卵巢肿瘤英文课件

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1、OVARIAN CANCEROVARIAN CANCER1INTRODUCTIONINTRODUCTION2I.Histologic Classification i.coelomic epithelium originating tumor accounts for 50-70%of primal ovarian tumor,85-90%of ovarian malignace.developed from germinal epithelium primal coelomic epithelium various muller,s epithelium tubal epithelium,c

2、ervical mucosa epithelium,endometrium the coelomic epithelial tumors include (i).serous tumor (ii).mucinous tumor (iii).endometrioid tumor (iv).clear cell tumorI.Histologic Classification3 (v).Brenner tumor/transitional cell tumor (vi).mixed epithelial tumor (vii).undifferentiated carcinoma ii.germ

3、cell tumor accounts for 20-40%of ovarian tumor.germ cells originate from endogerm tissues.in the course of its origination,transformation and development the cellular heterogeneity may occur and form various tumors germ cell tumors include (i).dysgerminoma (ii).endodermal sinus tumor (v).Brenner tum

4、or/transit4 (iii).embryonic carcinoma (iv).polyembryonic tumor (v).choriocarcinoma (vi).teratoma i).immature type ii).mature type (a).solid teratoma (b).cystic teratoma a).dermoid cyst b).malignant change of dermoid cyst (c).monodermal and highly specialized tumors a).struma ovarii b).carcinoid (vii

5、).mixed type (iii).embryonic carcinoma5 iii.ovarian gonadal sex cord stromal tumor accounts for 5%of ovarian tumor.sex cord stroma originates from mesenchymal tissues of primal coelom female and male differentiation epithelium differentiationgranulosa,Sertolic cell tumor functional tumor stromal dif

6、ferentiation theca cell,Leydig cell tumor sex cord stromal cells tumor includes (i).granulosa cell-stromal tumor i).granulosa cell tumor ii).theca cell tumor,fibroma iii.ovarian gonadal sex cord6 (ii).Sertolic-Leydig cell tumor i).androblastoma (iii).gynandroblastoma iv.metastasized tumor (ii).Serto

7、lic-Leydig cell7II.High risk factors of ovarian tumors i.hereditary and family factors about 20-25%malignant ovarian tumors have family history ii.environmental factors the mobidity of ovarian cancer is high in industry developed countrys,this may be because of high cholesterol diet in these country

8、s iii.endocrinic factors mobidity in less pregnant or infertile women is high(why),functional cancers may easily complicated with mammary andendometrial cancerII.High risk factors of ovaria8III.pathology i.epithelial ovarian tumors age:30-60;classification:benigh,borderline,malignant borderline tumo

9、r means:(i).serous cystadenoma mobidity:accounts for 25%benigh tumors macroexamination:unilateral,globular,different size,smooth surface,cystic,thin wall and filled by clear light-yellow fluid section:simple type,monocystic,smooth wall;papillary type,multicystic,intracystic papilla microscopic exani

10、nation:tumor wall is composed of fibro-connective tissues and lined by a single layer of cuboid or columnar epithelium III.pathology9 borderline serous cystadenoma macroexamination:moderate size bilateral,more extracystic papilla microscopic examination:thin papillary branch,epithelium3 layers,sligh

11、t cellular atypia,nuclear mitosis3 layers,obvious cellular atypia,stromal invasion 5 year survival rate:40-50%,prognosis is better than serous cystadenocarcinoma mucinous cystadenocarcinoma13 (iii).endometrioid tumor morbidity:less encountered,benign macroexamination:more unilateral,smooth surface m

12、icroscopic examination:surface is a single layer of columnar epithelium which very like endometrial gland epithelium,cavity is lined by pavement epithelium borderline:rare endometrioid carcinoma morbidity:10-24%of primary malignant tumor macroexamination:more unilateral,moderate size section:cystic

13、or solid,papilla,bloody fluid microscopic examination:very similar to endometrial cancer,more adenocarcinoma or adenoacanthoma,often complicated with endometrial carcinoma 5 year survival rate:40-50%(iii).endometrioid tumor14 ii.ovarian germ cell tumors a group of ovarian tumors originated from prim

