Ovarian tumor: Difference between revisions

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{{Comprehensiveness}}


==Microscopic evaluation==
==Microscopic evaluation==
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Look for the most common types of ovarian tumor:
Look for the most common types of ovarian tumor:
{| class="wikitable"
{| class="wikitable"
! Type !! Subtype !! Relative incidence<ref name=Vaidya2014>Unless otherwise specified in boxes, reference is: {{cite journal|last1=Vaidya|first1=SA|last2=Kc|first2=S|last3=Sharma|first3=P|last4=Vaidya|first4=S|title=Spectrum of ovarian tumors in a referral hospital in Nepal|journal=Journal of Pathology of Nepal|volume=4|issue=7|year=2014|pages=539–543|issn=2091-0908|doi=10.3126/jpn.v4i7.10295}}</ref> !! Percent malignant<ref name=Vaidya2014/> !! Comments !! Micrograph
! Type !! Subtype !! Relative incidence<ref name="Vaidya2014">Unless otherwise specified in boxes, reference is: {{cite journal|last1=Vaidya|first1=SA|last2=Kc|first2=S|last3=Sharma|first3=P|last4=Vaidya|first4=S|title=Spectrum of ovarian tumors in a referral hospital in Nepal|journal=Journal of Pathology of Nepal|volume=4|issue=7|year=2014|pages=539–543|issn=2091-0908|doi=10.3126/jpn.v4i7.10295}}</ref> !! Comments !! Micrograph
|-
|-
!rowspan=3| [[Germ cell tumor]] !! Mature cystic [[teratoma]]
! rowspan="3" | [[Germ cell tumor]] !! [[Dermoid cyst]] (teratoma)
| 46,0% || 0,17% to 2%<ref name="MandalBadhe2012">{{cite journal|last1=Mandal|first1=Shramana|last2=Badhe|first2=Bhawana A.|title=Malignant Transformation in a Mature Teratoma with Metastatic Deposits in the Omentum: A Case Report|journal=Case Reports in Pathology|volume=2012|year=2012|pages=1–3|issn=2090-6781|doi=10.1155/2012/568062}}</ref> || Cystic, with elements of all 3 [[germ layer]]s ([[endoderm]], [[mesoderm]] and [[ectoderm]]).<ref>{{cite web|url=https://www.pathologyoutlines.com/topic/skintumornonmelanocyticbenigncysticteratoma.html|title=Skin nonmelanocytic tumor - Other tumors of skin - Benign (mature) cystic teratoma|author=Hillary Rose Elwood|website=pathology Outlines}} Topic Completed: 1 November 2016. Revised: 4 April 2019</ref> || [[File:Mature Cystic Teratoma of the Ovary Hair Follicles (4047144010).jpg|thumb|190px|Hair follicles.]]
| 46% || Cystic, with elements of all 3 [[germ layer]]s ([[endoderm]], [[mesoderm]] and [[ectoderm]]).<ref>{{cite web|url=https://www.pathologyoutlines.com/topic/skintumornonmelanocyticbenigncysticteratoma.html|title=Skin nonmelanocytic tumor - Other tumors of skin - Benign (mature) cystic teratoma|author=Hillary Rose Elwood|website=pathology Outlines}} Topic Completed: 1 November 2016. Revised: 4 April 2019</ref> || [[File:Mature Cystic Teratoma of the Ovary Hair Follicles (4047144010).jpg|thumb|190px|Hair follicles.]]
|-
|-
! [[Immature teratoma]]  
! [[Immature teratoma]]  
| 2,5% || 100,0% || A [[teratoma]] that contains [[anaplastic]] immature elements, and is often synonymous with ''malignant teratoma''.<ref name="SunDing2019">{{cite journal|last1=Sun|first1=Hang|last2=Ding|first2=Hongxin|last3=Wang|first3=Jianjun|last4=Zhang|first4=Emma|last5=Fang|first5=Yihua|last6=Li|first6=Zhenhua|last7=Yu|first7=Xiao|last8=Wang|first8=Chongren|last9=Zhao|first9=Yifan|last10=Chen|first10=Kan|last11=Wen|first11=Siwan|last12=Li|first12=Liang|last13=Shan|first13=Shan|last14=Hong|first14=Liu|last15=Chen|first15=Face|last16=Su|first16=Pu|title=The differences between gonadal and extra-gonadal malignant teratomas in both genders and the effects of chemotherapy|journal=BMC Cancer|volume=19|issue=1|year=2019|issn=1471-2407|doi=10.1186/s12885-019-5598-0}}</ref> || [[File:Histopathology of immature teratoma of the ovary.jpg|200px]]
