Ovarian Tumer

Question 1

D/D of Ovarian Mass

Answer 1

Functional :
1. Follicular cyst
2. Corpus luteal cyst
3. Thea luteal cyst
Inflammatory :
1. Tubo-ovarian abscess
2. Oophoritis.
Neoplastic
1. Benign
2. Malignant
Other:
1. Endometriotic cyst
2. Enlarged ovary in PCOS
3. Para-ovarian cyst

Question 2

Ultrasound features of ovarian masses
Benign
Malignant
——
Internal structure:
Margins:
Echogenicity :
Content :
Vascularization :
Pouch of Douglas :

Answer 2

سلايد ٧

Question 3

What’s the type of benign ovarian tumer ?

Answer 3

• Epithelial : 60%
1. Serous cystadenoma
2. Mucinous cystadenoma
3. Brenner
• Germ cell :
1. Mature cystic teratoma (Dermoid cyst)
2. Stuma ovaraii
• Sex cord- stromal :
1. Fibroma
2. Thecoma

Question 4

Serous cystadenoma

Answer 4

1. composed of cells resembling the fallopian tube lining.
2. Unilocular, may have septations , with Papillary components
3. Unilateral, 10-20% are bilateral
4. CharacterisCc psammoma
   bodies

Question 5

Mucinous cystadenoma

Answer 5

1. Composed of cells resembling the endocervical lining
2. Multiloculated , unilateral 5-10% bilateral.
3. Can get extremely large 7-10kg
4. Round mass with smooth
   capsule.
5. Contain clear, viscid fluid

Question 6

Most common tumors of the reproductive age group (50% of all)

Answer 6

Benign Germ cell Ovarian Tumors

Question 7

DERMOID CYST (mature cyst teratoma)

Answer 7

• Most common ovarian tumor in young age
• Peak incidence 20 years
• 90% of germ cell tumors
• 10% are bilateral
> 15 % present with acute torsion Its contents may be the derivatives of 3 embryonic cell layers:
1. Ectoderm: skin, hair, teeth & nervous tissue
2. Mesoderm: cartilage, bone, and muscles
3. Endoderm: thyroid, stomach, & intestinal tissue

Question 8

STUMA OVARII

Answer 8

consists only of the active thyroid tissue

Question 9

Treatment of Benign Germ cell tumors

Answer 9

• Cystectomy. to preserve ovarian function. Careful evaluation of the opposite adnexa should be
performed, as dermoid cysts can occur bilaterally in 10–15% of cases.
• Oophorectomy: If an ovarian cystectomy cannot be done, then an oophorectomy is performed, but conservative management should always be accepted before an oophorectomy is done.
• Follow-up is on an annual basis.

Question 10

Benign sex cord-stromal Ovarian Tumors

Answer 10

• These are solid tumors
• Composed of stromal cells
• Present in post-menopausal women

Question 11

OVARIAN FIBROMA

Answer 11

Meig’s syndrome consists of pleural effusion, ascites & ovarian fibroma

Question 12

THECOMA (theca cell)

Answer 12

((secrets estrogen)) cause :
1. post-menopausal bleeding
2. associated with ca endometrium

Question 13

What is the type of Malignant Ovarian Tumors

Answer 13

Epithelial 90% :
1. Serous cystadenocarcinoma
2. Mucinous cystadenocarcinoma
3. Endometrioid ca
4. Clear cell carcinoma
5. Undifferentiated.

Germ cell 5% :
1. Malignant teratoma
2. Dysgerminoma
3. Endodermal sinus tumor
4. Choriocarcinoma
5. Gonadoblastoma

Sex cord- stromal 3-5%:
1. Granulosa cell
2. Theca cell
3. Sertoli-leydig cell
4. Gyandroblastoma

Question 14

Mucinous cystadenocarcinoma

Answer 14

Pseudomyxoma peritoneii’ a thick, jelly-like ascites with mucinous tumor deposits throughout the abdominal cavity.

Question 15

Borderline ovarian tumors (BOTs)

Answer 15

1. Variant of epithelial ovarian cancers
2. Tumors of low malignant potential
3. Well-differentiated with nuclear pleomorphism and cellular atypia but doesn’t invade the basement membrane
4. Behaves much less aggressively and prognosis is very
   favorable
5. 10% of malignant ovarian tumors.
6. Presents at a younger age, at approximately 48 years
7. Staging by using the FIGO
8. > 75% of presentaCons are at stage1

Question 16

Malignant germ cell tumors (5%)

Answer 16

1. Unilateral (except for dysgerminoma).
2. Young age
3. Lymphatic spread
4. Rapid growth
5. Most are stage I and confined to the ovary at the time of diagnosis.
6. increased incidence with dysgenetic gonads.

Question 17

Patient with pain in the right side and there is a mass on ovary and she is down syndrome. What type of the tumor maybe she has?

Answer 17

Malignant germ cell tumors.