14、al germ cells,its morbidity is secondary to the epithelial tumors,most occurs in childhood and adolescence,morbidity before adolescence accounts for 60-90%,while after menopause it only accounts4%(i).teratoma mature teratoma:also called dermoid cyst morbidity:the most common benign ovarian tumor,10-

15、20%of ovarian tumors,85-97%of germ cell tumors,over 95%of teratoma age:occurs at any age,mostly between 20-40 macroexamination:more unilateral,moderate size,round or elliptic,smooth and thin walll,ii.ovarian germ cell tumors15 section:more nuicystic,filled by lipid and hair,occasionally tooth and bo

16、ne can be seen,scolex on the wall components:endoderm,ectoderm and mesoderm highly specialized teratoma:monoderm,such as struma ovarii malignant change rate:2-4%,more in postmenopause,metasta-sized by spreading and peritoneal implantation prognosis:bad,5 year survival rate 15-31%immature teratoma:ma

17、lignant tumor components:2-3germ layers,immature embryonic tissue age:adolescence macroexamination:more solid malignance:dependent upon the ratio and differentiation of immature tissue and the quantity of nervous epithelium recurrent and metastatic rate:high,5year survival rate20%section:more nuicys

18、ti16 (ii).dysgerminoma:mid malignant tumor morbidity:5%of malignant ovarian tumors most in adolescence and reproductive period macroexamination:solid,more unilateral,round or elliptic,moderate size,touching like eraser,smooth surface or lobular section:light-brown color microscopic examination:round

19、 or polygonal cells,lymphocyte invasion in stroma prognosis:very sensitive to radiotherapy,5year survival rate90%(ii).dysgerminoma:mid ma17 (iii).endodermal sinus tumor:also called yolk sac tumo morbidity:rarely encountered age:mostly occurred in children and young women macroexamination:unilateral,

20、relatively large,round or elliptic section:partially cystic,brittle tissue,bleeding and necrosis area,gray-red or gray-yellow color microscopic examination:endodermal sinus structure,flat or cuboid or columnar tumor cells which produce AFP,AFP is an important diagnostic and therapeutic marker progno

21、sis:average survival time is 1 year (iii).endodermal sinus tu18 iii.ovarian gonadal sex cord stromal tumor accounts for 5-8%of malignant ovarian tumor (i).granulosa-stromal cell tumor i).granulosa cell tumor:low malignance morbidity:3-6%of ovarian tumor,80%of sex cord stromal tumor age:at any age,mo

22、stly between 45-55 feminization effect:secret estrogen macroexamination:unilateral,different size,round or elliptic,lobular,smooth surface,solid or partially cystic section:brittle and soft tissue,bleeding and necrosis microscopic examination:Call-Exner body prognosis:better,5year survival rate over

23、 80%iii.ovarian gonadal sex co19 ii).theca cell tumor:benign tumor feminization effect:secret estrogen,often coexist with granulosa cell tumor macroexamination:unilateral different size,round or elliptic,thin smooth fibrocapsule section:solid,gray white microscopic examination:short spindal cells,li

24、pid in cytoplasm prognosis:malignant tumor is rare,prognosis is better than other ovarian cancer iii).fibroma:common benign tumor morbidity:2-5%of ovarian tumor age:mostly in mid-aged women ii).theca cell tumor:20 macroexamination:unilateral,moderate size,smooth surface or nodular section:gray white

25、,solid and hard microscopic examination:composed of spindle cells Meigs syndrome:accompanied with hydrothorax and ascites macroexamination:unil21 (ii).Sertoli Leydig cell tumor:also called androblastoma morbidity:rare age:below40 macroexamination:unilateral,small,solid smooth surface section:gray wh

26、ite accompanied by cystic degeneration,bloody or serous or mucinous cystic fluid virilism effect:secret androgen prognosis:10-30%is malignant,5year survival rate 70-90%(ii).Sertoli Leydig cell 22iv.ovarian metastatic tumor:all of the cancers in the human body can metastasize to the ovary,the common

27、primary origination is at breast,intestine,stomach,reproductive tract,urinary tract and other organs morbidity:5-10%of ovarian tumor Krukenberg tumor:a special metastatic adenocarcinoma,its primary origination is in the gastrointestinal tract macroexamination:bilateral,renal shape,no adhesion,often

