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Difference between revisions of "Ovarian tumours"
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An introduction to the ovary is in the ''[[ovary]]'' article, which also deals benign cysts. | 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. | Gynecologists use a scoring system to help decide which patients need surgery and estimate their pre-op risk of malignancy. | ||
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*RMI > 200 -- predicts malignancy. | *RMI > 200 -- predicts malignancy. | ||
=Classification= | |||
===The Latta rule of fives=== | ===The Latta rule of fives=== | ||
Can be divided as follows:<ref name=Ref_PBoD1093>{{Ref PBoD|1093}}</ref><ref>LAE. 22 October 2009.</ref> | Can be divided as follows:<ref name=Ref_PBoD1093>{{Ref PBoD|1093}}</ref><ref>LAE. 22 October 2009.</ref> | ||
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#[[Teratoma]]. | #[[Teratoma]]. | ||
=Common special tumours= | |||
===Endometriosis-related tumours=== | ===Endometriosis-related tumours=== | ||
Tumours associated with endometriosis:<ref>LAE. 22 October 2009.</ref> | Tumours associated with endometriosis:<ref>LAE. 22 October 2009.</ref> | ||
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**Granulosa-theca cell tumour. | **Granulosa-theca cell tumour. | ||
= | =A morphologic approach= | ||
Where is the tumour arising? | Where is the tumour arising? | ||
*Central location -- think GCTs and SCST. | *Central location -- think GCTs and SCST. | ||
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*Characteristic of colorectal adenocarcinoma, may be absent in ovarian tumours -- limited value.<ref name=pmid9421090>{{cite journal |author=DeCostanzo DC, Elias JM, Chumas JC |title=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 |journal=Int. J. Gynecol. Pathol. |volume=16 |issue=3 |pages=245–9 |year=1997 |month=July |pmid=9421090 |doi= |url=}}</ref> | *Characteristic of colorectal adenocarcinoma, may be absent in ovarian tumours -- limited value.<ref name=pmid9421090>{{cite journal |author=DeCostanzo DC, Elias JM, Chumas JC |title=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 |journal=Int. J. Gynecol. Pathol. |volume=16 |issue=3 |pages=245–9 |year=1997 |month=July |pmid=9421090 |doi= |url=}}</ref> | ||
=Grading of ovarian cancer= | |||
*Silverberg grading system,<ref>{{cite journal |author=Silverberg SG |title=Histopathologic grading of ovarian carcinoma: a review and proposal |journal=Int. J. Gynecol. Pathol. |volume=19 |issue=1 |pages=7-15 |year=2000 |month=January |pmid=10638449 |doi= |url=http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0277-1691&volume=19&issue=1&spage=7}}</ref> aka ''universal grading system''. | *Silverberg grading system,<ref>{{cite journal |author=Silverberg SG |title=Histopathologic grading of ovarian carcinoma: a review and proposal |journal=Int. J. Gynecol. Pathol. |volume=19 |issue=1 |pages=7-15 |year=2000 |month=January |pmid=10638449 |doi= |url=http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0277-1691&volume=19&issue=1&spage=7}}</ref> aka ''universal grading system''. | ||
*Based on ''pattern'', ''cytologic atypia'' and ''mitotic rate''. | *Based on ''pattern'', ''cytologic atypia'' and ''mitotic rate''. | ||
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==Serous tumours== | ==Serous tumours== | ||
===Classification<ref>PBoD | ===General=== | ||
*Most common malignant ovarian tumour. | |||
====Classification==== | |||
Based on features predictive of behaviour:<ref name=Ref_PBoD1096>{{Ref PBoD |1096}}</ref> | |||
*Benign. | *Benign. | ||
*Borderline. | *Borderline. | ||
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*Malignant. | *Malignant. | ||
**Cytologic atypia. | **Cytologic atypia. | ||
** | **+/-Papillae. | ||
===Microscopic=== | ===Microscopic=== | ||
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**Columnar. | **Columnar. | ||
*Papillae. | *Papillae. | ||
*Psammoma bodies (concentric calcifications). | *[[Psammoma bodies]] (concentric calcifications). | ||
Note: | Note: | ||
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*Good sampling of mucinous tumours, i.e. many blocks, is important to lessen the chance of undercalling them. | *Good sampling of mucinous tumours, i.e. many blocks, is important to lessen the chance of undercalling them. | ||
== | ==Ovarian endometrioid carcinoma== | ||
=== | ===General=== | ||
*Associated with [[endometriosis]], i.e. people with endometriosis are more likely to have 'em. | *Associated with [[endometriosis]], i.e. people with endometriosis are more likely to have 'em. | ||
=== | ===Microscopic=== | ||
*Tubular glands. | *Tubular glands. | ||
**Cribriform pattern common. | **Cribriform pattern common. | ||
* May see mucinous secretion.<ref name=pmid18580313>{{cite journal |author=Baker P, Oliva E |title=A practical approach to intraoperative consultation in gynecological pathology |journal=Int. J. Gynecol. Pathol. |volume=27 |issue=3 |pages=353-65 |year=2008 |month=July |pmid=18580313 |doi=10.1097/PGP.0b013e31815c24fe |url=}}</ref> | * May see mucinous secretion.<ref name=pmid18580313>{{cite journal |author=Baker P, Oliva E |title=A practical approach to intraoperative consultation in gynecological pathology |journal=Int. J. Gynecol. Pathol. |volume=27 |issue=3 |pages=353-65 |year=2008 |month=July |pmid=18580313 |doi=10.1097/PGP.0b013e31815c24fe |url=}}</ref> | ||
* May have squamous differentiation/squamous metaplasia (useful for differentiating from sex-cord stromal tumours and germ cell tumours).<ref name=pmid18580313/> - very useful feature. | * May have squamous differentiation/squamous metaplasia (useful for differentiating from sex-cord stromal tumours and germ cell tumours).<ref name=pmid18580313/> - very useful feature. | ||
== | ==Ovarian clear cell carcinoma== | ||
*[[AKA]] clear cell carcinoma. | *[[AKA]] ''ovarian clear cell adenocarcinoma'', [[AKA]] ''clear cell carcinoma of the ovary''. | ||
===General=== | ===General=== | ||
* Thought to be related to endometrioid carcinoma.<ref name=Ref_PBoD1098>{{Ref PBoD |1098}}</ref> | * Thought to be related to endometrioid carcinoma.<ref name=Ref_PBoD1098>{{Ref PBoD |1098}}</ref> | ||
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*[[Hobnail morphology]] - apical surface larger than basal surface.<ref>URL: [http://www.pathologyoutlines.com/ovary.html http://www.pathologyoutlines.com/ovary.html]. Accessed on: 8 February 2011.</ref> | *[[Hobnail morphology]] - apical surface larger than basal surface.<ref>URL: [http://www.pathologyoutlines.com/ovary.html http://www.pathologyoutlines.com/ovary.html]. Accessed on: 8 February 2011.</ref> | ||
**"Nuclei bulge into the lumen". | **"Nuclei bulge into the lumen". | ||
*Hyaline droplets -- common, as in ''clear cell | *Hyaline droplets -- common, as in ''[[clear cell renal cell carcinoma]]''. | ||
**Eosinophilic bodies within lumen. | **Eosinophilic bodies within lumen. | ||
*Nucleoli - prominent. | *Nucleoli - prominent. | ||