OVARIES-1

Ovaries

Common Lesions

  • Functional or Benign Cysts: Common lesions found in ovaries.

  • Tumors: Less common, may be benign or malignant.

  • Rarer Lesions: Rare occurrences which may include intrinsic inflammation but usually accompanied by tubal inflammation.

  • Autoimmune Oophritis: Rare condition often linked with infertility.

Cystic Lesions

Follicular and Luteal Cysts

  • Arise from unruptured or ruptured Graafian follicles, leading to cyst formation.

  • Non-Neoplastic and Functional Cysts:

    • Follicular Cysts:

      • Typically bilateral and can grow up to 2 cm in diameter.

      • Filled with clear serous fluid.

      • Large cysts exceeding 2cm may be identified via ultrasound or palpation.

Symptoms and Effects of Cysts

  • May cause pelvic pain.

  • Granulosa lining cells may be present, absent under high intraluminal pressure.

  • Prominent theca cells may appear luteinized and have pale appearance due to increased cytoplasm.

  • High thecosis leads to increased estrogen production which can result in endometrial abnormalities.

Polycystic Ovaries (Stein-Leventhal Syndrome)

  • Affects 3%-6% of women in reproductive age, often associated with:

    • Numerous cystic follicles

    • Anovulatory oligoamenorrhea

    • Symptoms: persistent anovulation, 40% obesity, 50% hirsutism.

  • Morphology: Enlarged ovaries, smooth outer cortex, thickened cortex, and numerous subcortical cysts (0.5-1.5 cm).

    • Hyperplasia of theca internal cells, linked to hormone regulation issues.

Ovarian Cancer

  • Ovarian cancer is a common neoplasm among women, occurring less frequently than cervical and endometrial cancers.

Risk Factors for Ovarian Cancer

  • Nulliparity

  • Family History: Increased risk linked to genetic mutations, particularly BRCA1 and BRCA2.

  • Gonadal Dysgenesis: Increased risk in children.

  • Mutations of p53 Gene: Found in 50% of ovarian cancer cases.

Classification of Ovarian Tumors

  • Tumors classified based on probable tissue of origin:

    • Müllerian Epithelium tumors

    • Germ Cell Tumors

    • Sex Cord-Stromal Tumors

    • Metastatic Tumors

  • Surface Epithelium Tumors: Most common, ranging in size from small to large pelvic-filling tumors.

    • Present areas may be cystic (cystadenoma) or fibrous (adenofibromas).

Serous Tumors

  • Common cystic neoplasms lined with tall, columnar, ciliated epithelium filled with clear serous fluid.

  • Comprised of benign, borderline, and malignant types, accounting for 60-70% of ovarian tumors:

    • Serous Cystadenocarcinoma: Most common malignant tumor of the ovaries (40% of ovarian cancers).

    • Age distribution: Benign and borderline tumors seen predominantly in women aged 20-50, malignant forms arise later in life, potentially earlier in familial cases.

  • Morphology:

    • Irregularity of tumor mass indicates potential malignancy, with cysts showing different characteristics based on their nature.

Mucinous Tumors

  • Differ from serous tumors:

    • More cysts of various sizes, less frequency of bilateral occurrence, and typically multiloculated tumors filled with gelatinous fluid.

  • Their histology varies, and they make up about 25% of ovarian cancers.

Endometrioid Tumors

  • Account for 20% of ovarian cancers, mostly malignant with some benign (cystadenofibroma).

  • About 15%-30% linked with endometrial carcinoma, association increases survival prognosis.

Other Uncommon Tumors

  • Clear Cell Adenocarcinoma: Resembles clear cell carcinoma of the endometrium.

  • Brenner Tumor: Benign or uncommon adenofibromas, unilateral.

Clinical Presentation

  • Often late diagnosis results in large tumor or metastases, leading to a poor survival rate (5-10 years).

  • Common symptoms include:

    • Abdominal enlargement

    • Lower abdominal pain

    • Gastrointestinal complaints

    • Frequency and dysuria

    • Pelvic pressure.

  • Treatment for benign tumors usually involves resection.

  • Malignant tumors show progressive symptoms and complications, including ascites.

Germ Cell Tumors

  • Account for 15-20% of ovarian tumors, mostly benign cystic teratomas.

Types of Teratomas

  • Mature (Benign): Commonly cystic, known as dermoid cysts, usually found in young women.

    • Characterized by hair and sebaceous material; can develop from multiple germ layers and show signs of malignant transformation in rare cases.

  • Immature (Malignant): Exhibit aggressive behavior and occur primarily in young women, characterized by large, smooth tumors with necrosis and immature tissue.

  • Dysgerminoma: Represents 2% of ovarian cancer; associated with clear cytoplasm cells and favorable prognosis in early-stage.

  • Endodermal Sinus Tumor: Second most common malignant germ cell tumor in children and young women, identified by abdominal pain and large mass.

Choriocarcinoma

  • Known for high aggressiveness and tends to metastasize early; generally poorly responsive to chemotherapy.

Mixed Germ Cell Tumors

  • Such as dysgerminomas, teratomas, and other germ cell tumors, showcasing various combinations in their pathology.