Difference between revisions of "Ovarian tumours"
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**[http://path.upmc.edu/cases/case270/micro.html Sex cord stromal tumour with Sertoli-Leydig component - several images (upmc.edu)]. | **[http://path.upmc.edu/cases/case270/micro.html Sex cord stromal tumour with Sertoli-Leydig component - several images (upmc.edu)]. | ||
== | ==Hilus cell tumour== | ||
{{Main|Leydig cell tumour}} | |||
*[[AKA]] ''Leydig cell tumour''.<ref name=pmid19697637>{{Cite journal | last1 = Zafrakas | first1 = M. | last2 = Venizelos | first2 = ID. | last3 = Theodoridis | first3 = TD. | last4 = Zepiridis | first4 = L. | last5 = Agorastos | first5 = T. | last6 = Bontis | first6 = JN. | title = Virilizing ovarian hilus (Leydig) cell tumor with concurrent contralateral hilus cell hyperplasia: a rare diagnosis. | journal = Eur J Gynaecol Oncol | volume = 30 | issue = 3 | pages = 338-40 | month = | year = 2009 | doi = | PMID = 19697637 }}</ref> | |||
===General=== | ===General=== | ||
* | *Rare.<ref name=pmid19697637/> | ||
*May cause virilization. | |||
**Development of male (sexual) characteristics in a female. | |||
=== | ===Microscopic=== | ||
Features - see ''[[Leydig cell tumour]]'': | |||
*Moderate eosinophilic cytoplasm. | |||
*+/-Reinke crystalloids (cytoplasmic inclusions). | |||
DDx: | |||
*Hilus hyperplasia. | |||
*[[Sertoli-Leydig tumour]]. | |||
=Benign= | =Benign= |
Revision as of 13:51, 8 June 2012
The article examines ovarian tumours including ovarian cancer.
An introduction to the ovary is in the ovary article, which also deals benign cysts.
Clinical
Gynecologists use a scoring system to help decide which patients need surgery and estimate their pre-op risk of malignancy.
Risk of malignancy index
- Abbreviated RMI.
- There are two versions.[1]
Elements & points (RIM 2):[1]
- Ultrasound features.
- Significant findings: multilocular cyst, solid component, bilateral lesions, ascites, suspected intra-abdominal metastases (one finding=1 point, two or more findings=4 points).
- Menopause/pre-menopause status (menopausal=4 points, pre-menopausal=1 point).
- CA-125 (blood test) in U/ml.
Interpretation:
- RMI > 200 -- predicts malignancy.
Classification
The Latta rule of fives
Can be divided as follows:[2][3]
- Surface epithelial tumours (most common).
- Sex cord stromal tumours (SCSTs).
- Germ cell tumours (GCTs).
- Metastatic tumours.
- Rare stuff that doesn't fit in any of the above (e.g. leiomyoma, angiosarcoma, ovarian small cell carcinoma of the hypercalcemic type).
Surface epithelial tumours:
- Serous carcinoma..
- Endometrioid carcinoma.
- Mucinous carcinoma.
- Transitional cell tumours[4] (Brenner tumour).
- Clear cell carcinoma.
Sex cord stromal tumours:
- Granulosa cell tumour (adult type, juvenile type).
- Sertoli cell tumour.
- Leydig cell tumour.
- Fibroma.
- Thecoma.
- Dysgerminoma.
- Endodermal sinus tumour (yolk sac tumour).
- Embryonal carcinoma.
- Choriocarcinoma.
- Teratoma.
Common special tumours
Tumours associated with endometriosis:[5]
- Endometrioid.
- Clear cell carcinoma.
- Endocervical mucinous (AKA Seroumucinous type and Muellerian type).
Solid ovarian tumours
Simple version: basically anything sex cord stromal.
List:[6]
- Brenner tumour.
- SCSTs:
- Fibroma.
- Thecoma.
- Fibrothecoma.
- Leydig tumour.
- Sertoli cell tumour.
- Sertoli-Leydig tumour.
- Granulosa cell tumour.
- Granulosa-theca cell tumour.
A morphologic approach
Where is the tumour arising?
- Central location -- think GCTs and SCST.
- Surface of ovary -- think surface epithelial tumour.
- If no surface is apparent... possibly obliterated by tumour.
Spindle cell morphology?
- Consider sex cord stromal tumours.
Nests of cells?
- Consider Brenner tumour.
Gland-like structures?
- Endometrioid carcinoma.
- Granulosa cell tumour.
- Definition: cellular debris within gland lumen.[7]
- Characteristic of colorectal adenocarcinoma, may be absent in ovarian tumours -- limited value.[8]
Grading of ovarian cancer
- Silverberg grading system,[9] aka universal grading system.
- Based on pattern, cytologic atypia and mitotic rate.
- System somewhat similar to breast grading, which can be remembered as: TMN (tubular formation, mitotic rate, nuclear atypia).
Silverberg system
- Pattern:
- Glandular = 1.
- Papillary = 2.
- Solid = 3.
- Cytologic atypia:
- Slight = 1.
- Moderate = 2.
- Marked = 3.
- Mitoses (see note below):
- 0-9/(0.345 x10 mm^2) = 1.
- 10-24/(0.345 x10 mm^2) = 2.
- >=25/(0.345 x10 mm^2) = 3.
Composite score (pattern score + cytologic score + mitotic score):
- Grade I = 3-5.
- Grade II = 6-7.
- Grade III = 8-9.
Note 1:
- Most resident microscopes have an eyepiece diameter of 22 mm. Thus, the approximate field diameter is 0.55 mm (22 mm/40 X = 0.55 mm), at highest magnification, and the field area is 0.23758 mm^2 (pi*(0.55/2)^2=0.23758 mm^2).
