of Brenner tumors(adenofibroma) o Follow movemnet of peritoneal fluid
o fluid moves with respiration from:
1. SEROUS TUMORS  pelvis
 Most common type of ovarian neoplasm  paracolic gutter especially on the
 Consist of ciliated epithelial cells that resemble those of right
fallopian tube  intestinal mesenteries to te right
 Thin walled, multiloculated hemidiaphragm
 If young age: usually benign in nature o Metastases:
 If adult age: usually malignant in nature  Posterior cul de sac
 If malignant: the tumor contains papillary cauliflower  Paracolic gutter
like excresensces on the outside and inside lining of  Right hemidiaphragm
the tumor  Liver capsule
 Pathognomonic sign for serous cystadenocarcinoma is  Omentum
the presence of presence of psammoma bodies  LYMPHATIC DISSEMINATION
 HEMATOGENOUS
2. MUCINOUS TUMORS (15%)
 Consists of epithelial cells filled with mucin MANAGEMENT:
 Most are BENIGN  Stage 1/ borderline ovarian tumors: SURGICAL
 Resembles cells of endocervix or may mimic  Management depends on the AGE OF THE PATIENT:
intestinal cells o Malignant in Young patient:
 Tumors rapidly growing; ovary very very large  SALPHINGOOPHORECTOMY
 gross: o Malignant in Older patient:
o Large size (200-300lbs)  TAHBSO with surgical staging
o Multiloculated o Borderline: OOPHORECTOMY
o w/ firm solid areas (Borderline; malignant) o Benign in young patient: CYSTECTOMY
o Some have intracysticpapillariesexcresences o Benign in Older patient (50s): TAHBSO
but more on serous o Malignant (all stages): TUMOR DEBULKING
o Fluid content is usually mucoid but can also  Followed by:
be watery o CHEMOTHERAPHY-borderline stage 1
 Tumor marker: CEA o RADIATION THERAPY

 Pseudomymomaperitonei:  SECOND LOOK OPERATION

o accumulation of gelatinous material in the o Refers to reoperation of pateint who has
peritoneal cavity also with benign or undergone unplanned course of chemotherapy
malignant mucinous tumors o Exhibits no symptom and clinical course of the
o when it ruptures, fluid inside leaks out and it disease
covers the intestine wherein it can cause o Purpose:
obstruction  To determine whether or not a
patient who is clinically free disease
3. ENDOMETROID TUMORS indeed has no evidence of the disease
 To give 2nd line of chemotherapeutic
 Consist of cells that resembles endometrium
agents in the presence of gross or
 Less frequent (5%)
microscopic tumor
 Associated with: endometriosis
 To improve the treatment
 Gross: solid

4. CLEAR CELL TUMORS (Mesonephromas)

 Contains cells with abundant glycogen called HOBNAIL
CELLS
 Histologically similar to clear cell cancer of the vagina
and uterus of young patients exposed to DES in utero
 Highly aggressive