ovarian tumors.pptx

ovarian tumors

1. OVARIAN TUMORS By: Jitendra K Patil D.Y.Patil Hospital kolhapur

2. Ovarian cancer is the second most common gynecological malignancy - highest in developed nations. The high mortality rates of ovarian cancer are partly due to its late detection, with 67% of patients presenting with advanced disease. Majority are E pithelial tumors Others include : germ cell tumors stromal-sex cord tumors metastatic cancers from extra-ovarian p rimary sites.

3. The ovaries are extraperitoneal organs , Oval in structures, vary i n size and appearance depending on the woman's age, hormonal status, and stage of the menstrual cycle . The adult ovary is about 2.5–5 cm long 1.5–3 cm wide 1–2 cm thick T he Ovary lies against the Lateral Wall of the Pelvis in a depression called the Ovarian Fossa Bounded by the : External iliac vessels above and by the Internal iliac vessels behind.

4. Posterior surface of the ovary is attached to the broad ligament by the mesovarium Uterine body by the utero-ovarian ligament Lateral pelvic wall by the suspensory ligaments . Tumor can spread via these ligaments to the adjacent pelvic organs.

5. Normal sonographic appearance R elatively homogeneous echotexture with a central, more echogenic medulla. Small, well-defined anechoic or cystic follicles may be seen peripherally in the cortex. TVS : Dominant follicle developing in a normal ovary.

6. NORMAL CT ANATOMY

7. Normal ovaries on MR imaging The landmark of the ovaries is the follicles Follicules are cortical cysts of high T2 signal. The average size of a functional follicle is 1 cm The follicles are of low to intermediate signal on T1Wls

8. Morphologic features at US that are suggestive of ovarian malignancy include : an irregular solid mass an irregular multilocular cystic mass solid components or papillary vegetations on the cyst wall high flow within solid components on color Doppler images (low impedance flow: RI <0.6) ascites peritoneal nodules, lymphadenopathy Solid components or papillary projections in a cystic adnexal mass on gray-scale US images are the most significant indicators of malignancy.

9. Computed Tomography Morphologic information from the use of enhanced CT, e.g. presence of a complex cystic mass with enhancing solid components. Calcification is occasionally seen in papillary serous adenocarcinoma and Brenner tumor. Ancillary findings of malignancy, such as ascites, peritoneal deposits, lymphadenopathy and pleural effusion may also be seen. Involvement of uterus, rectum, colon and small bowel by the tumor. Deposits on peritoneum, liver or bowel surfaces.

10. MR morphologic features that are indicative of a malignant adnexal mass include the presence of both solid and cystic areas within a lesion; necrosis within a solid lesion; papillary projections from the wall or septum of a cystic lesion; an irregular septum or wall; multiple thickened (>3 mm) septations; a large size (>6 cm); bilateral lesions; ascites, peritoneal disease, or lymphadenopathy

11. Epithelial tumors: Serous cystadenocarcinoma predominantly cystic masses. They may show wall thickening and nodularity, internal solid areas and septations. Malignant tumors tend to have more nodularity and solid areas than their benign counterpar t

12. Classic Signs : Classic signs of serous cystadenocarcinoma include bilateral thick-walled adnexal cystic lesions with solid components or papillary projections with ascites and peritoneal carcinomatosis.

13. Mucinous cystadenocarcinomas Predominantly large cystic masses but tend to be multiloculated with multiple thick internal septations. Diffuse internal echoes due to their high mucin content.

14. Endometrioid Carcinoma 10%-15% of all ovarian carcinomas. Almost always malignant. About 15%-30% - synchronous endometrial carcinoma or endometrial hyperplasia. Although rare, endometrioid carcinoma is the most common malignant neoplasm arising from endometriosis, followed by clear cell carcinoma. Bilateral involvement is seen in 30% - 50% of cases. Imaging findings are nonspecific and include a large, complex cystic mass with solid components.

15. Clear Cell Carcinoma ~5% of ovarian carcinomas and are always malignant. Majority in stage I at the time of diagnosis and tends to have a better prognosis than other ovarian malignancies. Second most common malignancy occurring in patients with endometriosis.

16. Brenner's tumors Rare lesions (2% to 3% of all ovarian tumors), and are composed of transitional cells and dense stroma. Rarely malignant, usually less than 2 cm, and typically discovered incidentally. Appears as either a multilocular cystic mass with a solid component or as a small predominately solid mass - mild or moderate enhancement at CT. Extensive calcification within the solid component is often present. MRI: dense stroma - low T2-weighted signal similar to that of a fibroma.

17. Germ cell tumors Benign cystic teratoma - "Dermoid cyst" Most common germ cell neoplasm of the ovary - B/L in 15-25% cases. Mature elements derived from ectoderm, mesoderm, or endoderm, resulting in a broad range of appearances. Age 10-30 yrs. Predominantly cystic, presence of mature ectodermal elements such as bone, teeth and hair give them a complex or varied appearance.

18. Characteristic USG features of a mature cystic teratoma: Hypoechoic mass with hyperechoic nodule (Rokitansky nodule or dermoid plug) Usually unilocular (90%) • Calcifications (30%) • May contain hyperechoic lines caused by floating hair. • May contain a fat-fluid level, i.e. fat floating on aqueous fluid

19. Immature teratoma Immature teratoma represents less than 1% of all teratomas and contains immature tissue from all three germ cell layers M alignant immature teratomas have prominent solid components and may demonstrate internal necrosis or hemorrhage. Usually a unilateral solid mass with coarse calcifications and rarely intratumoral fat. Peritoneal spread is common. Gliomatosis peritonei - multiple benign or low grade malignant deposits of immature teratoma throughout the peritoneal cavity.

20. Dysgerminoma Most common ovarian malignancy in children and young adults with 80% of patient under 30 years of age. Large, unilateral, well-defined solid mass - usually homogeneous; however, varying degree of necrosis. or hemorrhage may be present. Characteristic imaging findings include multilobulated solid masses with prominent fibrovascular septa

21. Yolk sac or endodermal sinus tumor Highly malignant ovarian tumor characterized by rapid growth and early metastases On CT and MRI - seen as complex c ystic or solid tumors with heterogeneous and intense contrast enhancement. Areas of necrosis and hemorrhages are often present.

22. Sex Cord–Stromal Tumors Granulosa Cell Tumor mostcommon malignant sex cord–stromal tumor as well as the most common estrogen-producingovarian tumor. The hyperestrogenemia may produce combined endometrial hyperplasia, polyps, or carcinoma. granulosa cell tumors do not have intracystic papillary projec-tions, have less propensity for peritoneal seeding

23. FIBROTHECOMA Fibroma and thecoma are forms of a spectrum of benign tumors. Lipid-rich thecoma demonstrates estrogenic activity and few fibroblasts. F ibroma has no thecal cells and demonstrates no estrogenic activity. Fibroma is composed of whorled bundles of cytologically bland, benign, spindle-shaped fibroblasts and collagen . They are associated with ascites or Meigs syndrome

24. Sertoli-Leydig Cell Tumor occur in young women (30 years of age) and are considered to be a low-grade malignancy. The tumor is co m posed of heterologous tissue and manifests as a well-defined, enhancing solid mass with intratumoral cysts

25. Metastases to ovaries Most commonly arise from primary tumors of the stomach, colon, pancreas or breast. May be solid, cystic or complex ovarian masses, frequently bilateral and usually associated with ascites. Less likely to be multilocular than primary ovarian tumors but otherwise there are no specific distinguishing features. 'Krukenberg tumor' - specific histological pattern of mucin-secreting signet cells with sarcomatous stroma, usually from a gastric primary.

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