- The number of HPFs should be adjusted if the area per field is different than 0.345 mm^2.
- If the field diameter is 0.55 mm and the sample area is 3.45 mm^2, this is equivalent to 14.52 HPFs (3.45 mm^2 / 0.23758 mm^2 = 14.52); thus, it would be appropriate to use 15 HPFs and the cut points above.
Note 2:
- A not-so-good alternative is to adjust the number of mitotic counts a keep the number of HPFs (10) constant.
- If the mitotic rate per area is held constant, and the cut points are 9, 10 and 24, the equivalent mitoses per area are:
- 0-4 mitoses/((HPF of 0.345 mm^2) x 10) = 1.
- 5-11 mitoses/((HPF of 0.345 mm^2) x 10) = 2.
- 12+ mitoses/((HPF of 0.345 mm^2) x 10) = 3.
- If the mitotic rate per area is held constant, and the cut points are 9, 10 and 24, the equivalent mitoses per area are:
Value of Silverberg...
Good correlation with five year survival (rounded values):[10]
- Grade I = 90%.
- Grade II = 65%.
- Grade III = 40%.
Peritoneal implants
General
- In the setting of serous borderline tumours there is much ado about implants.
Classification
There are two types:[11]
- Non-invasive implants.
- Subdivided into:
- Epithelial.
- Desmoplastic.
- Subdivided into:
- Invasive implants -- malignant cells within the stroma.
Notes:
- Invasive implants are significant clinically.
- Non-invasive implants have little clinical significance.
Microscopic
Non-invasive implant
Features (non-invasive implant epithelial-type):[12]
- Papillary proliferation on surface.
- +/-Smooth contoured invagination into:
- Submesothelium.
- Omental fat lobules.
- No "stromal response":
- Fibrosis.
- +/-Psammoma bodies.
Features (non-invasive implant desmoplastic-type):[12]
- Stromal reaction restricted to the:
- Serosal surface.
- Fibrous septae.
- +/-Psammoma bodies.
Note:
- No "destructive invasion".
- Irregular infiltration.
Invasive implant
Features (invasive implant):[12]
- Irregular infiltration of tumour into the submesothelial tissue - key feature - characterized by:
- +/-Solid nests.
- +/-Small glands +/- irregular "bridging" connections between glands - common.
- Nuclear atypia - common.
- +/-Psammoma bodies.
Stains
- Elastin stain:[11]
- Non-invasive implants are sit superficial to the peritoneal elastic lamina (PEL).
- Invasive implants are deep to the PEL.
Note:
- Elastin layer is not present in the omentum.
IHC
- Elastin stain.
Surface epithelial tumours
Most common subtypes - in short:[13]
- Serous:
- Columnar cells.
- Cilia.
- Psammoma bodies.
- Papillae.
- Endometrioid:
- Tubular glands.
- Squamous differentiation (eosinophilic cytoplasm, well-defined cell borders, +/-keratin).
- Mucinous:
- Tall columnar cells with mucin.
- Glands with mucin.
Where to start when considering a malignant (epithelial) tumour of the ovary:
Features | Serous | Endometrioid | Mucinous |
---|---|---|---|
Histology | low grade: cilia, columnar cells, psammoma bodies, papillary arch.; high grade: marked nuclear pleomorphism, prominent red nucleoli, psammoma bodies | gland forming - esp. cribriforming, endometrium-like | mucinous glands, colon-like |
Differentiators | cilia, psammoma bodies | squamous metaplasia | mucin, often lack of necrosis |
Associations | atrophy | endometriosis, endometrial hyperplasia | (?) |
Typical age | usually 60s+ | 40-60 | varies (?) |
Grade | typically high grade | typically low grade | often low |
IHC | p53 +ve (diffuse), WT-1 +ve, CA-125 +ve, D2-40 +ve | WT-1 -ve | CK7 +ve, CK20 +ve (other tumours CK7 +ve, CK20 -ve) |
Main DDx | poorly diff. endometrioid | serous | metastatic tumour (usually GI) |
Serous tumours - overview
General
- Most common malignant ovarian tumour.
Classification
Based on features predictive of behaviour:[14]
- Benign.
- Borderline.
- May have pseudostratification of epithelial cells.
- "Usually, borderline if first impression is borderline."[15]
- Malignant.
- Cytologic atypia.
- +/-Papillae.
Microscopic
Features:[14]
- Tubal like epithelium:
- Ciliated.
- Columnar.
- Papillae.
- Psammoma bodies (concentric calcifications).
Note:
- In serous borderline tumours, micropapillae are thought to have significance -- assoc. with increased risk of distant recurrence[16][17][18] - though is disputed.[19]
- Psammoma bodies may be seen in endosalpingiosis.[20]
Serous carcinoma of the ovary
- AKA ovarian serous carcinoma.
General
- Most common malignant ovarian tumour in the eldery.
- Poor prognosis.
Microscopic
Features:
- Marked nuclear pleomorphism:
- Variation in size - usually marked.
- Variation in staining.
- Variation in shape.
- Prominent nucleolus - key feature.
- Eccentric nucleus.
- Architecture:
- Solid.
- Papillary - classic.
- Glandular - uncommon.
- +/-Psammoma bodies - uncommon.
- +/-Necrosis - often extensive.
DDx:
- Clear cell carcinoma of the ovary - less nuclear size variation.
- Endometrioid carcinoma of the ovary - usu. lower grade.
- Primary peritoneal serous carcinoma - bulk of tumour in peritoneum, small ovarian tumour.
- Other non-ovarian serous carcinomas - see serous carcinoma.
Images:
IHC
- CK7 +ve.
- WT-1 +ve.
- CA-125 +ve.
- ER +ve.[21]
- p53 +ve.
