Ovary Pathology Non Neoplastic Lesions 1.) Cystic Follicle - follicular cyst <2cm/<2.

5cm -thin walled with clear fluid contents 2.) Follicular Cyst - most common ovarian mass; non-neoplastic - accum of fluid in follicle; rupture= sterile peritoitis with p ain - cystic follicle >2cm - lined by granulosa cells which are flattened out be cause of fluid 3.) Corpus Luteum CYst - most common ovarian mass in pregnancy; corpus luteum th at has become cystic; can develop even if not pregnant - rupture may produce pain or even bleed (corpus lut cyst w/hemorrhage and rupture) - bright yellow convloluted lining; hemorrhagic ce nter - lined by luteinized theca cells - >2.5cm 4.) Hyperreaction Luteinalis 5.) PCOS - cyst with subserosal thickening 6.) Endometiotic Cyst Neoplastic Tumors A. Surface Epith - derived from coelomic epith; seed the ementum 1.) Serous 2.) Mucinous 3.) Endometroid adenoCA 4.) Clear Cell 5.) Brenner B. Germ Cell Tumors 1.) Teratomas i. Immature ii. Mature iii. Monodermal 2.) Dysgerminoma 3.) Embryonal CA 4.) Yolk Sac Tumor C. Sex Cord 1.) Granulosa Cell Tumor 2.) Thecoma - thecoma/fibroma grouphard to differntiate 3.) Fibroma 4.) Sertoli-Leydig Cell -

Metastatic Tumors 1.) Krukenberg Tumor - signet ring cells hematogenous spread usually of a gastri c cancers Clinical Findings sign of seeding from malignant surface - derived cancers; malignant ascites; ind uration of rectal pouch on digital exam; inc obstruction with colicky pain palpable ovarian mas in postmenopausal women - should not be aplpable malignant pleural effusion - common site for cancer mets cystic teratomas undergo torsion leading to infarct - calcifications from bone a nd teeth inside these cavities signs of hyperestrinism from estrogen secreting tumors - bleeding from endometri al hyper/CA; 100% superficial squamous cells in cervical pap smear hirsutism or virilization from androgen-secreting tumors tumor markers- CA125 and HE4 in surface derived malignant tumors Clinical and moledcular featrues of 5 most common types HGSCA, LGCA, MCA, ECA, CCCA = surface derived malignant ovarian tumors risk factors for high gread serous = BRCA1/2 endometrioid = HNPCC - those indiv with early dev't of endometrial and colonic C A some artists would have developed both cancers=strong family history precursor lesions - tubal intraepithelial ca in hHGSCA serous BL tumor in LGSCA endometriosis has role in dev't of ECA cystadenoma? BL tumor? in MCA endometriosis also in CCCA pattern of spread: hgsca - very early transceloemic lgsca - early transcoelemoic spread MCA - confined to ovary endometroid and clear cell - confined to pelvis CHEMOSENSITIVITY Hgsca - highly chemosensitive but poor prognosis contrasted to favorable prognosis of mucinous and ECA Lgsca and CCCA - low response to chemo but intermediate prognosis