| 2.5% || A [[teratoma]] that contains [[anaplastic]] immature elements, and is often synonymous with ''malignant teratoma''.<ref name="SunDing2019">{{cite journal|last1=Sun|first1=Hang|last2=Ding|first2=Hongxin|last3=Wang|first3=Jianjun|last4=Zhang|first4=Emma|last5=Fang|first5=Yihua|last6=Li|first6=Zhenhua|last7=Yu|first7=Xiao|last8=Wang|first8=Chongren|last9=Zhao|first9=Yifan|last10=Chen|first10=Kan|last11=Wen|first11=Siwan|last12=Li|first12=Liang|last13=Shan|first13=Shan|last14=Hong|first14=Liu|last15=Chen|first15=Face|last16=Su|first16=Pu|title=The differences between gonadal and extra-gonadal malignant teratomas in both genders and the effects of chemotherapy|journal=BMC Cancer|volume=19|issue=1|year=2019|issn=1471-2407|doi=10.1186/s12885-019-5598-0}}</ref> || [[File:Histopathology of immature teratoma of the ovary.jpg|200px]]
|-
|-
! Other germ cell tumors  
! Other germ cell tumors  
| 3,0% ||  || Others mainly include [[dysgerminoma]], [[yolk sac tumor]], [[struma ovarii]] and [[squamous cell carcinoma]] arising from a dermoid cyst, and malignant mixed germ cell tumor.<ref name=Vaidya2014/>
| 3.0% || Others mainly include [[dysgerminoma]], [[yolk sac tumor]], [[struma ovarii]] and [[squamous cell carcinoma]] arising from a dermoid cyst, and malignant mixed germ cell tumor.<ref name="Vaidya2014" /> ||
[[File:Histopathology of endodermal sinus tumor with Schiller–Duval bodies.png|thumb|200px|Histopathology of yolk sac tumor with Schiller–Duval bodies.<ref>{{cite journal| author=Fischerova D, Indrielle-Kelly T, Burgetova A, Bennett RJ, Gregova M, Dundr P | display-authors=etal| title=Yolk Sac Tumor of the Omentum: A Case Report and Literature Review. | journal=Diagnostics (Basel) | year= 2022 | volume= 12 | issue= 2 | pages=  | pmid=35204394 | doi=10.3390/diagnostics12020304 | pmc=8871053 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=35204394  }} <br>- "This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/)."</ref>]]
|-
|-
!rowspan=4| [[Surface epithelial-stromal tumor]] !! Serous tumor   
! rowspan="4" | [[Surface epithelial-stromal tumor]] !! Serous tumor   
| 25,3% || 18,5% || Benign serous tumors of the right ovarian cyst are thinwalled unilocular cysts that are lined by ciliated pseudostratified cuboidal or columnar epithelium.<ref name="BaradwanAlalyani2018">{{cite journal|last1=Baradwan|first1=Saeed|last2=Alalyani|first2=Haneen|last3=Baradwan|first3=Amira|last4=Baradwan|first4=Afnan|last5=Al-Ghamdi|first5=Maram|last6=Alnemari|first6=Jameel|last7=Al-Jaroudi|first7=Dania|title=Bilateral ovarian masses with different histopathology in each ovary|journal=Clinical Case Reports|volume=6|issue=5|year=2018|pages=784–787|issn=20500904|doi=10.1002/ccr3.1466}}</ref> || [[File:Histopathology of lining of a benign serous tumor of the ovary.jpg|200px]]
| 25% || Benign serous tumors of the right ovarian cyst are thinwalled unilocular cysts that are lined by ciliated pseudostratified cuboidal or columnar epithelium.<ref name="BaradwanAlalyani2018">{{cite journal|last1=Baradwan|first1=Saeed|last2=Alalyani|first2=Haneen|last3=Baradwan|first3=Amira|last4=Baradwan|first4=Afnan|last5=Al-Ghamdi|first5=Maram|last6=Alnemari|first6=Jameel|last7=Al-Jaroudi|first7=Dania|title=Bilateral ovarian masses with different histopathology in each ovary|journal=Clinical Case Reports|volume=6|issue=5|year=2018|pages=784–787|issn=20500904|doi=10.1002/ccr3.1466}}</ref> || [[File:Histopathology of lining of a benign serous tumor of the ovary.jpg|200px]]
|-
|-
! Mucinous tumor
! Mucinous tumor
