Chapter 14: Malignant Disease of the Ovary

• Alpha-fetoprotein (AFP):


  Used as a tumour marker for carcinomas of embryonic origin
• BRCA1 / BRCA2:


  Inherited gene mutation associated with a significant increase of breast and ovarian cancer risk
• CA 125: 


  Protein found in tumour cells that results in an elevation of blood levels
• Carcinoembryonic antigen (CEA):


  Tumour marker for colon, stomach, breast, lung, some thyroid, and ovarian cancers
• Dysgerminoma:


  Malignant tumour of the ovary arising from undifferentiated germ cells of the embryonic gonad; histologically identical to seminoma found in the testicle
• Endometrioid tumour: 


  Tumour of the ovary containing epithelial or stromal elements resembling endometrial tissue; typically arises from the endometriosis; a large percentage are malignant
• Krukenberg tumour:


  Carcinoma of the ovary, usually metastatic from gastrointestinal cancer
• Laparotomy:


  Surgical incision into the abdomen, usually performed to evaluate the organs
• Meigs syndrome:


  Finding pleural effusion, ascites, and an ovarian mass
• Mucinous cystadenocarcinoma:


  Large epithelial cystic ovarian mass with thick-walled spetations; may have internal debris, layering components; has vascularity
• Are mucinous or serous cystadenocarcinoma larger ?

  Mucinous cystadenocarcinoma
• Pseudomyxoma peritonei:


  Accumulation of mucinous material in peritoneal cavity, either because of the rupture of benign or malignant cystic neoplasm of the ovary or *rupture of the appendix*
• Salpingo-oophorectomy:


  Surgical removal of the ovary and fallopian tube
• Serous carcinoma:


  Type of epithelial ovarian cancer; presents as a partially cystic mass with solid components
• Serous cystadenocarcinoma:


  Large epithelial multilocular ovarian neoplasm with papillary projections
• Sertoli-Leydig cells:

  Related to the sex-cord stromal tumours seen in ovaries, mostly in young adults
• Sex-cord stromal tumours:

  Solid ovarian mass originating from the embryonic gonadal ridges and Sertoli cells
• Struma ovarii:


  Extremely rare neoplasm of the ovary containing thyroid tissue
• Teratocarcinoma:


  Rare malignant form of a common germ cells tumour; contains fat, bone, hair, skin and teeth
• Yolk cell tumour:


  Malignant neoplasm originating in the germ cells
• What are some of the risk factors for ovarian carcinoma ?

  Nulliparity, early onset of menses, late menopause, postmenopausal estrogen use for more than 10 years, family history of ovarian cancer
• What are some signs/symptoms of ovarian carcinoma ?

  Pressure or bloating, acute pain, increasing abdominal girth, vaginal bleeding
• 80% of ovarian cancers result in high levels of what ?

  CA 125 tumor-associated antigen
• What are some other markers of ovarian carcinoma ?

  AFP, CEA, hCG, LDH
• What is the 5 year survival rate when ovarian cancer is caught early ?

  90 %
• What is the 5-year survival rate when ovarian cancer is caught in late stage ?

  15 %
• What are the usual sonographic features of ovarian carcinoma ?

  Large, complex, multi septated, daughter cysts, low resistance doppler flow
• What should you check when imaging the ovaries ?

  size, echogenicity, symmetry
• Ovarian volume is variable in menstrual women
• After suspecting an ovarian malignancy, where/what else should you check for?

  Ascites and kidneys for hydronephrosis
• What are some likely metastatic sites for ovarian cancer ?

  Diaphragm, liver, bowel, colon, pleura of lungs, stomach
• What is the triad of Meigs Syndrome ?

  Ascites, pleural effusion, ovarian neoplasm
• Serous cystadenoma is the most common epithelial tumour.
• What are signs/symptoms of serous cystadenoma ?

  Increased abdominal girth, pressure and bloating, irregular menses
• Serous cystadenoma occurs in the 4 th or 5 th decade of life
• How do serous cystadenomas appear sonographically ?

  large, cystic, smooth walled mass; has septations
• What is a differential diagnosis for serous cystadenoma ?

  Hydrosalpinx, theca lutein cyst, hyperstimulation syndrome
• Mucinous cystademona is the second most common epithelial tumour
• What is the sonographic appearance of a mucinous cystadenoma ?

  usually unilateral, multiple septations, large predominantly anechoic mass with thick smooth walls, mucoid material may cause low level echoes
• What is the most common type of ovarian cancer ?

  Serous cystadenocarcinoma