DR HEYAM AWAD FOLLICULAR AND LUTEAL CYSTS POLYCYSTIC OVARY OVARIAN TUMORS FOLLICULAR AND LUTEAL CYSTS COMMON CONSIDERED VARIANTS OF NORMAL PHYSIOLOGY ORIGENATE FROM UNRUPTURED FOLLICLES ID: 577459
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DISEASES OF THE OVARIES
DR HEYAM AWADSlide2
FOLLICULAR AND LUTEAL CYSTS.
POLYCYSTIC OVARY.
OVARIAN TUMORS.Slide3
FOLLICULAR AND LUTEAL CYSTS
COMMON.
CONSIDERED VARIANTS OF NORMAL PHYSIOLOGY.
ORIGENATE FROM UNRUPTURED FOLLICLES.
USUALLY MULTIPLE.
SMALL AND FILLED WITH SEROUS FLUID.
LINED BY GRANULOSA OR LUTEAL CELLS.
MAY RUPTURE AND CAUSE INTRAPERITONEAL BLEEDING OR ACUTE ABDOMEN.Slide4
POLYCYSTIC OVARY (PCO)
MULTIPLE CYSTIC FOLLICLES IN THE OVARIES.
PRODUCE EXCESS ESTROGEN AND ANDROGENS.
PRESENT IN TEENAGE GIRLS, WITH OLIGOMENORRHEA, HIRSITUISM, INFERTILITY, AND OBESITY.Slide5
PCO MORPHOLOGY
OVARIES TWICE THE NORMAL SIZE.
MULTIPLE SUBCORTICAL CYSTS.
HISTOLOGICALLY: THICK FIBROTIC OVARIAN CAPSULE, NUMEROUS CYSTS LINED BY GRANULOSA CELLS, AND ABSENT CORPORA LUTEA.Slide6
PCO
HIGH ANDROGEN LEVEL.
HIGH LH.
LOW FSH.
ANDROGENS CONVERTED TO ESTROGEN WHICH INHIBITS FSH.Slide7
OVARIAN TUMORS
EIGHTH MOST COMMON CANCER IN USA.
FIFTH LEADING CAUSE OF CANCER DEATH IN WOMEN.
THREE TUMOR TYPES: SURFACE EPITHELIAL TUMORS, GERM CELL NEOPLASMS AND SEX CORD TUMORS..Slide8
SURFACE EPITHELIAL TUMORS
CAN BE CYSTIC OR SOLID.
CAN BE BENIGN OR MALIGNANT.
USUALLY BENIGN LESIONS ARE CYSTIC.
MAIGNANT LESIONS CAN BE SOLID OR CYSTIC WITH A SOLID COMPONENT.Slide9
RISK FACTORS
NULLIPARITY.
FAMILY HISTORY. .. 5-10 % OF OVARIAN TUMORS
ARE
FAMILIAL
.
MOST OF THESE ASSOCIATED WITH BRCA 1 AND 2 GENES.
MUTATIONS IN CERTAIN TUMOR SUPRESSOR GENES.Slide10
SURFACE EPITHELIAL TUMORS
SEROUS.
MUCINOUS.
ENDOMETRIOID.
BRENNER TUMOR.Slide11
SEROUS TUMORS
THE MOST COMMON EPITHELIALTUMORS.
60% ARE BENIGN.
15% LOW MALIGNANT POTENTIAL.
25% MALIGNANT.Slide12
BENIGN SEROUS TUMORS USUALLY CYSTIC AND OCCUR IN PATIENTS BETWEEN 30 AND 40 YEARS.
MALIGNANT TUMORS AT 45-65 YEARS OF AGE.
BORDERLINE AND MALIGNANT SEROUS TUMORS ARE THE MOST COMMON OVARIAN MALIGNANCY (60%)Slide13
BENIGN SEROUS TUMORS
25% OF BENIGN SEROUS TUMORS ARE BILATERAL.