| 15,7% || 8,8% || Benign mucinous tumors of the ovary consist of simple, nonstratified columnar epithelium with basally-located hyperchromatic nuclei and resemble gastric foveolar epithelium.<ref name="BaradwanAlalyani2018"/> || [[File:Histopathology of lining of a benign mucinous tumor of the ovary.jpg|200px]]
| 15% || Benign mucinous tumors of the ovary consist of simple, nonstratified columnar epithelium with basally-located hyperchromatic nuclei and resemble gastric foveolar epithelium.<ref name="BaradwanAlalyani2018" /> || [[File:Histopathology of lining of a benign mucinous tumor of the ovary.jpg|200px]]
|-
|-
! [[Endometrioid tumor]]  
! [[Endometrioid tumor]]  
| 1,1% || 100,0%  || Tubular glands, resembling endometrium.<ref>{{cite web|url=https://www.pathologyoutlines.com/topic/ovarytumorendometrioid.html|title=Ovary tumor - Endometrioid tumors - General|author=Shahrzad Ehdaivand|website=Pathology Outlines}} Topic Completed: 1 December 2012. Revised: 6 March 2020</ref> || [[File:Histopathology of well-differentiated endometrioid adenocarcinoma.png|200px]]
| 1% || Tubular glands, resembling endometrium.<ref>{{cite web|url=https://www.pathologyoutlines.com/topic/ovarytumorendometrioid.html|title=Ovary tumor - Endometrioid tumors - General|author=Shahrzad Ehdaivand|website=Pathology Outlines}} Topic Completed: 1 December 2012. Revised: 6 March 2020</ref> || [[File:Histopathology of well-differentiated endometrioid adenocarcinoma.png|200px]]
|-
|-
! Other surface-epithelial tumors  
! Other surface-epithelial tumors  
| 1,4% ||  || Others include mainly malignant mixed [[mullerian tumor]], [[Brenner tumor]] and mixed epithelial tumor.<ref name=Vaidya2014/>
| 1.5% || Others include mainly malignant mixed [[mullerian tumor]], [[Brenner tumor]] and mixed epithelial tumor.<ref name="Vaidya2014" /> || [[File:Brenner Tumor of Ovary (5372353473).jpg|thumb|190px|[[Brenner tumor]].]]
|-
|-
!rowspan=3| [[Sex cord-stromal tumor]] !! [[Ovarian fibroma]]   
! rowspan="4" | [[Sex cord-stromal tumor]] !! [[Ovarian fibroma]]   
| 1,4% || 0,0% || [[Spindle-shape]]d fibroblastic cells and abundant collagen.<ref name="ParwatePatel2015">{{cite journal|last1=Parwate|first1=Nikhil Sadanand|last2=Patel|first2=Shilpa M.|last3=Arora|first3=Ruchi|last4=Gupta|first4=Monisha|title=Ovarian Fibroma: A Clinico-pathological Study of 23 Cases with Review of Literature|journal=The Journal of Obstetrics and Gynecology of India|volume=66|issue=6|year=2015|pages=460–465|issn=0971-9202|doi=10.1007/s13224-015-0717-6}}</ref> || [[File:Histopathology of an ovarian fibroma.jpg|200px]]
| 1.5% || [[Spindle-shape]]d fibroblastic cells and abundant collagen.<ref name="ParwatePatel2015">{{cite journal|last1=Parwate|first1=Nikhil Sadanand|last2=Patel|first2=Shilpa M.|last3=Arora|first3=Ruchi|last4=Gupta|first4=Monisha|title=Ovarian Fibroma: A Clinico-pathological Study of 23 Cases with Review of Literature|journal=The Journal of Obstetrics and Gynecology of India|volume=66|issue=6|year=2015|pages=460–465|issn=0971-9202|doi=10.1007/s13224-015-0717-6}}</ref> || [[File:Histopathology of an ovarian fibroma.jpg|200px]]
|-
|-
! Adult [[Granulosa cell tumour|granulosa cell tumor]]  
! Adult [[Granulosa cell tumour|granulosa cell tumor]]  
| 1,1% || 100,0%  || Small, bland, cuboidal to polygonal cells in various patterns.<ref>{{cite web|url=http://www.pathologyoutlines.com/topic/ovarytumorgctadult.html|title=Ovary tumor - Sex cord stromal tumors - Granulosa cell tumor - adult|author=Shahrzad Ehdaivand|website=Pathology Outlines}} Topic Completed: 1 December 2012. Revised: 9 March 2020</ref> || [[File:Granulosa Cell Tumor of the Ovary (5621714007).jpg|200px]]
