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This Concept Map, created with IHMC CmapTools, has information related to: Ovaries, Ovaries Sex Cord-Stromal Tumors SERTOLI-LEYDIG CELL (ANDROBLASTOMAS) ->masculinization or defem'tion -atrophy of breast, amenorrhea, sterility, alopecia ->virilization -some w/ estrogenic effects -can have heterologous elements -bone, cart, glands, Ovaries Tumors of Mull Epith (Coelomic) - 3/4 tumors -mostly young women CA-125 marker ENDOMETRIOID TUMORS -20% ovary CAs -mostly CARCINOMAS-malig -TUBULAR GLANDS RESEMBLE ENDOMETRIUM (ben, malig) -solid + cystic parts -40% bilateral, Ovaries Non-Neoplastic POLYCYSTIC OVARIES-PCOD-young women -numerous cystic follicles (hyperthecosis) -thickened capsule STEIN-LEVENTHAL SYN -PCOD + oligomenorrhea ->anovulation, hirsutism, infertility obesity, virilism -ov = 2x NL size; cysts=.5-1.5cm -inc'd LH->androgen (thecal-lutein cells) ->convert to estrone STROMAL HYPERTHECOSIS -cortical stromal hyperplasia -OLDER WOMEN or w/ PCOD in younger -bilateral, hypercellular stroma -luteinized stromal cells-nests -same Sx as PCOD, more virilism, Ovaries METASTASES ~5% OVARIAN TUMORS From mullerian primary: -uterus, salpinx, other ov, pelvic peritoneum =field effect -OR breast>GI KRUKENBURG TUMOR -bilateral mets, MUCIN, SIGNET-RING cells, gastric origin, Ovaries Germ Cell Tumors DYSGERMINOMA=male seminoma -2% ov CA, but 1/2 of germ cell CA -75% 10s-20s -some pts w/ gonadal dysgenesis -pseudohermaphroditism -some with ELEVATED HCG, synctio giant cells MORPH-unilateral, solid, any size -yellow-white, soft, fleshy -sheets of cells, scant fibrous stroma -mature lymphos, some granulomas -can be in cystic teratoma or contain one CLINICAL-all malignant, variable atypia, 1/3 aggressive -good Px w/ XRT, s urgery, Ovaries Tumors of Mull Epith (Coelomic) - 3/4 tumors -mostly young women CA-125 marker CLINICAL COURSE -lower abd pain, enlargement -GI, urinary freq, dysuria -ascites if seeding perit cavity -often mets to other ovary by time of laparotomy ->poor survival rates, Ovaries Germ Cell Tumors TERATOMAS -cells from ɭ germ layer 1. Mature (benign)-DERMOID CYST -20% of tumors, 90% GCTs -most freq benign ov tumor -young women, repoductive yrs -hair and shit-bilateral in 15% -1%->malignant (mostly SqCC) -maybe from meiotic germ cell 2. Immature (malig)-mean 18yo -show primitive, fetal-like tissue -solid structure 3. Monodermal (very specialized) -STRUMA OVARII- thyroid->hyperT -carcinoid --> 5-HT -always uniateral, Ovaries Tumors of Mull Epith (Coelomic) - 3/4 tumors -mostly young women CA-125 marker CYSTADENOFIBROMA -papillary processes not too branching -any type of epith -more fibrous prolif -rare borderline, rarer mets, Ovaries Sex Cord-Stromal Tumors OTHERS HILUS CELL TUMORS-pure Leydig Cell -Reinke crystalloids present -elevated 17-ketosteroid excretion -no cortisone suppression -benign, just excise PREGNANCY Theca cells can proliferate w/ gonadotropins ->virilization of mom, and FM baby GONADOBLASTOMA-germ and sex cord/stroma -in abnl sexual development -80% FM, 20% M w/ cytorchidism, female internal secondary organs -dysgerminoma in 50% SMALL CELL CA of OVARY-young women -hypercalcemia, Ovaries Germ Cell Tumors CHORIOCARCINOMA -usually placental origin -usually w/ other germ cell tumors -LOTS OF HCG elaborated -usually already spread far by time of Dx -FATAL if arose from ovary, Ovaries Non-Neoplastic FOLLICULAR CYSTS -very common -unruptured or sealed follicle ɚcm, smooth surface, clear fluid -sometimes ass'd w/ endomet hyperplasia, hyperestrinism -lined by granulosa cells LUTEAL CYSTS -normally present, corpus luteum -can rupture->peritoneal rxn -can have hemorrhage ->menstrual irregularities, Ovaries Tumors of Mull Epith (Coelomic) - 3/4 tumors -mostly young women CA-125 marker CLEAR CELL ADENOCARCINOMA -mullerian duct origin? -almost always MALIGNANT -solid or cystic -50% 5-yr survival, Ovaries Germ Cell Tumors OTHERS Embyronal-like in testes Polyembryoma-malignant w/ EMBRYOID BODIES Mixed-all diff types, Ovaries Germ Cell Tumors ENDODERMAL SINUS (YOLK SAC) -CHILDREN, YOUNG WOMEN -2nd most common germ cell -AFP, alpha1-AT-rich -Schiller-Duval body glom-like structure, vessel, germs -intra/extracell hyaline droplets in ALL -rapid, aggressive, but improved Px, Ovaries Sex Cord-Stromal Tumors GRANULOSA-THECA CELL -2/3 in POSTMENOPAUSAL -can be only granulosa cells MORPH-unilateral, solid, firm -yellow if endocrine activity -sheets of small, polygonal cells CALL-EXNER BODIES-glandlike, follicle-like structures -cells can be luteinized CLINICAL-can make lots of ESTROGEN -malig possible -in girls->PRECOCIOUS PUBERTY -women->endomet hyperplasia/CA, cystic dz of breast -can make androgens->masculinize Px-pretty good, can recur much later, if mainly theca cells, low malignancy, Ovaries Tumors of Mull Epith (Coelomic) - 3/4 tumors -mostly young women CA-125 marker MUCINOUS TUMORS-middle age -25% ovarian neoplasms Compared to serous: -more cysts, variable size -less frequently bilateral -LARGER w/ gelatinous fluid -tall col mucous cells (no cilia) CYSTADENOCARCINOMA -more solid, cell atypia, stratify --> PSEUDOMYXOMA PERITONEI -adhesions, implanted cysts on peritoneum, Ovaries Tumors of Mull Epith (Coelomic) - 3/4 tumors -mostly young women CA-125 marker SEROUS TUMORS -tall columnar cells w/ cilia (like salpinx) CYSTADENOMA - 20-50yo -few papillae CYSTADENOCARCINOMA-later years -40% of all ovary CA -more papillae; 66% bilateral MORPH-1-few fibrous-walled cysts -psammoma bodies -borderline w/ more complexity CLINICAL-peritoneal spread->inc mort, Ovaries Sex Cord-Stromal Tumors FIBROMA-THECOMAS -spindle cells-fibroblasts -4% ov tumors -hormonally active if mainly thecoma -estrogen-secreting -mostly fibroblastic and inactive MORPH-unilateral, solid, lobulated, glistening mucosa MEIGS SYNDROME: tumor + ASCITES in 40% hydrothorax (rt side) BASAL CELL NEVUS SYNDROME, Ovaries Tumors of Mull Epith (Coelomic) - 3/4 tumors -mostly young women CA-125 marker BRENNER TUMOR-mostly benign -nests of urothelial cells-sharp demarcation -sometimes w/ mucinous cystadenomas -usually unilateral; solid or cystic, Ovaries Non-Neoplastic CHOCOLATE CYST -endometriosis->hemorrhage, clot -ov is most freq site of endometriosis