Question 18

Malignant germ cell tumours
• Tumour markers

Answer 18

• Dysgerminoma ➙ LDH, Placental alk
phosphatase
• Endodermal sinus tumor ➙ alpha-
fetoprotein
• Choriocarcinoma ➙ (bHCG)

Question 19

Treatment of Malignant germ cell tumors

Answer 19

1. A unilateral salpingo-oophorectomy and surgical staging (peritoneal and diaphragmatic biopsies, peritoneal cytology, pelvic and paraAortic
   lymphadenectomy, and omentectomy)
2. postoperative chemotherapy (Vinblastine, Bleomycin, and cisplatin).
   ((( ALL pt ))).
3. Follow-up (( every three months )).

Question 20

Malignant Sex cord-Stromal Ovarian Tumors. What’s the type and what’s the characteristic?

Answer 20

1. Granulosa cell tumer
   • Low-grade malignancy
   • Reproductive age (5% prepubertal)
   • Produce estrogens Asso with : endometrial carcinoma 5% endometrial hyperplasia 25-50%
2. Sertoli-Leydig Tumour :

• Low-grade malignancy
• 75% <40 years
• Produce androgens : Asso with 70-85% - clinical virilization

Question 21

Sex-cord stromal tumors (5%)
What’s the hormonal produce ?

Answer 21

• Granulosa cell tumor ➨ Estrogen
• Sertoli cell tumor ➨ Estrogen
• Leydig cell tumor ➨ Antrogens

Question 22

Sex-cord stromal tumors
How are you gonna treat it?

Answer 22

Surgical removal

Question 23

Secondary or Metastatic Ovarian Tumours:

Answer 23

1. ovaries may get enlarger than primary malignancy
2. H/P shows the primary picture
3. From the Genital tract
4. From extragenital tract organs
   Krukenberg tumor:
   • secondary ovarian tumor from metastatic spread of gastric carcinoma • Uniform enlargement
   • Bilateral involvement Characteristic mucin-secreting signet-ring cell appearance.

Question 24

Ovarian Cancer Risk Factors

Answer 24

1. 50 years of age or older
2. Familial factors:
   A • Family history of breast, ovarian, or colon cancer 3x baseline risk.
   B • Personal history of breast or colon cancer
   C • Familial cancer syndrome (10%) :
   - BRCA (breast cancer) gene mutation
   - hereditary non-polyposis colon cancer.

[[ Other potential risk factors ]]

• Early menarche (younger than 12 years of age)
• Late menopause (older than 52 years of age)
• Nulliparity
• First pregnancy at older than 30 years of age
• Infertility , endometriosis
• (fertility Rx does not increase risk)
• Hormone replacement therapy

Question 25

BRCA1

Answer 25

chromosome 17

Question 26

BRCA2

Answer 26

chromosome 13

Question 27

A tumor suppressor gene

Answer 27

produces a protein for DNA repair>> predispose to the development of breast and ovarian cancer

Question 28

Hereditary nonpolyposis colorectal cancer

Answer 28

• Also known as “Lynch syndrome” • 12% risk of developing ovarian cancers. • A hereditary cancer syndrome caused by a mutation in mismatch repair genes. Individuals have a signifcantly higher risk of developing colorectal, gastric, ovarian, and endometrial cancer.

Question 29

Protective factors

Answer 29

Surgical interven : • Bilateral salpingo-oophorectomy. • Hysterectomy. • Tubal ligation. Hormonal factors : • Oral contraceptives. • breast-feeding. • Parity.

Question 30

Presentation S&S

Answer 30

• Can be asymptomatic • Incidentally found on routine pelvic examination or imaging • Early symptoms are nonspecifc • Changes in urination (e.g., frequency or urgency) • Bloating/abdominal distention • Early satiety • Nonspecifc pelvic pain • Abnormal bleeding • Postmenopausal bleeding • Rectal bleeding • Adnexal mass • Para neoplastic syndromes

Question 31

Clinical examination

Answer 31

Pelvic/abdominal mass (fxed/mobile); ascites; omental mass; pleural effusion ; supraclavicular lymph nodes.

Question 32

Tumour markers:

Answer 32

• CA125 • Carcinoembryonic antigen(CEA): raised in colorectal cancers, normal in ovarian CA • AFP, hCG, LDH, inhibin, and oestradiol

Question 33

What’s the investigation of the ovarian cancer?

Answer 33

1. Haematological tests: FBC, U&E, LFTs. 2. Tumour markers: • CA125 • Carcinoembryonic antigen (CEA): raised in colorectal cancers, normal in ovarian CA • AFP, hCG, LDH, inhibin, and oestradiol 3. Image : • Abdominal/pelvic USS: the presence of pelvic mass and ascites • CXR: pleural ecusion or lung metastases • CT abdomen/pelvis: the extent of metastasis • MRI abdomen/pelvis : to assess the origin & the extent of metastasis

Question 34

Surgical staging of primary ovarian cancer:

Answer 34

mid-line sub umbilical suprapubic exploratory laparotomy: 1. Exploration of the pelvic and peritoneal cavity 2. Aspiration of (ascites) or perform peritoneal washings for Cytology. 3. infracolic omentectomy. 4. Pelvic and paraAortic lymph node sampling 5. Resection of any visible enlarged nodules or masses.