Ovarian tumors – types and pictures
Ovary is a common tumor location in women. The tissues of the neoplasms that develop in the ovary are many and they vary – “epithelium” (mezothel covering the organs), specialized mesenchyme (unique for ovary), reproductive (germ) cells and the banal, non-specific stroma.
1. Epithelial Tumors – Epithelial tumors are the most common, accounting for 60% of benign and 90% of malignant ovarian tumors. Cancers rank third in frequency among the neoplasms of the female genitals. The age when the disease is most common is between 50-70 years. The incidence is greater in industrialized countries, nulliparous or treated for infertility for a long time. The tumor cells derive from cells that have penetrated deeply the covering mezothel cells (“epithelial”) of the ovary.
Serous tumors – usually unicameral cysts with papillary growths in the cavity and filled with clear yellowish liquid. Among them benign tumors are only those which have one row of cilioepithelial upholstery.
Mucinous tumors – usually multichamber cysts filled with light mucous substance. They are covered inside with high mucous-producing cells, reminiscent of endocervical epithelium or colonic mucosa epithelium. In malignant representatives cellular atypia and infiltrative growth are common.
Endometrioidal carcinomas – are 10-30% of all ovarian cancers. They are characterized by slower growth. The histological picture is similar to that of the endometrial cancer.
Clear-cell carcinoma – represent 10% of all ovarian cancers. The group has no clear-benign tumor representatives. They can be solid, solid-cystic, with slightly yellowish color. The cells with light cytoplasm rich in glycogen are interesting. The nuclei of the cells stand out as “nails of hiking shoes” because they are formed like tubules and cysts.
Brenner tumor (Brenner) – usually solid with small measurements but can reach 10-15 cm in diameter.The tumor has dense texture, off-white color and is well demarcated from surrounding tissue. The tumor has a dense fibrous stroma and nests of epithelial cells resembling transitional epithelium of the urinary tract. Malignant variants have transitional cells type of cancer.
2. Tumors of the sex cords- stromal (tumors of gender mesenchyme). They arise from cells of the granulose membrane, theca interna and theca externa and the male differentiated Sertoli and Leydig cells. Many tumors are functionally active – they produce sex steroids (estrogens and androgens) and have feminising or virilizing effect.
Granulous-cells tumors – they have estrogen effects. The high concentration of estrogen because of this tumor usually leads to premature sexual development, glandular endometrial hyperplasia, endometrial cancer, fibrous cystic changes in the breast. Granulous-cells tumors are usually unilateral, have thick consistency, cut in sections with visible hemorrhages and necrosis. The microscopic picture is quite diverse. The granulose tumor cells can form follicles, trabecules (cylinders) or solid drags and depending on of these structures the tumor is subdivided into three forms: follicular ( with typical cyst-like bodies of Kall-Eksener) cylindrical; diffuse. All tumors have potential or expressed malignancy.
Theca cell tumor (Tekom) – In structure it resembles fibroma. It is built of spindly cells arranged in bundles. The most characteristic mark of distinction is the presence of double reflecting lipids in the cytoplasm of cells. Tekoms larger than 6 cm are often combined with right-sided hydrothorax and ascites (syndrome Meigs). Tekom is usually considered benign tumor that is functionally active (it produces estrogen).
Androblastom (Sertoli-Leydig cell tumor) – most often unilateral, well encapsulated, solid or cystic formation, dense yellow-grey in color. Microscopically the tumor consists of cells of Sertoli-Laydig alone or in combination. This tumor resembles various stages of the development of male gonads. In the most differentiated type very successfully mimics testicular tissue. Produces androgens and has virilizing effects. In about 75% of cases it is benign.
3. Tumors of sexually non-differentiated mesenchyme – fibroma, leiomyoma; angioma and others, along with malignant types.
4. Germ cell tumors – originating from primary germ cells or their differentiation products.
Disgerminoma – This is the most common representative of these tumors and 1-3% of all ovarian tumors. It occurs mainly in young age (80% between 15-30 years). May occur unilaterally or bilaterally. The consistency is thick, and when the surface is cut necrosis and hemorrhage are visible. Microscopically it resembles seminoma in a man. Tumor cells are with pale cytoplasm and polygonal shape. They form drags and between them passes stroma with abundant stromal reaction of lymphocyte type. Disgerminoma is a rare hormonal active malignant tumor with a rapid evolution and a very poor prognosis, although highlysensitive to radiation therapy.
Teratoma – There is cystic and solid, immature and mature teratoma. The most frequently encountered cystic mature teratoma is called dermoid cyst. The prognosis is favorable.
5. Tumors of ectopic tissues (most likely)
Lipoid cell tumor (Luteom) – tumors associated with changed adrenal elements or with unclear genesis. Tumor cells contain lipids. Most often the tumor is benign, hormonally active and accompanied by signs of virilization (masculinisation), and in some cases of Cushing’s syndrome.
6. Metastatic ovarian tumors – Krukenberg Tumor