Ovarian neoplasms

Epithelial carcinoma (90%)
1. 50-60 yo
2. Histologies
  1. Serous (40-50%)
    1. 20% malignant
  2. Endometrioid (15-25%)
    1. 95% malignant
  3. Mucinous (5-15%)
    1. Pseudomyxoma (comes from appendix)
    2. 15% malgnant
  4. Clear cell (5-11%)
    1. 98% malignant
3. Staging
  1. 1A - limited to one ovary; 1B - both ovaries; 1C - +spill, rupture of capsule, peritoneal washings,
  2. 2A - extension to uterus/tubes; 2B - extension to other pelvic intraperitoneal tissues
  3. 3A - retroperitneal lymph nodes, microscopic mets; 3B - macroscopic peritoneal beyond pelvis up to 2 cm; 3C - macrosopic peritoneal beyond pelvis >2 cm
  4. 4A - pleural effusion; 2B- parenchymal mets, to extraabd organs
4. Treatment
  1. Surgery, then carboplatin, paclitaxel (6 cycles)
    1. Surgery mechanisms: inc tumor perfusion and cell kinetics, improve outcome of postop chemo, better anti-tumor immunologic defense
  2. Recurrence: refractory (0-3 mo), resistant (3-6 mo), sensitive (6-24 mo)
Germ cell (5%)
1. <20 yo
2. Derived from primordial germ cells
3. Treatment
  1. Surgery: oopherectomy & staging, fertility sparing usually
  2. Adjuvant chemo: bleomycin, etoposide, platinum
4. Histologies
  1. Immature teratoma
    1. aFP (sometimes)
    2. path: immature neural tissue
    3. rx: stage 1A, grade 1 - no adjuvent therapy; else, chemo therapy
    4. 100% malignant
  2. Dysgerminoma
    1. LDH
    2. path: epithelioid cells admixed w mature lymphocytes w fibrous septa
    3. 100% malignant
  3. Endodermal sinus tumor/yolk sac
    1. aFP
    2. path: Schiller-Duval bodies
    3. Treatment: ALL should have surgical staging and BEP
    4. 100% malignant
Sex cord stromal (5%)
1. 30-50 yo
2. Derived from sex cords and ovarian stroma/mesenchyme
3. Histology
  1. Granulosa: estrogen
    1. inhibin A, B, estradiol
    2. path: Call-Exner bodies
    3. presentation: age 40, usually stage 1 dx, associated with endometrial hyperplasia or neoplasia
    4. Treatment: TAH/BSO, staging vs. fertility-sparing with endometrial assessment. Chemo - stage 3/4, maybe BEP
  2. Sertoli-leydig: testosterone
    1. path: androgens
    2. presentation: early stage, clinical virilization
    3. Treatment: TAH/BSO, staging; consider fertility sparing
  3. Fibroma
    1. Presentation: ascites and pleural effusion

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Ovarian neoplasms

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	Created by parker.penelope over 10 years ago