Tumors of the Ovary

There are 3 cell types in the ovary that give rise to neoplasm:

(1) surface epithelium
(2) sex cord stromal cells
(3) germ cells

Types of Ovarian Cancer

(1) Surface Epithelial Tumors – from the embryological mesoderm bordering the coelonic cavity that gives rise to the:

(a) Mullerian epithelium, that is, the fallopian tubes (ciliated columnar serous cells)
(b) endometrial lining (noncilliated columnar cells)
(c) endocervical glands (mucinous nonciliated cells)

epithelium can invaginate into stroma to form cysts; may include cystic areas (cystadenomas), cystic and fibrous areas (cystadenofibromas), and fibrous areas (adenofibromas)

each neoplasm can be further categorized as Benign, Borderline, or Malignant

more serous = more likely benign; more fibrous = more like malignant

The corresponding neoplasms are:

Serous Tumors – most are benign, but also include the most common malignant ovarian tumors

columnar ciliated epithelial cell filled with serous fluid

Benign: Serous cystadenoma, serous cyst sack, see blood vessels, visible on ultra sound;good prognosis

inner lining smooth single cell layer

Borderline Malignant: Serous papillary cystadenoma: lining thrown into folds, no invasion

Malignant: Serous cystadenocarcinaoma, more solid; complex folding, frank invasion; poor prognosis

bilaterality is common (see table above)

All 3 types can grow into to the peritoneum, so accurate classification is critical

Mucinous Tumors – rarely on surface; less frequently bilateral and generally larger cysts than Serous

Benign: cystadenoma looks like a serous cyst except filled with mucin (yellow color)

characterized by a lining of tall columnar epithelial cells with apical mucin and absence of cilia
Akin to benign cervical or intestinal epithelia

Borderline Malignant: looks like tubular or villous adenomas of intestines

Abundant gland like or papillary growth with nuclear atypia and stratification.

Malignant: cystadenocarcinaoma –solid with epithelial cell atypia and stratification; loss of gland architecture

Pseudomyxoma peritionei: tumor with mucinous ascites, cystic epithelial peritoneal implants, adhesions

Evidence Þ extraovarian (usually appendiceal) primary mucinous tumor with secondary ovarian and peritoneal spread

(2) Endometroid Tumors: Clear cell/cystadenofibroma/Brenner Tumor – he did not want to talk about these

Clinical Course: Greatly affected by presence of implants and/or invasion

Implants (peritoneal seeding): 20-40% of cases; associated with exophytic tumor at surface and visa versa

Invasion: results in destruction of omentum or peritoneum; micro invasion < 3mm: > survival than Frank Inv

Non-invasion: islands are present with out tissue destruction (can sill be large)

Borderline or Low Malignant Potential (LMP) if no implants or nonivasive if implants are present

(3) Germ Cell: 90% are Teratomas (3 germ layers) -98% are Mature; 2% Immature Graded: observe {I), II, (III} chemo

Monodermal: ex: struma ovarii- functional or non functional thyroid tumor
< 1% are cancerous (see above for other tumors and statistics)

(4) Sex Cord Tumors: can dedifferentiate into male or female gonad cells: Sertoli, Leydig, Granulosa, Theca

Granulosa Cell Tumor: produces estrogen to cause precocious puberty (in juvenile) or estrogen induced disease (in adult)

(5) Metastatic Tumors: from any primary. Most common are mullerian origin

field effect: classic primary is gastrointestinal
Kurkenburg tumor – mucin secreting, signet ring cancer cells most often of gastric origin