Ovarian Cancer. Hystology
Ovarian tumors are usually categorized by their tissue of origin: epithelial (from the coelomic epithelial cells that line the ovary), sex cord-stromal (from the mesenchymal tissue of the ovary), and germ cell (from the germinal epithelium). Epithelial tumors account for approximately 85% of ovarian cancers, germ cell cancers account for approximately 10%, and the remaining 5% of tumors are sex cord-stromal in origin. The World Health Organization’s classification system for ovarian tumors is shown in the box, pages 40-41.
Of the malignant epithelial ovarian cancers, 40-50% are serous tumors, 15-25% are endometrioid tumors, 6-16% are mucinous tumors, and 5-11% are clear cell tumors. Transitional cell (Brenner), mixed epithelial, and undifferentiated carcinomas are encountered less frequently. Epithelial tumors may be benign, have low malignant potential, or be frankly malignant. Tumors of low malignant potential (borderline tumors) have a much better prognosis than the frankly malignant cancers, but they are nevertheless malignant and can result in death. Malignant tumors are further subdivided by histologic grade either into three grades based on architecture (FIGO classification) or into four grades based on nuclear atypia (Broders’ index).
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The most common germ cell tumor is the mature cystic teratoma, a benign tumor. The most common malignant germ cell tumor is the dysgerminoma, followed in incidence by the endodermal sinus tumor and the immature teratoma. As can be seen in Figure 4, the germ cell tumors are most commonly seen in the first two decades of life.
The sex cord-stromal tumors are usually divided into the female type, characterized by the granulosa cell tumor, and the male type, characterized by the Sertoli-Leydig cell tumor. More than 90% of malignant stromal tumors are granulosa cell tumors. Although these tumors can occur at any age, they are more common before menopause.