Ovary
Barrett esophagus ph in vagina between 3.8 and 4.5 ph of stomach varies from 1-2 (hydrochloric acid) up to 4-5 BE probably results from upward migration of columnar cells from gastroesophageal junction (GEJ) GEJ cells are also origin of gastric-type metaplasia in distal esophagus It is unclear whether gastric-type metaplasia is a precursor to intestinal type metaplasia or whether they are separate entities
Diseases of the ovary nonneoplastic lesions - pelvic inflammatory disease - ovarian cysts - endometriosis ovarian tumors - epithelial (surface epithelial-stromal) - sex cord-stromal - germ cell - germ cell sex-cord stromal
Nonneoplastic inclusion functional endometrioid Ovarian cysts Cystic tumors epithelial tumors - cystadenoma (benign, borderline) - cystadenocarcinoma germ cell tumors - dermoid cyst
Nonneoplastic cysts inclusion cysts - inclusions of the surface epithelium - inclusions from fimbrial epitehlium functional cysts - follicular cyst - corpus luteum cyst - hemorrhagic cyst endometrioid cyst
Nonneoplastic cysts inclusion cysts - inclusions of the surface epithelium - inclusions from fimbrial epitehlium functional cysts - follicular cyst - corpus luteum cyst - hemorrhagic cyst - simple unilocular cysts - up to 1 cm in diameter - larger cyst - cystadenoma endometrioid cyst
Nonneoplastic cysts - unilocular thin walled cysts inclusion cysts - more than 3 cm in diameter - inclusions of the surface epithelium - content: serous, serosanguineous, - inclusions from fimbrial epitehlium clotted blood functional cysts - follicular cyst - corpus luteum cyst - hemorrhagic cyst endometrioid cyst
Nonneoplastic cysts inclusion cysts - thick and fibrotic wall - up to 15 cm in diameter - cyst content: semifluid, chocolate-colored functional cysts material - inclusions of the surface epithelium - inclusions from fimbrial epitehlium - follicular cyst - corpus luteum cyst - hemorrhagic cyst endometrioid cyst
Ovarian tumors
Classification of ovarian tumors epithelial tumors sex cord-stromal tumors germ cell tumors germ cell sex cord-stromal tumors
Classification of epithelial tumors according to their gross features: - cystadenoma (cystadenocarcinoma) - cystadenofibroma - adenofibroma (adenocarcinofibroma) - surface papilloma (surface papillary carcinoma) according to their histogenesis
Classification of epithelial tumors according to their gross features: - cystadenoma (cystadenocarcinoma) - cystadenofibroma - adenofibroma (adenocarcinofibroma) - surface papilloma (surface papillary carcinoma) according to their histogenesis!!!
Epithelial tumors benign borderline malignant serous - low grade - high grade endometrioid clear cell mucinous
Surface epithelial tumors benign borderline Tumors of müllerian origin malignant Müllerian (paramesonephric) ducts will give rise to: - upper vagina - cervix - uterus - Fallopian tube serous - low grade - high grade endometrioid clear cell mucinous
Benign epithelial tumors can be large (especially mucinous tumors the world s biggest tumor weighted 136 kilos) symptoms and signs usually nonspecific: - pelvic pain - discomfort - an asymptomatic pelvic mass up to 25% of tumors bilateral
Benign serous cystadenoma
Benign mucinous cystadenoma
Borderline tumors increased epithelial proliferation do not display invasion usually behave in a benign fashion but behavior can be malignant clinical features similar to those for benign tumors
Serous borderline tumor
Serous borderline tumor
Borderline tumor vs. carcinoma Borderline tumor Median age 46 56-60 % of tumor in 60-80 20-30 stage I 5-year survival 95-98 % 85-93 % rate for stage I 5-year survival 86-92 % 60-74 % rate for stage II 5-year survival 17-33 % 23-41 % rate for stage III metastatic spread rare common Invasive caricnoma
Ovarian cancer about 30% of all cancers of the female genital tract incidence rates are highest in the economically advanced countries (most frequent cause of death due to gynecological cancer) epithelial carcinomas account for 90% of these cancers in North America and Western Europe in some Asian countries, including Japan, germ cell tumours account for a significant proportion (20%) of ovarian malignancies