Others:
- HNF-1beta -ve.[22][23]
- Usually +ve in clear cell carcinoma of the ovary.
Serous cystadenoma of the ovary
- AKA ovarian serous cystadenoma.
General
- Benign.
- Very common.
- Not related to the serous cystadenoma of the pancreas.
Gross
- Usually unilocular.
Microscopic
Features:
- Simple epithelium with cilia - key feature.
- Cell morphology: columnar, cuboidal or flatted.
DDx:
- Serous cystadenofibroma.
Seromucinous borderline tumor of the ovary
General
- Rare.
- Associated with endometriosis.
Gross
- Mucin-filled cysts.
Image:
Microscopic
Features:
- Simple mucinous epithelium - endocervical type.[25]
- Tall columnar epithelium with apical pale cytoplasm.
- Simple serous epithelium - with cilia.
Mucinous tumours - overview
General
- Common.
- Tumours may be heterogenous; benign appearing epithelium may be beside clearly malignant epithelium.
- Good sampling of mucinous tumours, i.e. many blocks, is important to lessen the chance of undercalling them.
Subtypes
- Endocervical type.
- Less likely to be malignant.
- More common than malignant type.
- Intestinal type.
- More likely to be malignant.
- Goblet cells. (???)
- One large clear apical vacuole.
- If it doesn't look like intestine to you... it probably isn't.
- May vaguely resemble colorectal adenocarcinoma (hyperchromatic, columnar nuclei, nuclear pleomorphism).
- Image: [1]
Comparison of mucosa:
- Normal endocervical mucosa: endocervical mucosa.
- Normal colonic mucosa: colonic type mucosa.
Classification
- Benign. (Dx: mucinous cystadenoma or mucinous adenofibroma or mucinous cystadenofibroma)
- Single layer of cells.
- Borderline. (Dx: mucinous tumour of uncertain malignant potential or borderline mucinous tumour)
- Papillae.
- Malignant. (Dx: mucinous adenocarcinoma)
- Usually intestinal subtype.
Mucinous adenocarcinoma of the ovary
- AKA ovarian mucinous adenocarcinoma.
General
- Malignant.
- May arise in endometriosis.[26]
- Poor response to chemotherapy vis-à-vis serous carcinoma.[27]
Gross
Features:
- Multiloculated.
- Sticky, gelatinous fluid (glycoprotein).
- +/-Necrosis.
Microscopic
Features:
- Tall columnar cells in glands.
- Apical mucin.
- May vaguely resemble colorectal adenocarcinoma.
- Glands have mucin.
- +/-Nuclear atypia.
- No cilia.
- +/-Necrosis.
Subtypes
- Endocervical type.
- Less likely to be malignant.
- More common than malignant type.
- Intestinal type.
- More likely to be malignant.
- Goblet cells. (???)
- One large clear apical vacuole.
- If it doesn't look like intestine to you... it probably isn't.
- May vaguely resemble colorectal adenocarcinoma (hyperchromatic, columnar nuclei, nuclear pleomorphism).
- Image: [2]
Comparison of mucosa:
- Normal endocervical mucosa: endocervical mucosa.
- Normal colonic mucosa: colonic type mucosa.
IHC
- CK7 +ve.
- CK20 +ve.
Endometrioid carcinoma of the ovary
- AKA endometrioid ovarian carcinoma.
- AKA endometrioid adenocarcinoma of the ovary.
- AKA ovarian endometrioid adenocarcinoma.
General
- Associated with endometriosis, i.e. people with endometriosis are more likely to have 'em.
Gross
- Usually solid and cystic.
Image:
Microscopic
Features:
- Tubular glands.
- Cribriform pattern common.
- May see mucinous secretion.[28]
- May have squamous differentiation/squamous metaplasia (useful for differentiating from sex-cord stromal tumours and germ cell tumours).[28] - very useful feature.
DDx:
- Sertoli-Leydig cell tumour - also has tubules.
- Serous carcinoma of the ovary.
Clear cell carcinoma of the ovary
- AKA ovarian clear cell adenocarcinoma.
- AKA ovarian clear cell carcinoma.
- AKA clear cell adenocarcinoma of the ovary.
General
- Thought to be related to endometrioid carcinoma.[29]
- Increased risk of CC adenoca in people with endometriosis.
- Worse prognosis vs. other surface epithelial tumours[30]
Microscopic
Features:
- Cystic/tubular architecture - important low power feature.
- Clear cells - cytoplasm is clear - key feature.
- Hobnail morphology - apical surface larger than basal surface.[31]
- "Nuclei bulge into the lumen".
- Hyaline droplets -- common, as in clear cell renal cell carcinoma.
- Eosinophilic bodies within lumen.
- Nucleoli - prominent.
Note:
- Clear cell adenocarcinoma does not have to have clear cells. Yes, this is stupid; it is like papillary thyroid carcinoma -- which often isn't papillary -- see no truth in names.
- The hobnail morphology is important if this is the case.
Images:
- WC:
- www:
IHC
Panel for high grade serous vs. clear cell:[33]
- ER (+ve in serous),[34] HNF-1beta (+ve in clear cell), WT-1 (+ve in serous).
Transitional cell carcinoma of the ovary
General
- Rare.
- Fits into the transistional cell tumours category - in the surface epithelial group of ovarian tumours.[4]
Microscopic
Features:[35]
- Cystic spaces:
- Small - punched-out border - very common.
- Large.
- Papillae, usu. large, blunt.
- Occasionally small and filiform.
- +/-Bizarre giant cells (35%)
- +/-Gland-like tubules.
- +/-Squamous differentiation.
- +/-Psammoma bodies.
- Cells:
- Moderate basophilic cytoplasm and little intervening stroma.
- Marked nuclear pleomorphism.
