Wednesday, 6 July 2016

Ovarian masses

Ovarian cysts:

Follicular cyst -
Associated with hyperestrogenism, endometrial hyperplasia.

Theca-lutein cyst -
Due to gonadotropin stimulation.
Associated with choriocarcinoma and hydatidiform moles.

Ovarian neoplasms

Risk increase with -
. advanced age,
. infertility,
. endometriosis,
. genetic predisposition (BRCA-1 or BRCA-2 mutation, Lynch syndrome, strong family history).

Risk decreses with -
. previous pregnancy,
. history of breastfeeding,
. OCPs,
. tubal ligation.

Benign ovarian neoplasms

1) Serous cystadenoma
. Lined with fallopian tube–like epithelium.

2) Mucinous cystadenoma
. Lined by mucus-secreting epithelium .

3) Endometrioma

Endometriosis (ectopic endometrial tissue) within ovary with cyst formation.
“Chocolate cyst”— endometrioma filled with dark, reddish-brown blood.

4) Mature cystic teratoma (dermoid cyst)

Germ cell tumor.
A monodermal form with thyroid tissue(struma ovarii) uncommonly presents with hyperthyroidism .

5) Brenner tumor

Looks like Bladder ( both contains B )
“Coffee bean” nuclei on H&E stain.

6) Fibromas

Bundles of spindle-shaped fibroblasts.
Meigs syndrome—triad of ovarian fibroma, ascites, hydrothorax.

7) Thecoma

Like granulosa cell tumors, may produce estrogen.
Usually presents as abnormal uterine bleeding in a postmenopausal woman.

Malignant ovarian neoplasms

1) Granulosa cell tumor :

- Most common malignant stromal tumor.
- Often produces estrogen and/or progesterone and presents with postmenopausal bleeding,
- sexual precocity (in pre-adolescents),
- breast tenderness.

- Histology shows Call-Exner bodies (granulosa cells arranged haphazardly around collections of eosinophilic fluid, resembling primordial follicles).

2) Serous cystadenocarcinoma
Most common malignant ovarian neoplasm,
Psammoma bodies.

3) Mucinous cystadenocarcinoma
Pseudomyxoma peritonei–intraperitoneal accumulation of mucinous material from ovarian or appendiceal tumor.

4) Immature teratoma
Aggressive, contains fetal tissue, neuroectoderm.

5) Dysgerminoma

Equivalent to male seminoma .
Sheets of uniform “fried egg” cells .
hCG, LDH = tumor markers.

6) Yolk sac (endodermal sinus) tumor

Aggressive, in ovaries or testes (boys) and sacrococcygeal area in young children.
Schiller-Duval bodies (resemble glomeruli) .
AFP = tumor marker.

7) Krukenberg tumor

GI malignancy that metastasizes to ovaries > mucin-secreting signet cell adenocarcinoma.

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