PATHOLOGY OF OVARY

DR . HENNY SULASTRI Sp.PA

Classification of ovarian neoplasms based on cell of
origin.

Department of Anatomical Pathology Medical Faculty of

University of Sriwijaya Palembang 2
11/6/2018
3
Histogenesis of ovarian epithelial-stromal
tumors.

Department of Anatomical Pathology Medical Faculty of

University of Sriwijaya Palembang 4
11/6/2018
 SEROUS TUMOR
• 30% of all ovarian tumor
50% of ovarian ephitelial tumour
• Histologiy typing : Benign
• 70%
Borderline
• Risk factor for benign, borderline and
malignant incomplete understood.
• Benign serous tumor : cystic neoplasm,
underlined by columnar epithelium, ciliated
epithelial, containing clear and serous fluid,
offer on age 20 – 40 years
Serous borderline tumour
• exhibit complexity of the stromal papilae
• Stratification of epithelium but no invasion
into stroma
• Mild nuclear atypia
• Ephitelial proliferation form papillary pattern,
referred to as micropapilary cancer
 Serous Carcinoma
• Low grade tumor :
Arising in serous borderline tumor
Mutation in KRAS , BRAT or ERB B2 usualy
mild type Tl53
• High grade tumor :
Almost of high grade tumor ovarian carcinoma
arising in woman with BRCA1/BRCA2 mutation
and TP53 mutation.
• Complex growth pattern epithelial hyperplasia
serous tubal intra apithelial carcinoma
(STIC)
• Invasion cell undifferentiated serous feature
Serous Tumors
• Cortical inclusion
cysts of the ovary.
These cysts appear to
arise from the
overlying
mesothelium & are
presumed to be the
site of origin for many
ovarian epithelial
neoplasms.

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• A, Borderline serous
cystadenoma opened to
display a cyst cavity lined
by delicate papillary
tumor growths.
• B, Cystadenocarcinoma.
The cyst is opened to
reveal a large, bulky
tumor mass.
• C, Another borderline
tumor growing on the
ovarian surface (lower).

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Medical Faculty of University of Sriwijaya
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• Borderline serous cystadenoma exhibiting
increased architectural complexity & epithelial
cell stratification.

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 MUCINOUS TUMOR
• 20% - 25% of all ovarian neoplasma
• Mean age : middle adult life more before puberty
and after menopause
• Vast majority are benign/borderline
• Primary mucinous carcinoma ± 3% of all ovarian
cancer
• Associated with KRAS mutation
• Tend to produce larger cystic masses,
multioculated, filled with sticky and gelatinuos
rich glikoprotein.
mikroskopic
• Benign tumour :
lining by columnar epithelial cells with apical nuclear vast
majority shows gastric and untestinal differentiation.
• Borderline tumour :
epithelial stratification , tafting, papillary intraglandular
growth.
• Mucinuos carcinoma :
10% of all mucinuos tumour . Age insidence : 4-7 decade.
Cystic space with papillae, mixed with solid masses
Histology : cellular tumour containing crowded gland ,
papillae solid sheets of startiffied mucinuos cells
 Mucinous tumors

• A, A mucinous cystadenoma with its multicystic appearance and

delicate septa. Note the presence of glistening mucin within the cysts.
• B, Columnar cell lining of mucinous cystadenoma.
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 SEX CORD STROMAL TUMOUR
Granulosa cell tumor
• 5% of all ovarian tumor
• Granulosa cell tumor : - adult type 95%

- juvenile 5%
• Unilateral , encapsulated, solid mass with
cystic formation
Microscopic :
Individual cell small, cuboidal to polygonal.
Growth in anastomosing cord, shects or strand.
In the sheets punctuated small folicel structure
with acidofilic material in the central ( call exner bodies)
Clinical important : tumor cell elaborate estrogen
In pre pubertal girl ( juvenile GCT) may produce iso sexual
pseudo precoxcity
Adult GCT : May caused hiperplasia endometrium and
proliferative breast disease.
Classification of germ cell tumors of the ovarium

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Medical Faculty of University of Sriwijaya
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 Germ Cell Tumors
• Tends to benign  adult
Malignant  children
• The neoplastic germ cell may follow one of several
lines of differentiation, giving rise to tumors
analogous to those found in the male testis
- Dysgerminoma is composed by germ cell
neoplastik  similar with oogonia in fetal
ovary.
- Teratoma  differentiates toward somatic
(embryonic or adult) tissues.

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 Teratoma

• Teratoma is a tumor of germ cell origin that

differentiates toward somatic structures.
• Most teratomas contain tissues from at least two and
usually all three, embryonic layers.

MATURE TERATOMA
IMMATURE TERATOMA

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MATURE TERATOMA

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IMMATURE TERATOMA

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 Dysgerminoma

• Dysgerminoma is the ovarian counterpart of

testicular seminoma, and is composed of
primordial germ cells.
• < 2% ovarian tumors, but 10% cases of
malignant ovarian cancer on women <20 yrs.
• Tx : surgery  5 year’s survival rate with stage
1 tumor = 100%

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Dysgerminoma

• The neoplastic germ

cells have clear,
glycogen-filled
cytoplasm and central
nuclei.
• Fibrous septa
containing
lymphocytes traverse
the tumor.

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