- Mitoses - common.
Notes:
- Resembles urothelial carcinoma.[36]
- No Brenner tumour component (benign or malignant) should be present.[36]
Images:
IHC
Features:[36]
- Vimentin +ve,
- CA-125 +ve.
- WT1 +ve.
- CK20 -ve.
- Thrombomodulin -ve.
- Uroplakin III -ve.
Notes:
- 1-6 usu. opposite pattern in urothelial cell carcinoma.
Brenner tumour
General
- Fits into the transistional cell tumours category - in the surface epithelial group of ovarian tumours.
Epidemiology
- Mostly benign clinical course.
- Thought to arise from Walthard cell rest.
- Frequently an incidental finding, i.e. oophorectomy was done for another reason.
- May be malignant.
Gross
Features:[37]
- Classically solid, well-circumscribed, light yellow.
- May be cystic.
Note:
- Borderline tumours classically solid and cystic with papillary projections into the cystic component.[37]
Microscopic
Features:
- Nests of transitional epithelium with cells that have:[29]
- A "coffee bean nucleus".
- Elliptical shape (nucleus).
- Nuclear grooves.[38]
- Distinct nucleoli.
- Moderate-to-abundant gray/pale cytoplasm.
- A "coffee bean nucleus".
- Dense fibrous stroma around nests.
Notes:
- Main DDx of Coffee bean nucleus = granulosa cell tumour.
- Stromal component may be predominant.
DDx:
Images:
Germ cell tumours
These tumour are relatively uncommon, though are the most common grouping for young women.
Overview
- Dysgerminoma (most common).
- Female version of seminoma.
- Yolk sac tumour (endodermal sinus tumour).
- Embryonal carcinoma.
- Choriocarcinoma.
- Teratoma.
- Mixed GCT - 60% of GCTs are mixed.
- Common combinations:
- Teratoma + embryonal carcinoma + endodermal sinus tumour (yolk sac tumour) (TEE).
- Seminoma + embryonal (SE).
- Embryonal + teratoma (TE).
- Common combinations:
Mnemonic: SEE CT, S=Seminoma, Embryonal carcinoma, Endodermal Sinus Tumour, Choriocarcinoma, Teratoma.
Teratoma
- May be benign or malignant.
- Skin component only called "dermoid".
Dysgerminoma
General
Epidemiology:
- Most common GCT in females.
- Prognosis usually good.
Microscopic
Features:
- Fried egg appearance (clear cytoplasm, central nucleus).
- Nuclear membrane has "corners", i.e. is "squared-off" - or "polygonal".
- +/- Lymphocytes - often prominent.
- +/- Granulomata.
Dysgerminoma vs lymphoma:
- Dysgerminoma has "squared-off" nuclei,[40] i.e. the nuclei look are polygonal-shaped.
Gonadoblastoma
Details dealt with in the main article.
Microscopic
- Immature germ cells resembling Sertoli cells or granulosa cells.
- Cells with moderate cytoplasm is a trabecular or tubular architecture.
- Primitive germ cells resemble those of a dysgerminoma.
- Polygonal cells with a central nucleus, squared-off nuclear membrane and clear cytoplasm.
- +/-Calcification (very common).
Metastatic ovarian tumours
Generally
- Mostly Muellerian origin (uterus, fallopian tube) or pelvic peritoneum.
Extramuellerian metastatic tumours
DDx:
- Breast.
- Gastrointestinal (GI) tract.
- Pseudomyxoma peritonei, usu. appendiceal origin.
- Krukenberg tumour = signet ring cell cancer with mucin production of GI origin.
Microscopic
Features:
- Predominantly surface involvement and nodular at low power.
- Signet ring cells (suggestive of GI or breast primary).
- Lymphovascular invasion.
Mucinous carcinoma - GI tract metastasis vs. primary ovarian
Gross
Features favouring metastatic disease:[43]
- Bilaterality -- both ovaries involved.
- Small unilateral tumour size -- <10 cm = metastatic.
- >13 cm = primary ovarian.
IHC
Ovarian tumours:
- Dipeptidase 1 (DPEP1) +ve.[44]
- CK7 +ve.
Sex cord stromal tumours
General
- Most are unilateral.[45]
IHC
- Most are positive for alpha-inhibin.[45]
- Most are positive for calretinin -- considered more sensitive than alpha-inhibin.[46]
- Melan A +ve.
- CD99 +ve.
Memory device MAC = melan A, alpha-inhibin, calretinin.
Sex cord tumour with annular tubules
- Abbreviated SCTAT.
- NOT sex cord tumour with angulated tubules.
General
- Associated with Peutz-Jeghers syndrome.[47]
- Large tumours more likely sporadic.
- Small tumours more likely Peutz-Jeghers syndrome and incidental.
- Usually benign.
- Malignant cases reported.[48]
Microscopic
Features:
- Well-circumscribed nests of cells with nuclei at the periphery.
- Annular tubules (ring-shaped tubules) with dense hyaline material.
Notes:
- Annular = shape of a ring.[49]
- May focally have features of Sertoli cell tumour or granulosa cell tumour.[50]
DDx:
- Sertoli-Leydig tumour - has double palisading with overlap of the layers.
- Granulosa cell tumour - have Call-Exner bodies, which don't have a well-defined/solid content.
- Brenner tumour - coffee-bean nuclei.
Images:
- www:
- WC:
Juvenile granulosa cell tumour
General
- May secrete estrogen.
- May present with endometrial pathology, e.g. endometrial hyperplasia or endometrioid endometrial carcinoma.
- May present as precocious puberty.[51]
- Reported in males.[52]
Gross
- Classically solid.
Microscopic
Features:
- Microcystic spaces.
- Moderate-to-marked nuclear atypia.
