Ovary
Dr. Amitabha Basu MD
Topic
Normal ovary
 Polycystic ovary
 Tumors of the ovary

Normal ovary gross
Micro
Th) Theca
(MG) Membrana
granulosa
(CR) Corona radiata
(ZP) Zona pellucida
(CL) Corpus luteum
Polycystic ovarian disease
Definition
 Morphology
 Clinical features

Def: Multiple cystic follicles in the
ovary.
Pathophysiology
Excessive secretion of estrogen and
androgen.
 High LH
 Low FSH
 LH/FSH Ratio: high

Clinical features/complications
A. Oligomenorrhoea (Polycystic ovarian
disease with oligomenorrhea is known as
Stein-Leventhal syndrome)
B. Hirsuitism
C. Infertility
D. Endometrial Hyperplasia.
Tumors of the Ovary
1.
2.
3.
4.
Classification
Subtypes
Age Incidence
Etiopathogenesis
A.
B.
C.
D.
E.
Serous tumors
Mucinous tumors
Dysgerminoma
Teratoma
Granulosa-theca cell
tumor
F. Sertoli Leydig cell tumor
G. Metastasic tumor
Classification
Classification
A. Tumor arising form the surface
epithelium
B. Tumor arising form the germ cells
C. Tumor arising form Sex-cord stroma
surface epithelium
D. Metastasic tumor
Tumor arising form the surface epithelium
Origin
Frequency
Proportion of
malignant
ovarian tumor.
Age group
Germ cells
15-20%
3-5%
Types
1. Teratoma
2. Dysgerminoma
3. Endodermal sinus
0-25+ years
tumor
4. Choriocarcinoma
Tumor arising from sex cord stroma
Frequency
5-10%
Proportion of malignant
ovarian tumor.
2-3%
Age group
All age
Types
1. Fibroma
2. Granulosa-
theca cell
tumor
3. Sertoli Leydig
cell tumor
Metastasic tumor
Frequency
Proportion of
malignant ovarian
tumor.
Age group
5%
5%
Example :
Krukenberg tumor
All age
Etiopathogenesis


Multiparty
Family history

Genes
1. BRCA 1 AND BRCA 2
( IN HEREDITARY
OVARIAN CANCER)
1. ERB B2
2. K-RAS
3. TP53
Serous tumor : Types
1. Benign
2. Borderline
3. Malignant
Note: All surface epithelial tumors
can be divided in these three types
Features of Serous tumor






Common ovarian
tumor.
Mostly benign.
Cysts are lined by
single Ciliated
columnar epithelium.
Cyst contain serous fluid.
Bilateral (25%)
Usually Small.
Microscopy of serus tumor: Cysts are lined
by single Ciliated columnar epithelium
Borderline Serous Tumor

Between benign cyst adenomas and
malignant cystadenocarcinomas lies the
grey zone of "borderline" lesions that are
not clearly malignant, but are treated
as though they could be.
Malignant serous Tumor : Papillary serous
cystadenocarcinomas : note papillary areas.
Microscopy : Papillary process and cellular
crowding and Psammoma body (not seen)
Psammomma body in serous
tumors( malignant)
Spread of the tumor

These neoplasms characteristically spread
by "seeding" along peritoneal surfaces.

Marker for Surface epithelial tumors: CA
125
Features of Mucinous tumor
Not common ( 10%), Large
 Cysts are lined by single layer
Mucin secreting columnar
epithelium.
 Cyst contain Mucinous gelatinous
fluid: if rupture produce
Pseudomyxoma peritonei.

Histology : Multilocular cysts lined by a single layer
of benign mucinous columnar epithelium.
Compare Serous and mucinous tumors
Teratoma
Types
 Dermoid cyst
 Immature malignant Teratoma
 Struma Ovarii.

Types
1. Benign Teratoma ( Mature: usually
cystic)
2. Malignant Teratoma( Immature : usually
solid)
3. Monodermal Teratoma ( carcinoid Tumor,
struma ovarii)
Benign Teratoma ( Mature)
of ovary

It is also called Dermoid cyst. ( because it
contains dermal appendages).
Dermoid cyst : Mature cystic
Teratoma
Immature Malignant Teratoma
Mean age : 18 years
 Features : bulky, solid
 Histology : Tissue containing immature
neural tissue with neuroepithelial
differentiation.

Dysgerminoma
Etiopathogenesis : Occur with gonadal
dygenesis.
 Radiosensitive tumor : 80% cure
 Unilateral

Grey white homogenous
Mimic Seminoma histology !
Granulosa-theca cell tumor
Age : Post menopause but any age
 Unilateral
 Diagnostic point : Presence of call Exner
body in Histology.
 Function: Secrete estrogen ; promote
endometrial, breast carcinoma.

Presence of call Exner body
Sertoli Leydig cell tumor
Age: all age
 Unilateral
 Point for identification: Gross: Yellow
brown, solid. Micro: Pink Sertoli
Leydig cells.
 Clinical effect: Masculinizing (
defeminizing).

Gross: Yellow brown, solid.
Struma ovarii
 In
this tumor the Teratoma
contain predominantly thyroid
tissue.
Struma ovarii : produce
Hyperthyroidism
Metastasic tumor
Age: older age
 Primary Tumor: Breast, lung, GIT
 Big bilateral mass
 Example : Tumor name : Krukenberg
tumor

Krukenberg tumor
1. Primary tumor : Gastric
adenocarcinoma
2. Route of metastasis : Seeding
through body cavity.
3. Bilateral always.
4. Histology : contain “ signet ring”
cells.
Gross
Nice to Know this Tumor:
Thecoma-fibroma
Any age
 Unilateral
 Produce Meigs syndrome( ovarian
tumor with ascites and Hydrothorax)

Review
Endometriosis ( clinical features)
 Endometrial Hyperplasia . Etiology with
C/F
 Dermoid cyst Gross identification.
 Leiomyoma identification and c/f
 Carcinoma in situ
 Granulosa theca cell tumor.

Review









Metastasic tumors
Ectopic pregnancy
Genes for Ovarian cancers.
Clear cell carcinoma
Vaginitis
Lichen sclerosus
Polycystic ovary
Gonorrhea infection (PID)
Anovulatory cycle : and other Causes of DUB
Thank you!