| 1% || Small, bland, cuboidal to polygonal cells in various patterns.<ref>{{cite web|url=http://www.pathologyoutlines.com/topic/ovarytumorgctadult.html|title=Ovary tumor - Sex cord stromal tumors - Granulosa cell tumor - adult|author=Shahrzad Ehdaivand|website=Pathology Outlines}} Topic Completed: 1 December 2012. Revised: 9 March 2020</ref> Grooved, coffee bean-like nuclei.<ref>{{cite journal| author=Schubert TE, Stoehr R, Hartmann A, Schöne S, Löbelenz M, Mikuz G| title=Adult type granulosa cell tumor of the testis with a heterologous sarcomatous component: case report and review of the literature. | journal=Diagn Pathol | year= 2014 | volume= 9 | issue=  | pages= 107 | pmid=24894598 | doi=10.1186/1746-1596-9-107 | pmc=4100032 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24894598  }} - Figure 2<br>- "This article is licensed under a Creative Commons Attribution 4.0 International License"</ref> || [[File:Histopathology of adult granulosa cell tumor.jpg|200px]]
|-
! Leydig cell tumor
| <1% ||
*Diffuse architecture (may also be nodular with fibrous bands)<ref name="leydig">{{cite web|url=https://www.pathologyoutlines.com/topic/testisleydig.html|title=Testis & epididymis - Sex cord-stromal tumors - Leydig cell tumor|website=PathologyOutlines|author=Zhengshan Chen, M.D., Ph.D., Manju Aron, M.D.}} Topic Completed: 4 March 2021. Minor changes: 12 April 2021.</ref>
*Polygonal cells with abundant eosinophilic granular cytoplasm<ref name="leydig" />
*Uniform round nuclei and prominent central nucleoli<ref name="leydig" />
| [[File:Histopathology of leydig cell tumor of the ovary, high mag, annotated.png|200px]]
|-
|-
! Other sex cord-stromal tumors  
! Other sex cord-stromal tumors  
| 0,8% ||  || Others include mainly [[juvenile granulosa cell tumor]], [[thecoma]] and [[sclerosing stromal tumor]]<ref name=Vaidya2014/>
| 1% || Others include mainly [[juvenile granulosa cell tumor]], [[thecoma]] and [[sclerosing stromal tumor]]<ref name="Vaidya2014" />
|-
! colspan="2" | Secondary/metastatic) tumor
| 2% || Usually from [[breast cancer]], [[colon cancer]], [[endometrial cancer]], [[stomach cancer]] or [[cervical cancer]].<ref name="Lee-Jones">{{cite web|url=http://atlasgeneticsoncology.org/Tumors/OvarianTumOverviewID5231.html|title=Ovarian tumours : an overview|author=Lisa Lee-Jones, University of Wales College of Medicine|date=2003-12-01|website=Atlas of Genetics and Cytogenetics in Oncology and Haematology}}</ref>
|}
<gallery mode=packed heights=250>
File:Histopathology of ovarian serous borderline tumor.jpg|An ovarian serous '''[[borderline tumor]]''' is a subgroup of borderline tumors, with up to moderate atypia.
File:Histopathology of invasive low-grade serous carcinoma of ovary.png|Histopathology of invasive low-grade serous carcinoma of ovary with typical features. H&E stain. The left image shows lower magnification, including inverted macropapillae which are with broad fibrovascular cores surrounded by clear (white) clefts.<ref name=low-gradeserous/>
</gallery>
Invasion (characterized by small irregular nests to single cells) should be over 5 mm in size to distinguish a low-grade serous tumor from a borderline serous tumor. In both borderline and low-grade serous tumor, cells may have up to moderate atypia: They may have conspicuous nucleoli, and up to 3x variation in nuclear sizes compared to each other. More atypical features indicate a high-grade serous carcinoma.<ref name=low-gradeserous>Image by Mikael Häggström, MD. Source for findings: {{cite web|url=https://www.pathologyoutlines.com/topic/ovarytumorserouscarcinomalg.html|title=Low grade serous carcinoma|author=Erna Forgó, M.D., Teri A. Longacre, M.D.|website=Pathology Outlines}} Last staff update: 23 July 2020}}</ref>
 