- Cuboidal-to-polygonal cell in sheets or stands or cords.
- Basophilic cytoplasm.
Notes:
- Juvenile variant of GCT has more nuclear pleomorphism.
Images:
- WC:
IHC
- Inhibin positive.[53]
- Inhibin negative in Brenner tumour.
- Calretinin +ve.
Molecular
- Currently not used for the diagnosis.
Adult granulosa cell tumour
- AKA granulosa cell tumour.
- Should not be confused with granular cell tumour.
- Ideally, it should be called adult granulosa cell tumour to avoid confusion with juvenile granulosa cell tumour.
General
- May secrete estrogen.
- May present with endometrial pathology, e.g. endometrial hyperplasia or endometrioid endometrial carcinoma.
- Occasionally secrete antrogens lead to virilization.[56]
Note:
- Normal granulosa cells convert androgen from the theca cells to estrogen and/or progesterone.[57]
Gross
- Classically solid.
Microscopic
Features:
- Classic appearance includes gland-like structures filled with acidophilic material (Call-Exner bodies).
- Small cuboidal to polygonal cell in sheets or stands or cords.
- Nuclear grooves.
Note:
- There is a "10% rule" -- if less than 10% of a SCST is granulosa cells... it isn't granulosa cell tumour.
- Juvenile variant of GCT has more nuclear pleomorphism.
DDx:
- Urothelial cell carcinoma (UCC).
- UCC usually has extensive necrosis.
- Brenner tumour.
- Sertoli cell tumour.
IHC
- Inhibin positive.[53]
- Inhibin negative in Brenner tumour.
- Calretinin +ve.
Molecular
- Currently not used for diagnosis.
Fibroma-thecoma group
- Some say fibromas and thecomas are related,[60] while others believe they should be considered distinct entities.[61]
- A combination of a fibroma and a thecoma is known as a fibrothecoma.
Note:
- Some discourage the use of the term fibrothecoma and sugguest calling tumours in the fibrom-thecoma group fibroma unless there are lipid-laden cells and more than minimal alpha-inhibin positivity.[45]
Ovarian fibroma
General
- May be a part of:
- Meigs syndrome (mnemonic FAR: fibroma, ascites, right pleural effusion).
- Nevoid basal cell carcinoma syndrome (NBCCS), AKA Gorlin syndrome.[62]
- In NBCCS classically - calcified and bilateral.[63]
- Very rarely transform to fibrosarcoma <1%.[64]
Gross
Features:
- Solid white mass, usu. well-circumscribed.[65]
Note:
- Thecoma = yellow solid mass.[65]
Images:
Microscopic
- Spindle-shaped cells.
- Central nuclei.
- Stainable lipid - minimal or none.[45]
Images:
IHC
- Inhibin -ve (~75%).[45]
Thecoma
General
- Associated with compression & atrophy of ovarian cortex, thought to arise from medulla.[61]
- Approx. 50% have symptoms related to estrogen secretion.[45]
- May also be viralizing.
Gross
Features:
- Solid yellow mass, usu. well-circumscribed.[65]
DDx:
- Ovarian fibroma - white solid mass.[65]
- Fibroma-thecoma (fibrothecoma).
Microscopic
Features:[45]
- Nuclei with oval to spindle morphology.
- Abundant cytoplasm that is pale, vaculolated -- key feature.
Images:
IHC
- Alpha-inhibin +ve (90%+).[45]
Sertoli-Leydig cell tumour
- AKA androblastoma.
General
- Sertoli and leydig cells are normal in the testis.
- Poorly differentiated tumours have sarcomatous features.[62]
Microscopic
Features:
- Sertoli or Leydig cells.[62]
- Leydig cells:
- Abundant solid eosinophilic cytoplasm.
- Round nuclei with fine chromatin and a small or indistinct nucleolus.
- Often in small clusters ~ 5-25 cells/cluster.
- Sertoli cells:
- Pale/clear vacuolated cytoplasm.
- Irregular nuclei with irregular/vacuolated-appearing chromatin.
- Architecture: tubules, cords or sheets.
- Leydig cells:
- Stroma.
- +/- Sarcomatous features (mucinous glands, bone, cartilage).
DDx:
Images:
- WC:
- www:
Hilus cell tumour
General
- Rare.[67]
- May cause virilization.
- Development of male (sexual) characteristics in a female.
Microscopic
Features - see Leydig cell tumour:
- Moderate eosinophilic cytoplasm.
- +/-Reinke crystalloids (cytoplasmic inclusions).
DDx:
- Hilus hyperplasia.
- Sertoli-Leydig tumour.
Benign
- Benign mesothelial inclusion cyst - may mimic a tumour.
See also
References
- ↑ 1.0 1.1 URL: http://www.sign.ac.uk/guidelines/fulltext/75/section3.html. Accessed on: 16 September 2011.
- ↑ Cotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Nelso Fausto; Robbins, Stanley L.; Abbas, Abul K. (2005). Robbins and Cotran pathologic basis of disease (7th ed.). St. Louis, Mo: Elsevier Saunders. pp. 1093. ISBN 0-7216-0187-1.
- ↑ LAE. 22 October 2009.
- ↑ 4.0 4.1 Humphrey, Peter A; Dehner, Louis P; Pfeifer, John D (2008). The Washington Manual of Surgical Pathology (1st ed.). Lippincott Williams & Wilkins. pp. 401. ISBN 978-0781765275.
- ↑ LAE. 22 October 2009.
- ↑ NEED REF.
- ↑ http://www.cancer.gov/cancertopics/genetics-terms-alphalist/all#D. Accessed on: 14 September 2011.
