Ovarian Tumors (Prof. (Prof. Bassaw B assaw’’s Class) Background Some of these are benign others have malignant form.
Csts in !oung "omen #suall a$ects women in their %&'s. These include the following three csts
Simle Csts or *ollicular Csts Corus +uteal Csts Theca +uteal Csts ,ndometrioma
S-P+, C!ST/ *O++-C#+01 C!ST 2escri cri3on 3on
This is a follicle with us usuall clear 4u 4uid. id.
Character
This is as follows
Si5e Surface Bilateral +ocula3ons
Presenta3on
anagement
0smtoma 0smtoma3c6 3c6 a7orit a7orit will also regress regress themselves
This can resent as
1ut 1utur ured ed ,cto ,ctoi ic6 c6 8owe 8oweve verr mimics a rutured ectoic
it 7ust 7ust
0#B6 2ue to the roduc3on of estrogens from these csts can resent with blee ds +ower 0bdominal Pain
edical
This cst tends to have blood in it.
Some can grow usuall small Smooth surface #nilateral #nilocular
This as follows
CO1P#S +#T,0+ C!STS
-f 9cm or +ess and Smtoma3c6 +ow 2ose OCPs for : ccles and the will most likel regress
-f the a3ent is regnant then ;< the oosing ends as the Progesterone that the Corus +uteum makes is needed to maintain the regnanc. regnanc.
1eeat the Clinical ,
Surgical
-f no resonse from above then o$er surgical e
Other Seci;cs
T8,C0 +#T,0+ C!STS 2escri3on
,=2O,T1-O0/ C8OCO+0T, C!STS
-t is formed due to high levels of > 8C? in the Serum usuall associated with a ole or ul3le Pregnanc.
This is due to endometriosis on the Ovar.
C@. Comlete mole has the chance of becoming ?esta3onal Trohoblas3c 2isease.
C@. The most common site of ,ndometriosis is on the Posterior Ovar Surface as a Chocolate Cst. This is as follows
Character Si5e Surface Bilateral +ocula3ons
Presenta3on
This as follows
Ovarian ass on Pelvic ,
+arge usuall Smooth Surface Bilateral ul3loculated ,
This is as follows
#suall Ovarian asses become Central and are easil confused with the Bladder but the adhesions kee the chocolate cst in the 1-* as a mass.
C@. The Chocolate cst when +arge does not become Central comared to most other csts. -t stas in the 1-* due to 0dhesions. C@. C0 A% is elevated mildl is ,ndometriosis. 0lso is el evated in Pregnanc *ibroids and P-2. anagement
Treat the underling cause and it will regress once no longer under the e$ects of > 8C?. -f no regression aDer E weeks then the a3ent was not treated roerl. onitor with Serial #SS and > 8C?.
Other Seci;cs
Ovarian Tumors ,ithelial Origin
Serous Cstadenoma/ Cstadenocarcinoma ucinous Cstadenoma/ Cstadenocarcinoma Brenner Tumor ,ndometrioid Tumor Clear Cell Tumor Paillar Tumor
Se< Cord or Stromal Origin ,=2OC1-=, T#O1S ?ranulosa Cell ?ranulosa Theca Cell Thecoma *ibroma 0ndroblastoma6 +edig and Sertoli Cell Tumors
?erm Cell Origin
Teratoma Teratocarcinoma 2sgerminoma Choriocarcinoma !olk Sac Tumor
Secondar Cancer to the Ovaries
Breast Secondar ,ndometrial Secondar Frukenburg Tumor
Oera3ve ?uide with #ne<ected Tumor *inding
One o3on is to use *ro5en Sec3on while a3ent on the table. Contemlate doing a Total 0bdominal 8sterectom Bilateral Salingo6oohorectom
Omentectom. Chemothera is Post6O and is called 0d7uvant Treatment.
The Characteris3cs of alignant Csts
+arger6 ore alignant Chance Bilateral ul3loculated Peri Ovarian 0dhesions Solid with Cs3c Comonents 0scites6 Straw Colored Obvious Peritoneal 2eosits 6 on Omentum feels 8ard and like Cake
,ithelial Origin Tumors
Serous 0denoma or 0denocarcinoma 2escri3on s
ost common Ovarian Cancer.
Character
Benign
Other Seci;cs
alignant Cs3c Smooth Surface Small #nilocular Clear *luid
ucinous 0denoma or 0denocarcinoma
Benign
Cs3c and Solid 1ough Surface +arge ul3locular
alignant Cs3c Ger +arge ul3loculated Thick "alls ucoid aterial
Cs3c and Solid Ger +arge ul3loculated Thick "alls ucoid aterial
Tumor arker is C0 A%.
Tumor arker is C0 A%.