===Differential diagnosis===
<gallery>
File:Histology of mesonephric duct remnant.jpg|'''Mesonephric duct remnant''': Small tubules lined by low columnar to cuboidal cells without cilia, and surrounded by ample smooth muscle.<ref>{{cite web|url=https://www.pathologyoutlines.com/topic/fallopiantubesmesonephric.html|title=Fallopian tubes & broad ligament - Broad ligament - Mesonephric duct remnants|author=Nicole Riddle, M.D., Jamie Shutter, M.D.|website=Pathology Outlines}} Topic Completed: 1 May 2013. Minor changes: 30 December 2020</ref>
</gallery>
 
===Bilateral tumors===
In cases of a tumor in both ovaries, of presumable ovarian origin, the largest tumor is generally designated as the "primary tumor" if needed (generally as a mandatory entry in synoptic reports of malignant tumors). {{Comprehensive-begin}}Add a comment that "The largest tumor is designated as the primary".{{Comprehensive-end}}
 
===Staging===
Also include any '''[[peritoneal fluid]]''' sample.
 
Perform staging for malignant tumors, as follows:<ref>{{AJCC-8}}</ref>
{| class="wikitable"
! colspan="3" |Primary tumor (T)
|-
|'''TNM'''
|'''FIGO'''
|
|-
|TX
|
|Primary tumor cannot be assessed
|-
|T0
|
|No evidence of primary tumor
|-
|T1
|I
|Tumor confined to the ovaries or fallopian tubes
|-
|T1a
|IA
|Tumor limited to one ovary (capsule intact) or fallopian tube; no tumor on ovarian or fallopian tube surface; no malignant cells in ascites or peritoneal washings
|-
|T1b
|IB
|Tumor limited to both ovaries (capsule intact) or fallopian tubes; no tumor on ovarian or fallopian tube surface; no malignant cells in ascites or peritoneal washings
|-
|T1c
|IC
|Tumor limited to one or both ovaries or fallopian tubes with any of the following:
|-
|T1c1
|IC1
|Surgical spill
|-
|T1c2
|IC2
|Capsule ruptured before surgery or tumor on ovarian or fallopian tube surface
|-
|T1c3
|IC3
|Malignant cells in ascites or [[peritoneal washing]]s
|-
|T2
|II
|Tumor involves one or both ovaries or fallopian tubes with pelvic extension (below pelvic brim) or peritoneal cancer
|-
|T2a
|IIA
|Extension and/or implants on uterus and/or tube(s) and/or ovaries
|-
|T2b
|IIB
|Extension and/or implants on other pelvic tissues
|-
|T3
|III
|Tumor involves one or both ovaries or fallopian tubes, or primary peritoneal cancer, with microscopically confirmed peritoneal metastasis outside the pelvis and/or metastases to the retroperitoneal (pelvic and/or para-aortic) lymph nodes
|-
|
|IIIA
|Positive retroperitoneal lymph nodes and/or microscopic metastasis beyond pelvis
|-
|
|IIIA1
|Positive retroperitoneal lymph nodes only (cytologically or histologically proven)
|-
|
|IIIA1 (i)
|Metastasis up to 10 mm in greatest dimension
|-
|
|IIIA1 (ii)
|Metastasis more than 10 mm in greatest dimension
|-
|T3a
|IIIA2
|Microscopic extrapelvic (above the pelvic brim) peritoneal involvement, with or without positive retroperitoneal lymph nodes
|-
|T3b
|IIIB
|Macroscopic peritoneal metastasis beyond pelvis up to 2 cm in greatest dimension, with or without metastasis to the retroperitoneal lymph nodes
|-
|T3c
|IIIC
|Macroscopic peritoneal metastasis beyond the pelvis >2 cm in greatest dimension including extension to liver capsule or spleen without parenchymal involvement of those organs and with or without positive retroperitoneal lymph nodes
|}
{| class="wikitable"
! colspan="3" |Regional lymph nodes (N)
|-
|'''TNM'''
|'''FIGO'''
|
|-
|NX
|
|Regional lymph nodes cannot be assessed
|-
|N0
|
|No regional lymph node metastasis
|-
|N0(i+)
|
|Isolated tumor cells in regional lymph node(s) ≤0.2 mm
|-
|N1
|IIIA1
|Positive (histologically confirmed) retroperitoneal lymph nodes
|-
|N1a
|IIIAIi
|Metastasis ≤10 mm in greatest dimension
|-
|N1b
|IIIAIii
|Metastasis more than 10 mm in greatest dimension
|}
{| class="wikitable"
! colspan="3" |Distant metastasis (M)
|-
|'''TNM'''
|'''FIGO'''
|
|-
|M0
|
|No distant metastasis
|-
|M1
|IV
|Distant metastasis including cytology-positive pleural effusion; liver or splenic parenchymal involvement; extra-abdominal organ involvement including inguinal lymph nodes; transmural intestinal involvement
|-
|M1a
|IVA
|Pleural effusion with positive cytology
|-
|-
!colspan=2| Secondary/metastatic) tumor
|M1b
| 1,7% || 100,0%  || Usually from [[breast cancer]], [[colon cancer]], [[endometrial cancer]], [[stomach cancer]] or [[cervical cancer]].<ref name=Lee-Jones>{{cite web|url=http://atlasgeneticsoncology.org/Tumors/OvarianTumOverviewID5231.html|title=Ovarian tumours : an overview|author=Lisa Lee-Jones, University of Wales College of Medicine|date=2003-12-01|website=Atlas of Genetics and Cytogenetics in Oncology and Haematology}}</ref>
|IVB
|Liver or splenic parenchymal metastases; metastases to extra-abdominal organs (including inguinal lymph nodes and lymph nodes outside the abdominal cavity); transmural involvement of intestine
|}
|}
{{Bottom}}
{{Bottom}}
<references />