- ↑ DeCostanzo DC, Elias JM, Chumas JC (July 1997). "Necrosis in 84 ovarian carcinomas: a morphologic study of primary versus metastatic colonic carcinoma with a selective immunohistochemical analysis of cytokeratin subtypes and carcinoembryonic antigen". Int. J. Gynecol. Pathol. 16 (3): 245–9. PMID 9421090.
- ↑ Silverberg SG (January 2000). "Histopathologic grading of ovarian carcinoma: a review and proposal". Int. J. Gynecol. Pathol. 19 (1): 7-15. PMID 10638449. http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0277-1691&volume=19&issue=1&spage=7.
- ↑ Sato Y, Shimamoto T, Amada S, Asada Y, Hayashi T (January 2003). "Prognostic value of histologic grading of ovarian carcinomas". Int. J. Gynecol. Pathol. 22 (1): 52-6. PMID 12496698. http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0277-1691&volume=22&issue=1&spage=52.
- ↑ 11.0 11.1 Stewart, CJ.; Brennan, BA.; Crook, ML.; Russell, P. (Sep 2007). "Value of elastin staining in the assessment of peritoneal implants associated with ovarian serous borderline tumours.". Histopathology 51 (3): 313-21. doi:10.1111/j.1365-2559.2007.02789.x. PMID 17727474.
- ↑ 12.0 12.1 12.2 Bell, DA.; Weinstock, MA.; Scully, RE. (Nov 1988). "Peritoneal implants of ovarian serous borderline tumors. Histologic features and prognosis.". Cancer 62 (10): 2212-22. PMID 3179935.
- ↑ Cotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Nelso Fausto; Robbins, Stanley L.; Abbas, Abul K. (2005). Robbins and Cotran pathologic basis of disease (7th ed.). St. Louis, Mo: Elsevier Saunders. pp. 1096-7. ISBN 0-7216-0187-1.
- ↑ 14.0 14.1 Cotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Nelso Fausto; Robbins, Stanley L.; Abbas, Abul K. (2005). Robbins and Cotran pathologic basis of disease (7th ed.). St. Louis, Mo: Elsevier Saunders. pp. 1096. ISBN 0-7216-0187-1.
- ↑ LAE. 19 February 2009.
- ↑ LAE. 19 February 2009.
- ↑ URL: http://www.ncbi.nlm.nih.gov/pubmed/15897738. Accessed on: 7 April 2011.
- ↑ Piura B, Rabinovich A, Yanai-Inbar I (2000). "Micropapillary serous carcinoma of the ovary: case report and review of literature". Eur. J. Gynaecol. Oncol. 21 (4): 374–6. PMID 11055486.
- ↑ Prat J, De Nictolis M (September 2002). "Serous borderline tumors of the ovary: a long-term follow-up study of 137 cases, including 18 with a micropapillary pattern and 20 with microinvasion". Am. J. Surg. Pathol. 26 (9): 1111-28. PMID 12218568. http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0147-5185&volume=26&issue=9&spage=1111.
- ↑ Hallman KB, Nahhas WA, Connelly PJ (September 1991). "Endosalpingiosis as a source of psammoma bodies in a Papanicolaou smear. A case report". J Reprod Med 36 (9): 675–8. PMID 1774734.
- ↑ DeLair, D.; Oliva, E.; Köbel, M.; Macias, A.; Gilks, CB.; Soslow, RA. (Jan 2011). "Morphologic spectrum of immunohistochemically characterized clear cell carcinoma of the ovary: a study of 155 cases.". Am J Surg Pathol 35 (1): 36-44. doi:10.1097/PAS.0b013e3181ff400e. PMID 21164285.
- ↑ Tsuchiya, A.; Sakamoto, M.; Yasuda, J.; Chuma, M.; Ohta, T.; Ohki, M.; Yasugi, T.; Taketani, Y. et al. (Dec 2003). "Expression profiling in ovarian clear cell carcinoma: identification of hepatocyte nuclear factor-1 beta as a molecular marker and a possible molecular target for therapy of ovarian clear cell carcinoma.". Am J Pathol 163 (6): 2503-12. PMID 14633622. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1892387/?tool=pubmed.
- ↑ 23.0 23.1 Online 'Mendelian Inheritance in Man' (OMIM) 189907
- ↑ Shappell, HW.; Riopel, MA.; Smith Sehdev, AE.; Ronnett, BM.; Kurman, RJ. (Dec 2002). "Diagnostic criteria and behavior of ovarian seromucinous (endocervical-type mucinous and mixed cell-type) tumors: atypical proliferative (borderline) tumors, intraepithelial, microinvasive, and invasive carcinomas.". Am J Surg Pathol 26 (12): 1529-41. PMID 12459620.
- ↑ Shappell, HW.; Riopel, MA.; Smith Sehdev, AE.; Ronnett, BM.; Kurman, RJ. (Dec 2002). "Diagnostic criteria and behavior of ovarian seromucinous (endocervical-type mucinous and mixed cell-type) tumors: atypical proliferative (borderline) tumors, intraepithelial, microinvasive, and invasive carcinomas.". Am J Surg Pathol 26 (12): 1529-41. PMID 12459620.
- ↑ Cotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Nelso Fausto; Robbins, Stanley L.; Abbas, Abul K. (2005). Robbins and Cotran pathologic basis of disease (7th ed.). St. Louis, Mo: Elsevier Saunders. pp. 1097. ISBN 0-7216-0187-1.
- ↑ Shimada, M.; Kigawa, J.; Ohishi, Y.; Yasuda, M.; Suzuki, M.; Hiura, M.; Nishimura, R.; Tabata, T. et al. (Jun 2009). "Clinicopathological characteristics of mucinous adenocarcinoma of the ovary.". Gynecol Oncol 113 (3): 331-4. doi:10.1016/j.ygyno.2009.02.010. PMID 19275957.
