OVARIAN TUMOURS (Robbins pp 1067)

Tumours of surface (coelomic) epithelium

There are various types of these tumours. Each of these types can be benign, borderline, or highly malignant.

Serous tumours:

• General: The tumour is filled with clear serous fluid. Most bilateral.
  
• Epidemiology: Account for about 30% of all ovarian tumours, 25% malignant.
  
• Morphology: Macroscopically: cystic neoplasms lined with tall columnar cells, neoplasm filled with serous fluid, papillary projections seen in malignant cases. Microscopically: benign tumours (cystadenomas) have little/no papillae, borderline malignant tumours have increased papillae and show signs of epithelial stratification, malignant tumours (cystadenocarcinomas) have complex papillae with malignant cell features (atypia etc), psammoma bodies a characteristic of serous tumours.
• Clinical course: Transcoelomic/lymphatic spread are common. Prognosis is poor if peritoneum is involved, otherwise close to 100%.

Mucinous tumours:

• General: Sticky mucin present within cysts. Most not bilateral.
  
• Epidemiology: 25% of all ovarian neoplasms, most are benign/borderline.
  
• Morphology: Macroscopically: large multicystic tumour, sticky mucin inside, Microscopically: benign tumours: tall columnar epithelium, borderline: papillary structure, epithelial stratification beginning, malignant (cystadenocarcinoma): epithelial stratification, loss of glandular structure, necrosis.
• Clinical course: Pseudomyxoma peritonei is a condition associated with mucinous ovarian tumours: involves mucinous ascitis, peritoneal cysts, adhesions.
  
• Ovarian tumours spread: transcoelomic/lymphatic.

Endometroid tumours:

• General: Tubular glands resembling endometrium present.
• Epidemiology: 20% of all ovarian tumours, 10-15% coexist with endometriosis, up to 30% associated with endometrial carcinoma.
• Morphology: Macroscopically: solid & cystic areas, Microscopically: glandular pattern similar to endometrium.
• Clinical course: 40-50% 5 year survival rate.

Clear cell tumours:

• General: epithelial cells that line tumours have lots of clear cytoplasm.
• Morphology: Microscopically: clear cells arranged in sheet form (solid tumours), tubular form (cystic tumours).

Category: Pathology Notes