According to various authors, the frequency of ovarian tumors among all genital tumors over the past 10 years has increased from 6-11 to 19-25%. Most ovarian tumors are benign (75-87%).
The morphology of ovarian tumors is very diverse. This is primarily due to the fact that the ovaries (unlike other organs) do not consist of two components – the parenchyma and stroma, but of many elements of different histogenesis.
There are many variants of tissue that provide the basic functions of this organ: the maturation of the germ cells and the production of sex hormones (the epithelium of the epithelium, the egg cell and its embryonic and mature derivatives, granulose cells, tekatkani, chyleus cells, connective tissue, vessels, nerves, etc.) . In the origin of ovarian tumors, an important role is played by the rudiments that have been preserved from the period of embryogenesis. Many tumors develop from postnatal epithelium areas, growths susceptible to metaplasia and paraplasia, in particular from the epithelium of the fallopian tubes and uterus, which can be implanted on the surface of the ovary.
Some ovarian tumors develop from epithelium that is capable of submerged growth; genital strand tumors are formed from it: granulocellular tumors, Tacoma, androgen-producing tumors (androblastoma) from the remnants of the male part of the gonad.
Risk factors for the occurrence of ovarian tumors determine how to prevent this disease. These include: early or late menarche, later (after 50 years) the onset of menopause, menstrual disorders. With the risk of ovarian tumors associated with reduced reproductive function of women, infertility, miscarriage. Chronic inflammatory diseases of the uterus can form a premorbid background of the tumor process.
Great importance in the etiology and pathogenesis of ovarian tumors is attached to genetic factors, endocrine disorders.
Due to the variety of cellular elements of ovarian tumors, there are many classifications, of which the most acceptable are based on ovarian microscopy. In modern gynecology, the histological classification of ovarian tumors is used (WHO, 1973).
In clinical practice, you can use a simplified scheme of the most common variants of ovarian formations. The scheme is based on the microscopic characterization of tumors, taking into account the clinical course of the disease. Depending on the cellular composition of the ovarian formation are divided into:
• epithelial tumors;
• tumors of the genital trauma;
• germitic tumors;
• rare tumors;
• tumor processes.
All variants of tumors are divided into benign, borderline (low-grade ovarian tumors) and malignant. The classification takes into account one of the most important features of ovarian tumors – often the cancer develops against the background of previous benign ovarian tumors.
Epithelial ovarian tumors
The largest group of benign epithelial tumors of the ovaries are cystadenomas (formerly called cystoma). Depending on the structure of the epithelial lining and the inner contents of cystadenoma, they are divided into gray-gray and mucous shuzy.
Serous tumors account for 70% of all ovarian epithelial neoplasms. They are divided into simple serous (smooth-wall) and papillary (papillary). A simple serous cystadenoma is a true benign ovarian tumor. Serous cystadenoma is covered with low cubic epithelium, under which is located the connective tissue stroma. The inner surface is lined with ciliated epithelium, resembling a tube, capable of proliferation.
Microscopically determined well-differentiated epithelium, resembling that in the fallopian tube and able to become indifferent, flattened cubic in formations stretched by the contents. The epithelium in some areas may lose cilia, and in some places even be absent, sometimes it undergoes atrophy and sloughing. In such situations, morphologically smooth serosal cystadenomas are difficult to distinguish from functional cysts. In appearance, such a cystadenoma resembles a cyst and is called serous.
Macroscopically, the tumor surface is smooth, the tumor is located on the side of the uterus or in the posterior vault. Most often, the tumor is one-sided, single-chamber, ovoid shape, elastic elastic consistency. Cystadenoma is not large, mobile, painless. Typically, the contents of the tumor is represented by a straw-colored clear serous fluid. Simple serous cystadenoma turns into cancer extremely rarely.
Papillary (coarse papillary) serous cystadenoma is a morphological type of benign serous cystadenum, less common than smooth-wall serous cystadenomas. It is 7–8% of all ovarian tumors and 35% of all cystadenomas. The tumor has the form of a single-or multi-chamber cystic neoplasm, on the inner surface of which there are single or numerous dense papillary vegetations on a broad base, whitish in color.
The structural basis of the papillae is small-cell fibrous tissue with a small number of epithelial cells, often with signs of hyalinosis. The integumentary epithelium is similar to the epithelium of smooth-wall cilioepithelial cystadenes. Coarse papillae are an important diagnostic feature, since such structures are found in serous cystadenomas and are never noted in non-neoplastic ovarian cysts. Roughly papillary papillary growths with a high degree of probability make it possible to exclude the possibility of malignant tumor growth already at an external examination of the surgical material. Degenerative wall changes can be combined with the appearance of layered petrification.
Papillary serous cystadenoma has the greatest clinical significance due to a pronounced malignant potential and a high incidence of cancer. The frequency of malignancy reaches 50%.
The essential difference between papillary serous cystadenoma and coarsenal papilla is the ability of the integumentary epithelium to proliferate briskly, creating more or less mature structures. Papillary growths of a softish consistency often merge with each other and are unevenly arranged on the walls of individual chambers. Papillae can form large nodes, inverting tumors.
Multiple papillae can fill the entire capsule of a tumor, sometimes germinating through the capsule to the outer surface. The tumor takes the form of cauliflower, causing suspicion of malignant growth.
Papillary cystadenomas can spread over a large extent, disseminate through the peritoneum, and lead to ascites.
The tumor is limitedly mobile, with a short leg, often bilateral, sometimes located intraligamentally. The occurrence of ascites is associated with the proliferation of papillae on the surface of the tumor, the peritoneum and impaired resorptive capacity of the peritoneum of the uterine-rectal space. Everting papillary cystadenomas are much more often bilateral; in this case, the course of the disease is more severe. In this form, ascites is 2 times more common. All this makes it possible to consider an everting papillary tumor clinically more severe than an inverting one.
Border papillary cystadenoma (low grade) has more abundant papillary growths with the formation of extensive fields. Microscopically determined nuclear atypism and increased mitotic activity. The main diagnostic criterion is the absence of invasion of the stroma, but deep invaginates can be detected without the germination of the basement membrane and without marked signs of atypism and proliferation.
The most serious complication of papillary cystadenoma is its malignancy – the transition to cancer.