Latest revision as of 13:21, 13 June 2024

Author: Mikael Häggström [note 1]

Comprehensiveness

On this resource, the following formatting is used for comprehensiveness:

  • Minimal depth
  • (Moderate depth)
  • ((Comprehensive))

Microscopic evaluation

File:Ovarian tumors by incidence and cancer risk.png
Ovarian tumors by incidence and risk of ovarian cancer[1]

Look for the most common types of ovarian tumor:

Type Subtype Relative incidence[2] Comments Micrograph
Germ cell tumor Dermoid cyst (teratoma) 46% Cystic, with elements of all 3 germ layers (endoderm, mesoderm and ectoderm).[3]
File:Mature Cystic Teratoma of the Ovary Hair Follicles (4047144010).jpg
Hair follicles.
Immature teratoma 2.5% A teratoma that contains anaplastic immature elements, and is often synonymous with malignant teratoma.[4] File:Histopathology of immature teratoma of the ovary.jpg
Other germ cell tumors 3.0% Others mainly include dysgerminoma, yolk sac tumor, struma ovarii and squamous cell carcinoma arising from a dermoid cyst, and malignant mixed germ cell tumor.[2]
File:Histopathology of endodermal sinus tumor with Schiller–Duval bodies.png
Histopathology of yolk sac tumor with Schiller–Duval bodies.[5]
Surface epithelial-stromal tumor Serous tumor 25% Benign serous tumors of the right ovarian cyst are thinwalled unilocular cysts that are lined by ciliated pseudostratified cuboidal or columnar epithelium.[6] File:Histopathology of lining of a benign serous tumor of the ovary.jpg
Mucinous tumor 15% Benign mucinous tumors of the ovary consist of simple, nonstratified columnar epithelium with basally-located hyperchromatic nuclei and resemble gastric foveolar epithelium.[6] File:Histopathology of lining of a benign mucinous tumor of the ovary.jpg
Endometrioid tumor 1% Tubular glands, resembling endometrium.[7] File:Histopathology of well-differentiated endometrioid adenocarcinoma.png
Other surface-epithelial tumors 1.5% Others include mainly malignant mixed mullerian tumor, Brenner tumor and mixed epithelial tumor.[2]
File:Brenner Tumor of Ovary (5372353473).jpg
Brenner tumor.
Sex cord-stromal tumor Ovarian fibroma 1.5% Spindle-shaped fibroblastic cells and abundant collagen.[8] File:Histopathology of an ovarian fibroma.jpg
Adult granulosa cell tumor 1% Small, bland, cuboidal to polygonal cells in various patterns.[9] Grooved, coffee bean-like nuclei.[10] File:Histopathology of adult granulosa cell tumor.jpg
Leydig cell tumor <1%
  • Diffuse architecture (may also be nodular with fibrous bands)[11]
  • Polygonal cells with abundant eosinophilic granular cytoplasm[11]
  • Uniform round nuclei and prominent central nucleoli[11]
 File:Histopathology of leydig cell tumor of the ovary, high mag, annotated.png
Other sex cord-stromal tumors 1% Others include mainly juvenile granulosa cell tumor, thecoma and sclerosing stromal tumor[2]
Secondary/metastatic) tumor 2% Usually from breast cancer, colon cancer, endometrial cancer, stomach cancer or cervical cancer.[12]

Invasion (characterized by small irregular nests to single cells) should be over 5 mm in size to distinguish a low-grade serous tumor from a borderline serous tumor. In both borderline and low-grade serous tumor, cells may have up to moderate atypia: They may have conspicuous nucleoli, and up to 3x variation in nuclear sizes compared to each other. More atypical features indicate a high-grade serous carcinoma.[13]

Differential diagnosis

Bilateral tumors

In cases of a tumor in both ovaries, of presumable ovarian origin, the largest tumor is generally designated as the "primary tumor" if needed (generally as a mandatory entry in synoptic reports of malignant tumors). ((Add a comment that "The largest tumor is designated as the primary".))

