OVARIES MLS Basic histological diagnosis MLS HIST 422 Semester 8- batch 7 L13 Dr: Ali Eltayb.
OBJECTIVES Recognize different disease of ovaries Classify ovarian cyst Describe the pathogenesis, morphology and clinical featurs of PCOD List the three classification of ovarian tumors Report the relative incidence Describe and contrast the pathology and behavior of ovarian serous and mucinous cystadenomas, borderline tumor, and carcinoma Define and causes pseudomyxoma peritonei
FOLLICLE AND LUTEAL CYSTS so commonplace, originate from graafian follicles, either unruptured or immediately sealed after ruptured Morphology: it range between 1-4.5 cm.filled with serous fluid and lined by granulosa or luteal cells C\F:, palpable masses and pelvic pain, cysts rupture, intraperitoneal bleeding and peritoneal symptoms (acute abdomen)
Follicular Cyst
Luteal cysts (corpora lutea
POLYCYSTIC OVARIAN DISEASE.Also known as Stein-Leventhal syndrome Multiple cystic follicles in the ovaries produce excess androgens and estrogens. C/F: teenage girls or young adults who present with oligomenorrhea, hirsutism, infertility, and sometimes obesity.
POLYCYSTIC OVARIAN DISEASE Gross:enlarged ovaries. C/S: subcortical cysts 0.5 to 1.5 cm in diameter Micro,sllec aceht -asolunarg yb denil tsyc eht : evitcnitsid a si aetul aroproc fo esnesba dna. erutaef. principal biochemical abnormalities are excessive androgens, high LH, and low concentrations of FSH
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TUMORS OF THE OVARY are amazingly varied. due to the presence of three cell types in the normal ovary: - The multipotent surface (coelomic) epithelium, - The totipotent germ cells, - The sex cord stromal cells. each of which gives rise to a number of different tumors.
Important risk factors nulliparity,family history, and germline mutations in certain tumor suppressor genes.. Around 5% to 10% of ovarian cancers are familial, and most of these are associated with mutations in BRCA1 and BRCA2 tumor suppressor genes
TUMORS OF THE OVARY Tumors may arise from: Epithelium, Sex cord stromal cells, Or germ cells..
Surface Epithelial Tumors The major types are serous, mucinous, and endometrioid. Each has a benign, malignant, and borderline (low malignant potential) counterpart.
Surface Epithelial Tumors are the most common malignant ovarian tumors and are more common in women older than 40 years of age. Serous Tumors(most common) Mucinous Tumors Endometrioid Tumors Brenner Tumor
Serous tumors )tnangilam,enilredrob,ngineb( Continue Most common ovarian neoplasm Occur at 25-50 years years old. malignant seen old age. Mostly are cystic but solid tumor may occur Cystic neoplasm are lined by columnar ciliated epithelium and filled by serous fluid malignant complex papillae lined by more than one layer and stroal invasion
)tnangilam,enilredrob,ngineb(mucinous Tumors Less common than serous Occur between the age - 30-40 years. 80 %of mucinous tumors are benign Borderline & malignant tumor account in 10 % Usually are unilateral, however bilaterality may presents in 5 %of cystadenoma cystadenocarcinoma & 25 %of
MORPHOLOGY
Germ cell tumors mostly cystic teratomas are the most common ovarian tumor in young women; a majority are benign. Germ cell tumors may differentiate toward oogonia (dysgerminoma), primitive embryonal tissue (embryonal), yolk sac (endodermal sinus tumor), placental tissue (choriocarcinoma), or multiple fetal tissues (teratoma).
Benign (Mature) Cystic Teratomas mature tissues derived from all three germ cell layers: ectoderm, endoderm, and mesoderm. On cut section, they often are filled with sebaceous secretion and matted hair, teeth protrude. cysts lined by epidermis replete with adnexal appendages (dermoid cysts). 1% of cases, malignant transformation, usually to a squamous cell carcinoma
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Immature Malignant Teratomas The mean age being 18 years Gross :often are bulky, predominantly solid on cut section Mic: presence of immature elements mainly foci of neuroepithelial differentiation, Specialized Teratomas: composed entirely of specialized tissue. The most common example is struma ovarii, composed entirely of mature thyroid tissue
Sex cord stromal tumors. May display differentiation toward granulosa, Sertoli, Leydig, or ovarian stromal cell type. Depending on differentiation, they may produce estrogens or androgens.
Clinical Correlations. tumors are well advanced on presentation Large tumor local pressure symptoms (e.g., pain, gastrointestinal complaints, urinary frequency) Functioning neoplasms exert hormonal effects (endocrinopathies) 30% discovered incidentally increase in abdominal girth. acute abdomen. If torision occur Ascites metatstatic seeding
Treatment Remains unsatisfactory Screening methods to date are of limited value One such marker, the protein CA-125, are of greatest value in monitoring response to therapy.
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