Classification Surface epithelial-stromal tumor

1 classification

1.1 serous tumors

1.1.1 pathology
1.1.2 prognosis


1.2 mucinous tumors

1.2.1 pathology
1.2.2 prognosis


1.3 endometrioid tumors

1.3.1 pathology
1.3.2 prognosis


1.4 clear cell tumors

1.4.1 prognosis


1.5 brenner tumor
1.6 small cell tumors

classification

ovarian cancers in women aged 20+, area representing relative incidence , color representing 5-year relative survival rate. surface epithelial-stromal tumors labeled in center of main diagram, , represent types except ones separated @ top.

epithelial-stromal tumors classified on basis of epithelial cell type, relative amounts of epithelium , stroma, presence of papillary processes, , location of epithelial elements. microscopic pathological features determine whether surface epithelial-stromal tumor benign, borderline, or malignant (evidence of malignancy , stromal invasion). borderline tumors of uncertain malignant potential.

this group consists of serous, mucinous, endometrioid, clear cell, , brenner (transitional cell) tumors, though there few mixed, undifferentiated , unclassified types.

serous tumors

these tumors vary in size small , imperceptible large, filling abdominal cavity.
benign, borderline, , malignant types of serous tumors account 30% of ovarian tumors.
75% benign or of borderline malignancy, , 25% malignant
the malignant form of tumor, serous cystadenocarcinoma, accounts approximately 40% of carcinomas of ovary , common malignant ovarian tumors.
benign , borderline tumors common between ages of 20 , 50 years.
malignant serous tumors occur later in life on average, although earlier in familial cases.
20% of benign, 30% of borderline, , 66% of malignant tumors bilateral (affect both ovaries).

components can include:

the chance of malignancy of tumor increases amount of solid areas present, including both papillary structures , necrotic tissue present.

pathology

lined tall, columnar, ciliated epithelial cells
filled clear serous fluid
the term serous originated description of cyst fluid has come describe particular type of epithelial cell seen in these tumors
may involve surface of ovary
the division between benign, borderline, , malignant ascertained assessing:

cellular atypia (whether or not individual cells abnormal)
invasion of surrounding ovarian stroma (whether or not cells infiltrating surrounding tissue)
borderline tumors may have cellular atypia not have evidence of invasion
the presence of psammoma bodies characteristic microscopic finding of cystadenocarcinomas



prognosis

the prognosis of serous tumor, neoplasms, depends on

degree of differentiation

this how closely tumor cells resemble benign cells
a well-differentiated tumor closely resembles benign tumors
a poorly differentiated tumor may not resemble cell type of origin @ all
a moderately differentiated tumor resembles cell type of origin, appears frankly malignant


extension of tumor other structures

in particular serous malignancies, presence of malignant spread peritoneum important regard prognosis.

the 5 year survival rate of borderline , malignant tumors confined ovaries 100% , 70% respectively. if peritoneum involved, these rates become 90% , 25%.

while 5-year survival rates of borderline tumors excellent, should not seen evidence of cure, recurrences can occur many years later.

mucinous tumors

mucinous tumors:

closely resemble serous counterparts unlikely bilateral
somewhat less common, accounting 25% of ovarian neoplasms
in cases mucinous tumors characterized more cysts of variable size , rarity of surface involvement compared serous tumors
also in comparison serous tumors, mucinous tumors less bilateral, approximately 5% of primary mucinous tumors bilateral.
may form large cystic masses, recorded weights exceeding 25 kg

pathology

mucinous tumors characterized lining of tall columnar epithelial cells apical mucin , absence of cilia, similar in appearance benign cervical or intestinal epithelia. appearance can similar colonic or ovarian cancer, typically originates appendix (see mucinous adenocarcinoma clinical condition pseudomyxoma peritonei). clear stromal invasion used differentiate borderline tumors malignant tumors.

prognosis

10-year survival rates borderline tumors contained within ovary, malignant tumors without invasion, , invasive malignant tumors greater 95%, 90%, , 66%, respectively. 1 rare noteworthy condition associated mucinous ovarian neoplasms pseudomyxoma peritonei. primary ovarian mucinous tumors unilateral (in 1 ovary), presentation of bilateral mucinous tumors requires exclusion of non-ovarian origin, appendix.

endometrioid tumors

endometrioid tumors account approximately 20% of ovarian cancers , malignant (endometroid carcinomas). made of tubular glands bearing close resemblance benign or malignant endometrium. 15-30% of endometrioid carcinomas occur in individuals carcinoma of endometrium, , these patients have better prognosis. appear similar other surface epithelial-stromal tumors, solid , cystic areas. 40% of these tumors bilateral, when bilateral, metastases present.

pathology

glands bearing strong resemblance endometrial-type glands

benign tumors have mature-appearing glands in fibrous stroma
borderline tumors have complex branching pattern without stromal invasion
carcinomas (malignant tumors) have invasive glands crowded, atypical cells, frequent mitoses. poorer differentiation, tumor becomes more solid.



prognosis

prognosis again dependent on spread of tumor, how differentiated tumor appears. overall prognosis worse serous or mucinous tumors, , 5-year survival rate patients tumors confined ovary approximately 75%.

clear cell tumors

micrograph of ovarian clear cell carcinoma. h&e stain.

clear cell tumors characterized large epithelial cells abundant clear cytoplasm , may seen in association endometriosis or endometrioid carcinoma of ovary, bearing resemblance clear cell carcinoma of endometrium. may predominantly solid or cystic. if solid, clear cells tend arranged in sheets or tubules. in cystic variety, neoplastic cells make cyst lining.

prognosis

these tumors tend aggressive, 5 year survival rate tumors confined ovaries approximately 65%. if tumor has spread beyond ovary @ diagnosis, prognosis poor

brenner tumor

brenner tumour. h&e stain.

brenner tumors uncommon surface-epithelial stromal cell tumors in epithelial cell (which defines these tumors) transitional cell. these similar in appearance bladder epithelia. tumors may small large, , may solid or cystic. histologically, tumor consists of nests of aforementioned transitional cells within surrounding tissue resembles normal ovary. brenner tumors may benign or malignant, depending on whether tumor cells invade surrounding tissue.

small cell tumors

small cell ovarian cancer (scco) classified epithelial tumors associated distinctive endocrine features.

the world health organisation (who) recognises scco 2 distinct entities: small cell ovarian cancer of hypercalcemic type ( sccoht) , small cell ovarian cancer of pulmonary type ( sccopt).

small cell tumours rare , aggressive, contribute less 2% of gynaecologic malignancies. average age of diagnosis 24 years old, , majority of patients present hypercalcemia (62%). typically present unilateral large tumor. women die within year of diagnosis.