Staging

Also include any peritoneal fluid sample.

Perform staging for malignant tumors, as follows:[15]

Primary tumor (T)
TNM FIGO
TX Primary tumor cannot be assessed
T0 No evidence of primary tumor
T1 I Tumor confined to the ovaries or fallopian tubes
T1a IA Tumor limited to one ovary (capsule intact) or fallopian tube; no tumor on ovarian or fallopian tube surface; no malignant cells in ascites or peritoneal washings
T1b IB Tumor limited to both ovaries (capsule intact) or fallopian tubes; no tumor on ovarian or fallopian tube surface; no malignant cells in ascites or peritoneal washings
T1c IC Tumor limited to one or both ovaries or fallopian tubes with any of the following:
T1c1 IC1 Surgical spill
T1c2 IC2 Capsule ruptured before surgery or tumor on ovarian or fallopian tube surface
T1c3 IC3 Malignant cells in ascites or peritoneal washings
T2 II Tumor involves one or both ovaries or fallopian tubes with pelvic extension (below pelvic brim) or peritoneal cancer
T2a IIA Extension and/or implants on uterus and/or tube(s) and/or ovaries
T2b IIB Extension and/or implants on other pelvic tissues
T3 III Tumor involves one or both ovaries or fallopian tubes, or primary peritoneal cancer, with microscopically confirmed peritoneal metastasis outside the pelvis and/or metastases to the retroperitoneal (pelvic and/or para-aortic) lymph nodes
IIIA Positive retroperitoneal lymph nodes and/or microscopic metastasis beyond pelvis
IIIA1 Positive retroperitoneal lymph nodes only (cytologically or histologically proven)
IIIA1 (i) Metastasis up to 10 mm in greatest dimension
IIIA1 (ii) Metastasis more than 10 mm in greatest dimension
T3a IIIA2 Microscopic extrapelvic (above the pelvic brim) peritoneal involvement, with or without positive retroperitoneal lymph nodes
T3b IIIB Macroscopic peritoneal metastasis beyond pelvis up to 2 cm in greatest dimension, with or without metastasis to the retroperitoneal lymph nodes
T3c IIIC Macroscopic peritoneal metastasis beyond the pelvis >2 cm in greatest dimension including extension to liver capsule or spleen without parenchymal involvement of those organs and with or without positive retroperitoneal lymph nodes
Regional lymph nodes (N)
TNM FIGO
NX Regional lymph nodes cannot be assessed
N0 No regional lymph node metastasis
N0(i+) Isolated tumor cells in regional lymph node(s) ≤0.2 mm
N1 IIIA1 Positive (histologically confirmed) retroperitoneal lymph nodes
N1a IIIAIi Metastasis ≤10 mm in greatest dimension
N1b IIIAIii Metastasis more than 10 mm in greatest dimension
Distant metastasis (M)
TNM FIGO
M0 No distant metastasis
M1 IV Distant metastasis including cytology-positive pleural effusion; liver or splenic parenchymal involvement; extra-abdominal organ involvement including inguinal lymph nodes; transmural intestinal involvement
M1a IVA Pleural effusion with positive cytology
M1b IVB Liver or splenic parenchymal metastases; metastases to extra-abdominal organs (including inguinal lymph nodes and lymph nodes outside the abdominal cavity); transmural involvement of intestine

Notes

  1. ↑ For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Patholines:Authorship for details.