- ↑ 28.0 28.1 Baker P, Oliva E (July 2008). "A practical approach to intraoperative consultation in gynecological pathology". Int. J. Gynecol. Pathol. 27 (3): 353-65. doi:10.1097/PGP.0b013e31815c24fe. PMID 18580313.
- ↑ 29.0 29.1 Cotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Nelso Fausto; Robbins, Stanley L.; Abbas, Abul K. (2005). Robbins and Cotran pathologic basis of disease (7th ed.). St. Louis, Mo: Elsevier Saunders. pp. 1098. ISBN 0-7216-0187-1.
Cite error: Invalid
<ref>
tag; name "Ref_PBoD1098" defined multiple times with different content - ↑ Hauptmann S, Köbel M (2005). "[Prognostic factors in ovarian carcinoma]" (in German). Verh Dtsch Ges Pathol 89: 92-100. PMID 18035678.
- ↑ URL: http://www.pathologyoutlines.com/ovary.html. Accessed on: 8 February 2011.
- ↑ Tsuchiya, A.; Sakamoto, M.; Yasuda, J.; Chuma, M.; Ohta, T.; Ohki, M.; Yasugi, T.; Taketani, Y. et al. (Dec 2003). "Expression profiling in ovarian clear cell carcinoma: identification of hepatocyte nuclear factor-1 beta as a molecular marker and a possible molecular target for therapy of ovarian clear cell carcinoma.". Am J Pathol 163 (6): 2503-12. PMID 14633622. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1892387/?tool=pubmed.
- ↑ Köbel M, Kalloger SE, Carrick J, et al. (January 2009). "A limited panel of immunomarkers can reliably distinguish between clear cell and high-grade serous carcinoma of the ovary". Am. J. Surg. Pathol. 33 (1): 14–21. doi:10.1097/PAS.0b013e3181788546. PMID 18830127.
- ↑ DeLair, D.; Oliva, E.; Köbel, M.; Macias, A.; Gilks, CB.; Soslow, RA. (Jan 2011). "Morphologic spectrum of immunohistochemically characterized clear cell carcinoma of the ovary: a study of 155 cases.". Am J Surg Pathol 35 (1): 36-44. doi:10.1097/PAS.0b013e3181ff400e. PMID 21164285.
- ↑ Eichhorn, JH.; Young, RH. (Apr 2004). "Transitional cell carcinoma of the ovary: a morphologic study of 100 cases with emphasis on differential diagnosis.". Am J Surg Pathol 28 (4): 453-63. PMID 15087664.
- ↑ 36.0 36.1 36.2 Tazi, EM.; Lalya, I.; Tazi, MF.; Ahellal, Y.; M'rabti, H.; Errihani, H. (2010). "Transitional cell carcinoma of the ovary: a rare case and review of literature.". World J Surg Oncol 8: 98. doi:10.1186/1477-7819-8-98. PMID 21073751.
- ↑ 37.0 37.1 Borah, T.; Mahanta, RK.; Bora, BD.; Saikia, S. (Jan 2011). "Brenner tumor of ovary: An incidental finding.". J Midlife Health 2 (1): 40-1. doi:10.4103/0976-7800.83273. PMC 3156501. PMID 21897739. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3156501/.
- ↑ URL: http://www.pathologyoutlines.com/ovarytumor.html#brennergen. Accessed on: 8 February 2011.
- ↑ Cotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Nelso Fausto; Robbins, Stanley L.; Abbas, Abul K. (2005). Robbins and Cotran pathologic basis of disease (7th ed.). St. Louis, Mo: Elsevier Saunders. pp. 1101. ISBN 0-7216-0187-1.
- ↑ Baker P, Oliva E (July 2008). "A practical approach to intraoperative consultation in gynecological pathology". Int. J. Gynecol. Pathol. 27 (3): 353?65. doi:10.1097/PGP.0b013e31815c24fe. PMID 18580313.
- ↑ Cotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Nelso Fausto; Robbins, Stanley L.; Abbas, Abul K. (2005). Robbins and Cotran pathologic basis of disease (7th ed.). St. Louis, Mo: Elsevier Saunders. pp. 1104. ISBN 0-7216-0187-1.
- ↑ URL: http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675%2806%2970245-5. Accessed on: 8 April 2011.
- ↑ Yemelyanova, AV.; Vang, R.; Judson, K.; Wu, LS.; Ronnett, BM. (Jan 2008). "Distinction of primary and metastatic mucinous tumors involving the ovary: analysis of size and laterality data by primary site with reevaluation of an algorithm for tumor classification.". Am J Surg Pathol 32 (1): 128-38. doi:10.1097/PAS.0b013e3180690d2d. PMID 18162780.
- ↑ Okamoto, T.; Matsumura, N.; Mandai, M.; Oura, T.; Yamanishi, Y.; Horiuchi, A.; Hamanishi, J.; Baba, T. et al. (Feb 2011). "Distinguishing primary from secondary mucinous ovarian tumors: an algorithm using the novel marker DPEP1.". Mod Pathol 24 (2): 267-76. doi:10.1038/modpathol.2010.204. PMID 21076463.
- ↑ 45.0 45.1 45.2 45.3 45.4 45.5 45.6 45.7 45.8 Roth LM (July 2006). "Recent advances in the pathology and classification of ovarian sex cord-stromal tumors". Int. J. Gynecol. Pathol. 25 (3): 199–215. doi:10.1097/01.pgp.0000192271.22289.e6. PMID 16810055.
- ↑ Movahedi-Lankarani, S.; Kurman, RJ. (Nov 2002). "Calretinin, a more sensitive but less specific marker than alpha-inhibin for ovarian sex cord-stromal neoplasms: an immunohistochemical study of 215 cases.". Am J Surg Pathol 26 (11): 1477-83. PMID 12409724.
