Malignant Ovarian Tumours obstetrics.pptx

Obg

1. Malignant Ovarian Tumours Joel John Jacob Roll number: 52

2. Classification of Ovarian Tumours SECONDARY PRIMARY Epithelial Non Epithelial Serous Mucinous Endometrioid Brenner Undifferentiated Germ Cell Sex Cord Stromal Unclassified Typical Atypical

3. Uterus - U Multiple Thin Septa - Arrows Right ovary Serous Cystadenoma Serous Cystadenoma/ Adenocarcinoma Accounts for 40% of all malignant ovarian tumours Benign lesions (Cystadenoma) Unilocular/multilocular cysts with multiple septations Sharply defines walls Septa undulates if gently palpated with transducer No solid tissue seen Boarderline lesions cannot be distinguished (15%)

4. Uterus - U Multiple Thin Septa - Arrows Right ovary Serous Cystadenoma Accounts for 40% of all malignant ovarian tumours Benign lesions (Cystadenoma) Unilocular/multilocular cysts with multiple septations Sharply defines walls Septa undulates if gently palpated with transducer No solid tissue seen Boarderline lesions cannot be distinguished (15%) Serous Cystadenoma/ Adenocarcinoma

5. Uterus - U Multiple Thin Septa - Arrows Right ovary Serous Cystadenoma Serous Cystadenoma/ Adenocarcinoma Malignant Lesions Thickening of septa Increased number and size of mural nodules Foci of Solid tissue Ascites (Due to peritoneal spread) In more than 60% of the cases it is bilateral

6. Serous Cystadenoma/ Adenocarcinoma Serous Cystadenocarcinoma Thickened Septa Solid Component protruding into the cystic cavity (Arrow) Malignant Lesions Thickening of septa Increased number and size of mural nodules Foci of Solid tissue Ascites (Due to peritoneal spread) In more than 60% of the cases it is bilateral Serous Cystadenoma Right ovary Uterus - U Multiple Thin Septa - Arrows

7. Serous Cystadenocarcinoma Serous Cystadenoma/ Adenocarcinoma Thickened Septa Solid Component protruding into the cystic cavity (Arrow) Malignant Lesions Thickening of septa Increased number and size of mural nodules Foci of Solid tissue Ascites (Due to peritoneal spread) In more than 60% of the cases it is bilateral

8. Serous Cystadenoma/ Adenocarcinoma Serous Cystadenocarcinoma Thickened Septa Solid Component protruding into the cystic cavity (Arrow)

9. Mucinous Adenocarcinoma Multiple Septations Low internal echoes Multiple Septa dividing fluid containing loculations More numerous septa than serous counterpart Low level of internal echoes

10. Mucinous Adenocarcinoma Multiple Septations Low internal echoes Multiple Septa dividing fluid containing loculations More numerous septa than serous counterpart Low level of internal echoes Multiple Thickened septa ( Arrow heads) Low level echoes suggestive of mucin (Arrow)

11. Mucinous Adenocarcinoma Multiple Thickened septa ( Arrow heads) Low level echoes suggestive of mucin (Arrow) Multiple Septations Low internal echoes

12. Endometrioid Carcinoma Solid Appearance Areas of necrosis and hemorrhage Histology similar to endometrial carcinoma of uterus Solid ( Arrow Heads) Cystic spaces seen which is not characteristic

13. Endometrioid Carcinoma Solid ( Arrow Heads) Cystic spaces seen which is not characteristic Solid Appearance Areas of necrosis and hemorrhage Histology similar to endometrial carcinoma of uterus

14. Dermoid (Teratoma) Fluid/Debris level (Arrow Head) Highly reflective Calcium focus (Arrow) Acuostic Shadow (S) Comprises of mixture of fat, hair, sebum, calcium, neural elements and debris in varying proportions Can be cystic, solid or complex A well circumscribed mass with fluid/debris level Internal focus of highly reflective material causing an acoustic shadow

15. Dermoid (Teratoma) Fluid/Debris level (Arrow Head) Highly reflective Calcium focus (Arrow) Acuostic Shadow (S) Comprises of mixture of fat, hair, sebum, calcium, neural elements and debris in varying proportions Can be cystic, solid or complex A well circumscribed mass with fluid/debris level Internal focus of highly reflective material causing an acoustic shadow

16. Sex cord Stromal Tumors Thecoma Produces Acoustic Shadow along the entire length of the tumour Unilateral Histologically benign Hormone producing tumours These tumours show no distinguishing ultrasound features for identification

17. Sex cord Stromal Tumors Hormone producing tumours These tumours show no distinguishing ultrasound features for identification Granulosa Cell Tumor Produce estrogen in post menopausal women Small- Solid When increased in size, it may be cystic with septa Thecoma Produces Acoustic Shadow along the entire length of the tumour Unilateral Histologically benign

18. Sex cord Stromal Tumors Thecoma Produces Acoustic Shadow along the entire length of the tumour Unilateral Histologically benign Granulosa Cell Tumor Produce estrogen in post menopausal women Small- Solid When increased in size, it may be cystic with septa

19. Thank you

20. References Shaw’s Textbook of Gynecology (16 th edition) DC Dutta’s Textbook of Gynecology Clinical Ultrasound- Keith Dewbury , Hylton Meire , David Cosgrove Ultrasound in Obstetrics and Gynecology (3 rd Edition)- Nerendra Malhotra