28、accompanied by ascites section:solid microscopic examination:signet-ring cell which produce mucus prognosis:very badiv.ovarian metastatic tumor:al23IV.Metastatic Path i.metastatic character:there is subclinical metastasis on omentum,peritoneum,retroperitoneal LN and diaphragm although the tumor is l

29、ocalized from its apparence ii.metastatic path:(i).directly spreading:this is the chief metastatic path.the tumor cells may directly invade the capsule,involve the neighbour organs and extensively implant on the peritoneum and omentum (ii).lymphetic vessels metastasis:this is an important metastatic

30、 way which includes i).spread along the ovarian blood vessels and is metastasized to para-aortic LN through ovarian lymphetic vesselsIV.Metastatic Path24 ii).from ovarian hilus lymphetic vessels to internal and external iliac LN,and then from the common iliac LN to para-aortic LN iii).along the roun

31、d ligament enters the external iliac and inguinal LN.diaphragm is the place to which the cancer is easily metastasized,especially the right diaphragm is the most easily invaded because of its dense lymphetic plexus (iii).blood metastasis is very rare.but at very late stage it may metastasize to the

32、liver and lung ii).from ovarian hil25V.Histologic grades the WHO standards of histologic grading is chiefly according to the histologic structure and cellular differentiation.Grade I:means the cell is well differentiated Grade II:means moderate differenation Grade III:means undifferenationthe effect

33、s of histologic grade on the prognosis is more important than that of the histologic types V.Histologic grades26VI.Clinical stage:the FIGO(1986)clinical stage is adoptedstage I tumor is localized in the ovaryIa tumor is localized in one ovary,the capsule is integrated,no tumor on ovary surface,no as

34、citesIb tumors are localized in bilateral ovarys,integrated capsule no tumor on surface,no ascitesIc based on Ia or Ib,there is tumor on the surface(unilateral or bilateral);or capsule is ruptured;or there is malignant cells in ascites;or the abdominal cavity irrigating fluid is positiveVI.Clinical

35、stage:the FIGO(19827Stage II unilateral or bilateral ovarian tumor with pelvic metastasisIIa spread to uterus and(or)fallopian tubeIIb spread to other tissues in pelvisIIc based on the IIa or IIb,there is implantation on unilateral or bilateral ovarian surface;or the capsule is ruptured;or the ascit

36、es contains malignant cells;or the abdominal cavity irrigating fluid is positiveStage II unilateral or bila28Stage III unilateral or bilateral ovarian tumor.there is extrapelvic peritoneal implantation and(or)the retroperitoneal or inguinal LN is positive,liver surface metastasis is stage IIIIIIa ma

37、croexamination shows that the tumor is loca-ted in the true pelvis,LN is negative but there is microscopic peritoneal implantationIIIb unilateral or bilateral ovarian tumor,there is peritoneal surface implantation and its diameter is2cm and (or)retroperitoneal or inguinal LN is positivestageIV unila

38、teral or bilateral ovarian tumor with telemetastasis,hydrothorax contains cancer cells,and there is liver parenchyma metastasisStage III unilateral or bil29VII.Clinical Manifestation i.benign ovarian tumor (i).at early stage (ii).when tumor is moderate size (iii).when tumor is large enough to occupy

39、 the full pelvis or abdominal cavity ii.malignant ovarian tumor (i).at early stage (ii).once there are symptoms (iii).the severity of the symptoms depends ouon i).the tumor size,location and whether there is neighbour tissues or organs invasion ii).the histologic type of the tumor iii).whether there

40、 is complicationVII.Clinical Manifestation30 (iv).at late stage i).symptoms ii).body signsVIII.Diagnosis i.cytologic examination ii.B-Ultrasound iii.radiodiagnosis:(i).abdominal plain film (ii).intravenous pyelography,barium meal,barium double contrast radiography or mammary soft tissue X-ray (iii).

