Ovarian tumors

1. OVARIAN TUMORS

2. Learning Objectives
Classify tumors of the ovaries
-Surface epithelial ovarian tumors
- Germ cell tumors
- Sex cord-stromal tumors
Describe epidemiology and morphology of common epithelial ovarian
tumors
Enlist functional ovarian tumors and their consequences.
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3. Ovarian Neoplasms
Fifth leading cause of cancer
mortality in women, originate from
three cell types of the ovary:
1. Multipotent surface epithelium
2. Totipotent germ cells
3. Sex cord– stromal cells
Surface epithelial 90% of ovarian
cancers
Germ cell and sex cord–stromal
cell tumors constitute 20% to 30%
of ovarian tumors

4. Frequency of Major Ovarian Tumors
Tumor Type % of Malignancy % of Bilaterally
Serous 40
•Benign (60%) 25
•Borderline (15%) 30
•Malignant (25%) 65
Mucinous 10
•Benign (80%) 5
•Borderline (10%) 10
•Malignant (10%) <5
Endometrioid carcinoma 20 40
Undifferentiated carcinoma 10 —
Clear cell carcinoma 6 40
Granulosa cell tumor 5 5
Teratoma 15
•Benign (96%)
•Malignant (4%) 1 Rare
Metastatic 5 >50
(Krukernberg tumor, mets from breast and lung cancers)
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5. Ovarian Surface Epithelial Tumors
Risk Factors:
• Null parity
• Family history
• Heritable mutations
• Unmarried
• Married with low parity
• Gonadal dysgenesis
• 5% to 10% of ovarian cancers familial, associated with mutations in
BRCA1, BRCA2 and p53 tumor suppressor genes
• Express HER2/neu
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6. Serous Ovarian Neoplasms: Morphology
Gross
Most , large, rounded cystic mass up to 30 to
40 cm in diameter
Benign tumors, serosal surface smooth and
glistening as compare to nodular irregularities
in the malignant
On cut section, unilocular to multilocular cystic
masses filled with a clear serous fluid
Cystic cavities shows papillary projections,
more prominent in malignant tumors

7. Serous Ovarian Neoplasms: Morphology
Microscopy
Benign; a single layer of tall columnar
epithelial cells lines the cyst cavity Psammoma
bodies in the tips of papillae
Malignant; multilayered lining
epihtelium,complex papillary pattern and nests
or sheets of malignant cells invade axial fibrous
tissue
Borderline; exhibit less cytologic atypia and no
stromal invasion Metastases; spread
into peritoneal cavity and periaortic lymph
nodes

8. Mucinous Neoplasms
Gross
Larger, multicystic masses, with mucinous
cystic contents
Capsular penetration and solid areas of
growth; suggestive of malignancy
Microscopy;
Cysts lined by mucin-producing columnar
epithelial cells
Malignant tumors; characterized by the
presence of architectural complexity,
including solid areas of growth, cellular
stratification, cytologic atypia and stromal
invasion

9. Endometrioid Tumors
Sometimes develop with endometriosis
15% to 30% of women have concomitant
endometrial carcinoma
Benign, borderline and malignant tumors
Gross
Solid or cystic masses
Microscopy
Tubular glands, similar to endometrium
Endometrioid carcinomas of ovary have
mutations in PTEN tumor suppressor gene
similar to endometrioid carcinoma of uterus

10. Brenner Tumors
May arise from the surface epithelium or from
urogenital epithelium trapped within the germinal
ridge
Gross: Solid, encapsulated, gray-white
ranging from a few cm to 20 cm in diameter
Microscopy: Abundant stroma containing
nests of transitional-type epithelium

11. Self Assessment
Q. Name the hormone producing ovarian neoplasms and the type of
hormone they produce.

12. References
Basic Pathology, 10th Edition 2017; Kumar, Abbas, Aster
www.webpathology.com