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80% benign, young women age 20-45
Malignant more common in older white women
- >90% of malignant ovarian neoplasms are carcinoma (epithelial)
1. Surface epithelial cells - can occur anywhere in peritoneum after Mallerian degeneration/transformation.
2. Germ cell
3. Sex cord-Stroma - hormone-secreting cells
4. Metastases to ovaries
Behavior:
- Benign - cystadenoma, cystadenofibroma
- Borderline - low malignant potential
- Malignant - carcinoma, cystadenocarcinoma.
Histologic types
- Serous (most common)
- Mucinous
- Endometrioid
- Clear cell
- Brenner/Transitional cell
Can have any combination!
Serous tumors of ovary - percentage malignant and benign?
2/3 benign, 1/3 malignant
Benign serous tumor of ovary - population and appearance, histology
- Occur in middle aged women
- Can be bilateral
- Typically cystic - Serous cystadenoma
Histology: Lined by benign, nonproliferative epithelium, not thrown into papillae (don't need to know)
Borderline serous tumors (of low malignant potential) of ovary - population, appearance/location
Population: Slightly older than benign serous tumor population
Appearance: Frilly, soft, lush papillary projections
- Can be inside cyst or on surface of ovary
- Multifocal - both ovary and other sites in peritoneum involved. INDEPENDENT origin, not metastatic.
Borderline serous tumors (of low malignant potential) of ovary - prognosis and treatment
Prognosis depends on surgical complications and number of sites.
- Limited to ovary - 100% 5-yr survival
- Extra-ovarian - 90% 5-yr survival
Treatment - No chemotherapy!!
Serous carcinoma of ovary - typical presentation, gross appearance, and prognosis
Most common ovarian malignant tumor
Presentation:
Silent until stage 3 when involves omentum
- Ascites, omentum kick
Appearance:
- Bilateral ovarian involvement, solid cystic necrotic ovaries by the time detected
Prognosis - determined by stage
Precursor of carcinoma of ovary
No precursor ever detected! IT'S A MYSTERY
Proposed that significant percentage of BRCA1-- and BRCA2- related ovarian tumors and some sporadic high-grade ovarian and primary peritoneal serous carcinomas may originate from distal/fimbriated end of fallopian tube.
- Called serous/tubular intra-epithelial carcinoma (STIC)
- Then implant on ovary or peritoneum.
Molecular underpinnings of serous ovarian carcinoma
Type I (very rare) - Low grade pathway - Arise from borderline tumors or endometriosis
- Mutations in KRAS, BRAF, or HER2/Neu
Type II (majority) - Serous/tubular intraepithelial carcinoma (STIC)
- Precursor in fallopian tube
- Involves abdominal organs quickly, deadly
- Mutations in p53
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