Main page

References

  1. ↑ - Vaidya, SA; Kc, S; Sharma, P; Vaidya, S (2014). "Spectrum of ovarian tumors in a referral hospital in Nepal ". Journal of Pathology of Nepal 4 (7): 539–543. doi:10.3126/jpn.v4i7.10295. ISSN 2091-0908. 
    - Minor adjustment for mature cystic teratomas (0.17 to 2% risk of ovarian cancer): Mandal, Shramana; Badhe, Bhawana A. (2012). "Malignant Transformation in a Mature Teratoma with Metastatic Deposits in the Omentum: A Case Report ". Case Reports in Pathology 2012: 1–3. doi:10.1155/2012/568062. ISSN 2090-6781. 
  2. ↑ 2.0 2.1 2.2 2.3 Unless otherwise specified in boxes, reference is: Vaidya, SA; Kc, S; Sharma, P; Vaidya, S (2014). "Spectrum of ovarian tumors in a referral hospital in Nepal ". Journal of Pathology of Nepal 4 (7): 539–543. doi:10.3126/jpn.v4i7.10295. ISSN 2091-0908. 
  3. ↑ Hillary Rose Elwood. Skin nonmelanocytic tumor - Other tumors of skin - Benign (mature) cystic teratoma. pathology Outlines. Topic Completed: 1 November 2016. Revised: 4 April 2019
  4. ↑ Sun, Hang; Ding, Hongxin; Wang, Jianjun; Zhang, Emma; Fang, Yihua; Li, Zhenhua; Yu, Xiao; Wang, Chongren; et al. (2019). "The differences between gonadal and extra-gonadal malignant teratomas in both genders and the effects of chemotherapy ". BMC Cancer 19 (1). doi:10.1186/s12885-019-5598-0. ISSN 1471-2407. 
  5. ↑ Fischerova D, Indrielle-Kelly T, Burgetova A, Bennett RJ, Gregova M, Dundr P (2022). "Yolk Sac Tumor of the Omentum: A Case Report and Literature Review. ". Diagnostics (Basel) 12 (2). doi:10.3390/diagnostics12020304. PMID 35204394. PMC: 8871053. Archived from the original. . 
    - "This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/)."
  6. ↑ 6.0 6.1 Baradwan, Saeed; Alalyani, Haneen; Baradwan, Amira; Baradwan, Afnan; Al-Ghamdi, Maram; Alnemari, Jameel; Al-Jaroudi, Dania (2018). "Bilateral ovarian masses with different histopathology in each ovary ". Clinical Case Reports 6 (5): 784–787. doi:10.1002/ccr3.1466. ISSN 20500904. 
  7. ↑ Shahrzad Ehdaivand. Ovary tumor - Endometrioid tumors - General. Pathology Outlines. Topic Completed: 1 December 2012. Revised: 6 March 2020
  8. ↑ Parwate, Nikhil Sadanand; Patel, Shilpa M.; Arora, Ruchi; Gupta, Monisha (2015). "Ovarian Fibroma: A Clinico-pathological Study of 23 Cases with Review of Literature ". The Journal of Obstetrics and Gynecology of India 66 (6): 460–465. doi:10.1007/s13224-015-0717-6. ISSN 0971-9202. 
  9. ↑ Shahrzad Ehdaivand. Ovary tumor - Sex cord stromal tumors - Granulosa cell tumor - adult. Pathology Outlines. Topic Completed: 1 December 2012. Revised: 9 March 2020
  10. ↑ Schubert TE, Stoehr R, Hartmann A, Schöne S, Löbelenz M, Mikuz G (2014). "Adult type granulosa cell tumor of the testis with a heterologous sarcomatous component: case report and review of the literature. ". Diagn Pathol 9: 107. doi:10.1186/1746-1596-9-107. PMID 24894598. PMC: 4100032. Archived from the original. .  - Figure 2
    - "This article is licensed under a Creative Commons Attribution 4.0 International License"
  11. ↑ 11.0 11.1 11.2 Zhengshan Chen, M.D., Ph.D., Manju Aron, M.D.. Testis & epididymis - Sex cord-stromal tumors - Leydig cell tumor. PathologyOutlines. Topic Completed: 4 March 2021. Minor changes: 12 April 2021.
  12. ↑ Lisa Lee-Jones, University of Wales College of Medicine (2003-12-01). Ovarian tumours : an overview. Atlas of Genetics and Cytogenetics in Oncology and Haematology.
  13. ↑ 13.0 13.1 Image by Mikael Häggström, MD. Source for findings: Erna Forgó, M.D., Teri A. Longacre, M.D.. Low grade serous carcinoma. Pathology Outlines. Last staff update: 23 July 2020}}
  14. ↑ Nicole Riddle, M.D., Jamie Shutter, M.D.. Fallopian tubes & broad ligament - Broad ligament - Mesonephric duct remnants. Pathology Outlines. Topic Completed: 1 May 2013. Minor changes: 30 December 2020
  15. ↑ Amin, Mahul (2017). AJCC cancer staging manual (8 ed.). Switzerland: Springer. ISBN 978-3-319-40617-6. OCLC 961218414. 
    - For access, see the Secrets chapter of Patholines.
    - Copyright note: The AJCC, 8th Ed. is published by a company in Switzerland, and the tables presented therein are Public Domain because they consist of tabular information without literary or artistic innovation, and therefore do not fulfil the inclusion criterion of the Swiss Copyright Act (CopA) which applies to "literary and artistic intellectual creations with individual character" (see Federal Act on Copyright and Related Rights (Copyright Act, CopA) of 9 October 1992 (Status as of 1 January 2022)). edit

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