C@. Can also contain Psamomma Bodies.
C@. This ucinous Tumor is associated with Peritoneal deosits called Pseudom
,ndometrioid
Brenner
2escri3on
Character
The cells resembles the cells of These are tumors which are usuall ,ndometrial Cancer. The can co e
Solid Small
-t can rogress to a Transi3onal Cell Cancer. C@. This can rogress to Transi3onal Cell Cancer.
Other Seci;cs
Clear Cell Tumor
2escri3on Character
+arge with Clear Ctolasm. =uclei are dee staining called 8ob =ail =uclei.
Other Seci;cs
C@. *or both the Clear Cell and Paillar Tumors the have oor rognosis and usuall arise from the *alloian Tubes. C@. Clear Cell Tumors have 8OB =0-+ nuclei which are dee staining.
Se< Cord Origin Tumors ?ranulosa 2escri3on
Character
Some3me has both ?ranulosa Theca Cell comonents.
Other Seci;cs
Thecoma This is a solid tumor.
+arge 1ubber 8ard
These are ver slow growing but alignant. Produce ,strogens. Presents as
Precocious Pubert6 0#B Post enoause Bleed
C@. Contains Call ,
Produce ,strogens.
Post enoausal Bleed
C@. #suall Benign.
C@. Tumor arker for these are -nhibin.
*ibroma 2escri3on
0ndroblastoma6 +edig and Sertoli Cell
These are Benign. Tumors are Solid.
The +edig Cell are Benign and the +edig6 Sertoli mi< can be alignant.
C@. 0ssociated with eig's Sndrome. Triad of 0scites Pleural ,$usion and Benign Ovarian Tumor. These resolve with Tumor 1esec3on.
C@. Causes Girilisa3on. Produces 0ndrogens. Check the 0drenal and Ovaries when facing Girilisa3on.
Character Other Seci;cs
?erm Cell Origin 2escri3on
2ermoid Cst or Teratoma
2sgerminoma
Commonest cell te is ectodermal so 8air and Sebum ver common.
-n oung females from A&6 :& ears. Behaves like a seminoma.
Common in %nd and :rd 2ecade. 1ule of A&'s
Character
A&H of Ovar Tumor A&H Bilateral A&H alignant A&H 1ecur A& cm 2iameter 0s follows
Clinical Presenta3on
#nilocular with Protuberance into +umen called 1okitansk Tubercle that carries its blood sul Cs3c The are as follows
0s follows
Solid +arge
Other Seci;cs
0smtoma3c Torsion/ 1uture Pelvic 8erthroidism6 due to resence of throid 3ssue
Treatment i s with Cstectom and 2issec3on of other side because A&H are Bilateral.
C@. Onl one that is 1adiosensi3ve.
C@. Fnow the Protuberance called 1okitansk Tubercle. C@. -t can herthroidism.
resent
with
C@. The Teratocarcinoma is a from Skin Cell origin so is SIuamous Cell Cancer. C@. Tumor arker is J *P.
2escri3on
Other Seci;cs
Choriocarcinoma
!olk Sac or ,ndodermal Sinus Tumor
=o rela3on to regnanc and arises Primar in t he Ovar.
-n ver oung girls before ears. 8ighl aggressive. Poor Prognosis.
=o resonse to Chemothera. Tumor arker is > 8C?.
Tumor arker is J *P.
Secondar Ovarian Tumors The sread usuall comes from the following
Breast ,ndometrial *alloian Tube Stomach
=B. C@. Frukenburg Tumor or Secondaries from the Stomach contain Signet Cells which have eccentric nuclei.
"orku of alignanc The a3ent who is susected of Cancer is -nves3gated with C0 A% and TG #SS *indings and this is used to Calculate a Score to 2etermine if she needs a Staging done in a Cancer Centre for ?neoncolog. 1- or 1isk of alignanc -nde< K #S *indings < C0 A% < Pre or Post enoause Score
*-?O Staging Stage -
Con;ned to the ovaries.
Stage --
-t can have Ovarian 1uture Surface Tumor or 0scites. -nvolves one or both Ovaries with Pelvic ,
Stage ---
-nvolves one or Both Ovaries with sread to eritoneum outside the elvis or retroeritoneal lmh node involvement.
Stage -G
2istant metastasis e
-t is staged S#1?-C0++!. This is done with Staging +aarotom. This a3ent would have undergone the 1- inde< and taken to a ?neoncologist who would have done this +aarotom. This consists of the following
2ebulking T08 L BSO Omentectom 1emoval of 0dhesions Ctologic "ashings
Post Surgical *ollow # The a3ent can be for Pallia3ve or Cura3ve -ntent Chemothera.
Carbola3n6 C@. BeMer than Cisla3n due to +ess =ehroto