Risk factors age reproductive factors - early menarche, late menopause high socioeconomic status - lower fertility BRCA1/2 mutation (5-10% hereditary) Ovarian cancer Protective factors increased parity oral contraceptive use surgically induced: - hysterectomy - tubal ligation - bilateral salpingooophorectomy
Ovarian cancer: age-standardised (world) incidence and mortality rates per 100 000 (all ages) in 18 world regions Sankaranarayanan R, Ferlay J. Worldwide burden of gynaecological cancer: the size of the problem. Best Pract Res Clin Obstet Gynaecol. 2006 Apr;20(2):207-25. http://dx.doi.org/10.1016/j.bpobgyn.2005.10.007
Incidence and mortality Czech Republic 2006 Incidence Mortality 1074 cases 764 deaths 20,4 / 100 000 women 14,5 / 100 000 women 6,1%
high grade serous (70%) y ne og ci ol di th Me Pa of ity of ty rs te ul ive itu ac n st F U In rst les Fi har low grade serous (<5%) C surface epithelialstromal tumors endometrioid (10%) clear cell (10%) mucinous (3%)
y ne og ci ol di th Me Pa of ity of ty rs te ul ive itu ac n st F U In rst les Fi har C surface epithelialstromal tumors high grade serous (70%) Supposed origin of surface epithelial-stromal tumors according lowwho: grade serous (<5%) to mesothelial surface lining of the ovaries endometrioid (10%) and/or invagination of this lining into the ovarian cortex (inclusion cysts) clear cell (10%) mucinous (3%)
1) intraepithelial carcinoma in the tubal fimbriae 2) endosalpingiosis (inclusions from fimbrial epithelium) 3) inclusions from surface epithelium high grade serous (70%) low grade serous(<5%) precursor lesion: serous borderline tumor Epithelial tumors Precursor lesions and origin: unknown Putative precursor lesions: 1) endometriosis 2) mucinous metaplasia of Walthard nests 3) some can be of germ cell origin endometrioid (10%) clear cell (10%) mucinous (3%) precursor lesion: endometriosis precursor lesion: endometriosis
High grade serous carcinoma
High grade serous carcinoma y ne og ci ol di th Me Pa of ity of ty rs te ul ive itu ac n st F U In rst les Fi har C
y ne og ci ol di th Me Pa of ity of ty rs te ul ive itu ac n st F U In rst les Fi har C
Clear cell carcinoma
Clear cell carcinoma y ne og ci ol di th Me Pa of ity of ty rs te ul ive itu ac n st F U In rst les Fi har C
Prognostic factors C y ne og ci ol di th Me Pa of ity of ty rs te ul ive itu ac n st F U In rst les Fi har histologic subtype histologic grade stage advanced cancer: - macroscopic absence of residual tumor after primary surgery
Sex cord-stromal tumors C y ne og ci ol di th Me Pa of ity of ty rs te ul ive itu ac n st F U In rst les Fi har about 8 % of all ovarian tumors composed of: granulosa cells theca cells fibroblasts of stromal origin Sertoli cells Leydig cells singly or in various combinations
Sex cord-stromal tumors (adult or juvenile type) C y ne og ci ol di th Me Pa of ity of ty rs te ul ive itu ac n st F U In rst les Fi har about 8 % of all ovarian tumors composed of: granulosa cells theca cells fibroblasts of stromal origin Sertoli cells Leydig cells granulosa cell tumor singly or in various combinations thecoma fibroma fibrosarcoma Sertoli cell tumor Leydig cell tumor
Germ cell tumors different tumor types derived from the primitive germ cells of the embryonic gonad represents: - about 30% of all ovarian tumors (up to 95 % are mature cystic teratomas) - about 3 % of all ovarian cancers (western world) - up to 20 % of all ovarian cancers (Asia)
Germ cell tumors - histogenesis Dysgerminoma Germ cell Tumors of totipotential cells Embryonal carcinoma Embryonal carcinoma Extraembryonic structures Embryonic structures Yolk sac tumor Choriocarcinoma Teratoma
y ne og ci ol di th Me Pa of ity of ty rs te ul ive itu ac n st F U In rst les Fi har C
y ne og ci ol di th Me Pa of ity of ty rs te ul ive itu ac n st F U In rst les Fi har C