CYSTIC.
SMOOTH SURFACE.
HISTOLOGICALLY: LINED BY A SINGLE LAYER OF TALL COLUMNER OR CUBOIDAL CILIATED CELLS.
PSAMMOMA BODIES ARE COMMON.Slide14Slide15
SEROUS CARCINOMA
SEROUS CYST ADENOCARCINOMA OR SOLID SEROUS CARCINOMA.
IF CYSTIC, SOLID AREAS PRESENT.
HISTOLOGICALLY: STRATIFICATION, ANAPLASIA, MITOSES, COMPLEX PAPILLARY FORMATION AND INASION.
BETTER PROGNOSIS IF CONFINED TO OVARY.Slide16Slide17
BORDERLINE SEROUS TUMORS
LESS ATYPIA AND LITTLE OR NO STROMAL INVASION.
NEARLY 100% SURVIVAL.
.Slide18
MUCINOUS TUMORS
80% BENIGN.
10% BORDERLINE.
10% MALIGNANT.Slide19
MUCINOUS TUMORS
GROSSLY SIMILAR TO SEROUS COUNTERPARTS.
HISTOLOGICALLY LINED BY COLUMNER MUCIN SECRETING EPITHELIUM.
LESS LIKELY TO BE BILATERAL.
IF RUPTURED THEY SEED THE PERITONEUM AND CAUSE LARGE AMOUNT OF MUCIN = PSEUDOMYXOMA PERITONEISlide20
PSEUDOMYXOMA PERITOMESlide21
ENDOMETRIOID TUMORS
MAJORITY MALIGNANT.
30% BILATERAL.
15-38% HAVE ALSO ENDOMETRIAL CARCINOMA.Slide22
BRENNER TUMOR
UNCOMMON.
SOLIOD.
USUALLY UNILATERAL.
NESTS OF TRANSITIONAL EPITHELIUM IN ABUNDANT STROMA.
MOST ARE BENIGN ALTHOUGH BORDERLINE AND MALIGNANT COUNTERPARTS EXIST.Slide23
TUMORS OF GERM CELL ORIGIN
DYSGERMINOMA: USUALLY UNILATERAL AND MALIGNANT.
RESPONDS TO RADIOTHERAPY WITH 80% CURE RATE.
CHORIOCARCINOMA :UNILATERAL AND METASTASIZES EARLY.
TERATOMASlide24
SEX CORD TUMORS
GRANULOSA CELL TUMOR.
THECOMA FIBROMA.
SERTOLI_ LEYDIG CELL TUMOR.Slide25
METASTATIC TUMORS
MOSTLY BILATERAL.
GI IS THE MOST COMMON PRIMARY METASTASIZING TO OVARIES= KRUKENBURG TUMORS.
OTHER PRIMARIES.. LUNG AND BREASTSlide26
TERATOMA
15-20 % OF OVARIAN TUMORS.
IN THE FIRST TWO DECADES OF LIFE.
THE YOUNGER THE PATIENT , THE MORE LIKELIHOOD OF MALIGNANCY.
90% ARE BENIGN CYSTIC TERATOMAS.Slide27
BENIGN CYSTIC TERATOMA= MATURE TERATOMA
MATURE TISSUE FROM THE THREE GERM CELL LINES: ENDODERM, MESODERM AND ECTODERM.
90% UNILATERAL.
IN 1% OF CASES MALIGNANT TRANSFORMATION SEEN, USUALLY SCC.Slide28Slide29Slide30
IMMATURE TERATOMA
MALIGNANT.
YOUNG AGE.
USUALLY SOLID.
IMMATURE TISSUE SEEN HISTOLOGICALLY.Slide31
SPECIALIZED TERATOMAS
RARE.
ONE TYPE OF TISSUE.
STRUMA OVARII… MATURE THYROID TISSUE…. CAN CAUSE HYPERTHYROIDISM.
OVARIAN CARCINOID.