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-
Associated with Psammoma Bodies – target shaped
calcifications
o
Not
pathognomonic
o
Seen
in non-ovarian tumors, hybrid tumors, etc.
-
These tumors tend to spread all over peritoneal surfaces
o
Such
as omental spread
Mucinous Tumors of the Ovaries
-
These are among the largest tumors in the
body…they can be seriously huge.
-
85%
benign
-
6%
LMP, 9 % malignant
-
Associated with Pseudomyxoma peritonei
o
These are Mucinous ascites
o
The
term “Psudomyxoma peritonei” apparently means “jelly
belly” so just picture a gigantic tumor filled with
gelatinous material sitting inside someone’s gut…you can
thank me for that pleasant image later.
-
These tumors are loculated – meaning they have
bubbles within bubbles
o
They
are not papillary
-
These can recur after surgery and cause intestinal
obstruction
Okay, that’s it for the Epithelial Tumors, let’s move on
to the Germ Cell Tumors
Germ
Cell Neoplasms of the Ovaries
-
No
one knows what causes these
-
Tissues from all three cell layers (endoderm, mesoderm,
ectoderm) are seen
-
Most
are Benign Cystic Teratoma (AKA Dermoid Cysts)
-
The
rest are a variety of malignancies
o
Immature Teratoma
o
Yolk
sac tumor (endometrial sinus)
o
Dysgerminoma
o
Choriocarcinoma
o
Embryonal
o
Mixed
-
Very
common
-
May
have no symptoms
-
Treated with cystectomy – this procedure preserves the
ovary
-
Have
lots of ectodermal cells – thus they have skin and
sebacesous glands – this means they produce a lot of
sebaceous material and are thus pretty heavy…this can
cause them to twist or rupture.
o
This
sebaceous material can lead to pretty significant
chemical peritonitis because it’s really irritating.
-
Rokitansky’s Protuberance
– the one flat side of the neoplasm
o
Online, I found that that this is the point of contact
of the tumor with the residual ovarian tissue and teeth
and hair arise from here. But Dr. Heller didn’t really
make a big deal about this.
-
Stroma ovarii
– this is a monodermal teratoma which is
basically overgrowths of a single tissue instead of all
three tissue layers
o
Mostly thyroid tissue
Time
for Stromal Neoplasms…
Stromal Neoplasms of the Ovaries
-
Tumors of the Specialized Stroma: Granulosa cell tumors,
fibrothecomas, Sertoli-Leydig cell tumors, Steroid cell
tumors
o
Some
of these are feminizing and some are masculinizing
-
Various occasional nonspecialized stroma tumors
o
DON’T
worry about these
-
Granulosa Cell Tumor
o
Low
grade malignancy
o
Usually unilateral
o
Hemorrhagic
o
Can
produce E2 (estradiol) and overstimulate endometrium
o
Coffee bean nuclei – grooved nuclei
o
Call-Exner Bodies
– the hallmark
§
Small fluid filled spaces in between granulosa cells
-
Fibrothecomas
o
Benign
o
Usually unilateral
o
More
frequent in menopause
o
Can
produce estrogen
o
Meig’s syndrome
– a combo of fibroma, right hydrothorax, ascites
o
Has
spindle cells – like fibrin but nuclei are pointier
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