- ↑ Purohit, RC.; Alam, SZ. (Mar 1980). "Sex cord tumour of the ovary with annular tubules (SCTAT).". Histopathology 4 (2): 147-54. PMID 7358344.
- ↑ Lele, SM.; Sawh, RN.; Zaharopoulos, P.; Adesokan, A.; Smith, M.; Linhart, JM.; Arrastia, CD.; Krigman, HR. (Apr 2000). "Malignant ovarian sex cord tumor with annular tubules in a patient with Peutz-Jeghers syndrome: a case report.". Mod Pathol 13 (4): 466-70. doi:10.1038/modpathol.3880079. PMID 10786816.
- ↑ URL: http://dictionary.reference.com/browse/annular. Accessed on: 6 August 2011.
- ↑ Young, RH.; Welch, WR.; Dickersin, GR.; Scully, RE. (Oct 1982). "Ovarian sex cord tumor with annular tubules: review of 74 cases including 27 with Peutz-Jeghers syndrome and four with adenoma malignum of the cervix.". Cancer 50 (7): 1384-402. PMID 7104978.
- ↑ Hashemipour, M.; Moaddab, MH.; Nazem, M.; Mahzouni, P.; Salek, M. (Jul 2010). "Granulosa cell tumor in a six-year-old girl presented as precocious puberty.". J Res Med Sci 15 (4): 240-2. PMID 21526089.
- ↑ URL: http://path.upmc.edu/cases/case631.html. Accessed on: 26 January 2012.
- ↑ 53.0 53.1 Cotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Nelso Fausto; Robbins, Stanley L.; Abbas, Abul K. (2005). Robbins and Cotran pathologic basis of disease (7th ed.). St. Louis, Mo: Elsevier Saunders. pp. 1102. ISBN 0-7216-0187-1.
- ↑ Schofield, DE.; Fletcher, JA. (Dec 1992). "Trisomy 12 in pediatric granulosa-stromal cell tumors. Demonstration by a modified method of fluorescence in situ hybridization on paraffin-embedded material.". Am J Pathol 141 (6): 1265-9. PMID 1466394.
- ↑ Mayr, D.; Kaltz-Wittmer, C.; Arbogast, S.; Amann, G.; Aust, DE.; Diebold, J. (Sep 2002). "Characteristic pattern of genetic aberrations in ovarian granulosa cell tumors.". Mod Pathol 15 (9): 951-7. doi:10.1097/01.MP.0000024290.55261.14. PMID 12218213.
- ↑ Patel, SS.; Carrick, KS.; Carr, BR. (Mar 2009). "Virilization persists in a woman with an androgen-secreting granulosa cell tumor.". Fertil Steril 91 (3): 933.e13-5. doi:10.1016/j.fertnstert.2008.10.038. PMID 19062005.
- ↑ Havelock, JC.; Rainey, WE.; Carr, BR. (Dec 2004). "Ovarian granulosa cell lines.". Mol Cell Endocrinol 228 (1-2): 67-78. doi:10.1016/j.mce.2004.04.018. PMID 15541573.
- ↑ Jamieson, S.; Fuller, PJ. (Feb 2012). "Molecular pathogenesis of granulosa cell tumors of the ovary.". Endocr Rev 33 (1): 109-44. doi:10.1210/er.2011-0014. PMID 22240241.
- ↑ Shah, SP.; Köbel, M.; Senz, J.; Morin, RD.; Clarke, BA.; Wiegand, KC.; Leung, G.; Zayed, A. et al. (Jun 2009). "Mutation of FOXL2 in granulosa-cell tumors of the ovary.". N Engl J Med 360 (26): 2719-29. doi:10.1056/NEJMoa0902542. PMID 19516027.
- ↑ http://www.pathologyoutlines.com/ovarytumor.html#fibroma
- ↑ 61.0 61.1 Nocito AL, Sarancone S, Bacchi C, Tellez T (February 2008). "Ovarian thecoma: clinicopathological analysis of 50 cases". Ann Diagn Pathol 12 (1): 12–6. doi:10.1016/j.anndiagpath.2007.01.011. PMID 18164409.
- ↑ 62.0 62.1 62.2 Cotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Nelso Fausto; Robbins, Stanley L.; Abbas, Abul K. (2005). Robbins and Cotran pathologic basis of disease (7th ed.). St. Louis, Mo: Elsevier Saunders. pp. 1103. ISBN 0-7216-0187-1.
Cite error: Invalid
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tag; name "Ref_PBoD1103" defined multiple times with different content Cite error: Invalid<ref>
tag; name "Ref_PBoD1103" defined multiple times with different content - ↑ Tytle, T.; Rosin, D. (Sep 1984). "Bilateral calcified ovarian fibromas.". South Med J 77 (9): 1178-80. PMID 6385289.
- ↑ URL: http://brighamrad.harvard.edu/Cases/bwh/hcache/353/full.html. Accessed on: 4 October 2011.
- ↑ 65.0 65.1 65.2 65.3 Rose, Alan G. (2008). Atlas of Gross Pathology with Histologic Correlation (1st ed.). Cambridge University Press. pp. 398. ISBN 978-0521868792.
- ↑ URL: http://www.pathologyoutlines.com/ovarytumor.html#fibroma. Accessed on: 7 May 2012.
- ↑ 67.0 67.1 Zafrakas, M.; Venizelos, ID.; Theodoridis, TD.; Zepiridis, L.; Agorastos, T.; Bontis, JN. (2009). "Virilizing ovarian hilus (Leydig) cell tumor with concurrent contralateral hilus cell hyperplasia: a rare diagnosis.". Eur J Gynaecol Oncol 30 (3): 338-40. PMID 19697637.