Female Genitalia

IV
Ovary
 Ovary
Inflammation

Non-neoplastic cysts
Neoplasms
 Ovary
Inflammation
 Primary inflammation is rare
 Usually secondary to spread
from fallopian tube (tubo-
ovarian abscess)
 Other causes- appendicitis,
diverticulitis etc
 Ovary
Non-neoplastic cysts
 Follicular cysts - Polycystic Ovarian
Syndrome (Stein-Leventhal)
 Corpus luteum cysts - may cause
intraperitoneal haemorrhage
 Simple cysts
 Endometriotic cysts - haemorrhage
within endometriotic deposits;
“chocolate cysts”
 Ovary
Neoplasms
Classification of Primary Neoplasms
 Surface (germinal) epithelium (approx.
65%)
 Germ cells (approx. 20%)
 Sex cord-stromal cells (approx. 10%)
 Miscellaneous, i.e. tumours not
specific to the ovary (approx. 5%)
Surface Epithelial Neoplasms
Classification
 Serous
 Mucinous
 Endometrioid
 Brenner
 Clear cell
 Undifferentiated
 Surface Epithelial
Neoplasms
Cystadenomas/cystadenocarcinomas
 Serous - lining resemble fallopian
tube
 Mucinous - resemble lining of cervix
 Endometrioid - resemble
endometrium
 Brenner - resemble urothelium
 Serous Tumours
 25% of all ovarian tumours
 30-50% bilateral
 Benign ones, predominantly cystic
 Malignant ones, more solid
 Papillary projections into cyst cavities
 Borderline (LMP) - features of
malignancy but no stromal invasion
Mucinous & Endometrioid Neoplasms
Mucinous
 Less common than serous, 10-20%
bilateral
 Benign, borderline, malignant
 Tend to grow to very large size
 “Pseudomyxoma peritonei”

Endometrioid
 Resemble endometrial carcinoma
and may coincide with it
Sex Cord-Stromal Tumours

Granulosa cell tumour

Thecoma/Fibroma
Sertoli-Leydig cell
tumour
 Granulosa Cell Tumours
 Occur at any age
 Peak incidence, postmenopausal

 25-75% produce excessive oestrogen

Children - precocious puberty
Reproductive age - menstrual
irregularities
Older age - p.m.b.
 All potentially malignant, but
 Most behave benign
 High-grade malignant varieties occur
 Thecoma/Fibromas
 Originate from theca cell
 Thecoma
Solid, firm
May produce oestrogen; a few
produce androgens
 Nearly always benign
 Fibroma
Solid, invariable benign
Meig’s syndrome
Sertoli-Leydig Cell Tumours
 Resemble Sertoli & Leydig cells of
testis
 Predominantly solid
 Usually found in young adults
 About half accompanied by excess
androgen secretion - virilization
 Most are of low-grade malignancy
 Germ Cell Tumours
 Dysgerminoma
 Yolk sac tumour (endodermal sinus;
embryonal ca)
 Choriocarcinoma
 Teratoma

Comprise about 20% of ovarian

tumours, but are most COMMON
ovarian tumour in girls and young
women
 Germ Cell Tumours
 Dysgerminoma
All malignant
Very radiosensitive with
Up to 95% 5-yr survival
 Yolk sac tumour - highly malignant;
alpha-fetoprotein
 Chorioca - Rare! Most are metastases
from corpus
 Teratoma
Benign cystic teratoma (dermoid cyst)
Most common GCT (up to 95% of
GCTs)
Are multilocular or unilocular cysts
Containing cheesy or porridge-like
sebaceous material with matted hair
Sometimes cartilage, bone and/or teeth
grossly
Tissues from all 3 germ cell layers but
ectodermal tissues predominate
“Struma ovarii” – may be functional
 Teratoma
Solid teratomas
Are invariably malignant
Are also known as "immature
teratomas"
Malignancy due to immaturity of
the tissues – usually immature
neuroepithelium
 Secondary (Metastatic)
Tumours
 Most common - stomach, colon,
breast, corpus and cervix uteri
 Krukenberg tumour - bilateral, solid,
mucin-secreting “signet ring” cells;
usually from stomach, colon, breast
 Mets to ovary connote poor prognosis
 Ovarian Tumours
General Features
 USA - most fatal gynae. malignancy;
kill more than ca.cx & corpus combined
 Ranked 6th in women in Ja
 Presentation - asymptomatic, pain,
mass, signs of malignancy, hormonal
changes etc
 Prognosis - tumour type; grade; stage
 Surgical +/- radioRx, chemoRx