41、CT (iv).at late stage31 (iv).laparoscopy (v).tumor marker i).CA-125 ii).AFP iii).HCG iv).sexual hormone (iv).laparoscopy32IX.Differential Diagnosis*i.differential diagnosis between the benign and malignant ovarian tumorDifferential contents benign tumor malignant tumorHistory long clinical course sh

42、ort clinical course and and gradually enlarge rapidly enlargeBody sign often unilateral,movable,often bilateral,fixed solid cystic,smooth surface or semisolid,rough surface,no ascites bloody ascites with cancer cellsGeneral condition better cachexia is gradually developedB-Ultrasound dark fluid echo

43、 area,there echo group or points exist may be intracystic diaph-in the dark fluid area tumor ragm,tumor outline is outline is not clear clearIX.Differential DiagnosisDiffe33 ii.differential diagnosis of benign ovarian tumor i.ovarian tumor like condition:may disappear within 2 month ii.tubo-ovarian

44、cyst iii.uterine myoma iv.pregnant uterus v.large quantity ascites iii.differential diagnosis of malignant ovarian tumor i.endometriosis:symptoms,body signs,B-Ultrasound and laparoscopy ii.pelvic connective tissues inflammation:history,symptoms,and body signs,B-Ultrasound iii.TB peritonitis:history,

45、general symptoms,body signs,B-Ultrasound and gastrointestinal X-ray iv.extra-reproductive tract tumors:B-Ultrasound,Barium meal and intravenous pyelography v.metastatic ovarian tumor:generally no primary tumor history ii.differential diagnosis o34X.Complications of ovarian tumor i.pediculotorsion:co

46、mmon gynecologic acute abdomen (i).mechanism (ii).components of the pedicle (iii).pathologic change (iv).typical symptoms (v).body signs (vi).management X.Complications of ovarian tum35卵巢肿瘤英文课件36 ii.tumor rupture:accounts for about 3%of ovarian tumor (i).traumatic and spontaneous rupture (ii).sympto

47、ms depends on the length of rupture,the quantity and the quality of the cystic fluid flowing into abdominal cavity (iii).body signs (iv).management ii.tumor rupture:accounts f37 iii.infection:rarely encountered (i).cause of the infection (ii).clinical manifestation (iii).management iv.malignant chan

48、ge (i).at early stage of malignant change (ii).suspicious manifestation (iii).management principle of ovarian tumor iii.infection:rarely encoun38XI.Prevention i.prevention of high risk factors:suggesting high protein and vitamin A diet and avoiding high cholesterol diet ii.popularizing the regular e

49、xamination and treatment iii.early diagnosis and treatmentXI.Prevention39XII.Treatment of ovarian tumor i.benign ovarian tumor:once the diagnosis is confirmed operation should be performed (i).young patient with unilateral tumor bilateral tumor (ii).perimenopausal patient with benign ovarian tumor (

50、iii).manipualtion principle of operationXII.Treatment of ovarian tumor40 ii.malignant tumor:the treating principle is chiefly by operation and the chemotherapy and radiotherapy is as the accessory treatment (i).operation:operation play the key role for the treatment especially the first time of oper

51、ation i).probe during operation ii).operating range:(a).for stage Ia or Ib (b).for stage Ic or over Ic (c).cytoreductive operation iii).the indications of reserving contralateral ovary (a).stage Ia,well differentiated (b).borderline or low malignant tumor (c).no tumor is found in the contralateral o

52、vary (d).has the condition of closely postoperative follow up ii.malignant tumor:the trea41 (ii).chemotherapy chemotherapy is a chief accessory therapy.malignant ovarian tumor is relatively sensitive to the chemotherapy,the chemotherapy has certain effect even if the tumor has extensively metastasiz

53、ed the chemotherapy may be either for the prevention of recurrence or for the postoperative treatment in the patient whose tumor can not be thoroughly removed for late stage patient who does not fit for the operation,the chemotherapy can shrink the tumor and create the condition for afterwards opera

54、tion (ii).chemotherapy42 (iii).radiotherapy:the accessory treatment for the operation and chemotherapy dysgerminoma is very sensitive to the radiotherapy,granulosa cell tumor is moderate sensitive to the radiotherapy epithelial ovarian cancer also has certain sensitivity to the radiotherapy (iii).ra

55、diotherapy:the ac43XIII.Prognosis:prognosis is associated with the clinical stage,histologic type,age and treating methods among which the clinical stage is the most importantXIV.follow up i.time of follow up:once a time within 1 year after operation;once every 3 month in the second year after operation;once every 6 month in the third year and once a year over 3 years after operation ii.contents:symptoms body signs,pelvic and general examination B-ultrasound,CT,MRI and tumor markerXIII.Prognosis:44