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Other histologies include the following:Epithelial ovarian cancer is thought to arise from epithelium covering the fimbria of the fallopian tubes, or the ovaries, both of which are derived from the coelomic epithelium in fetal development.

Four main histologic subtypes, which are similar to carcinoma, arise in the epithelial lining of the cervix, uterus, and fallopian tube, as follows:Some variation is observed in the patterns of spread and disease distribution within the various histologic subtypes.

Epithelial tumors are found as partially cystic lesions with Sodium Chloride-Sodium Bicarbonate and Potassium Chloride (HalfLytely and Bisacodyl Tablets)- Multum components. The surface may be smooth or covered in papillary projections (see the image below), and the cysts contain fluid ranging from straw-colored to opaque brown or hemorrhagic. Epithelial ovarian cancer most often spreads initially within the peritoneal cavity (see the image below). Metastatic disease often is found on the peritoneal surfaces, particularly on the undersurface of the diaphragms, the paracolic gutters, the bladder, and the cul-de-sac.

Other common sites are as follows:Outside the peritoneal cavity, epithelial ovarian cancer may spread to the pleural cavity, lungs, and groin lymph nodes. The presence of pleural effusion does not necessarily indicate disease in the chest, and malignancy can be diagnosed only cytologically.

Mucinous tumors tend to form large dominant masses, while papillary serous tumors have a more diffuse distribution and are more commonly bilateral.

Endometrioid and clear-cell variants more commonly exhibit local invasion, retroperitoneal disease, and hepatic metastases. Increasing evidence suggests that a high proportion of high-grade serous carcinoma originates from distal fallopian tube epithelium or Sodium Chloride-Sodium Bicarbonate and Potassium Chloride (HalfLytely and Bisacodyl Tablets)- Multum 5712 pill junction rather than the ovarian surface epithelium.

Clinical, molecular, and genetic studies, as well as in vitro and animal models, have also supported a tubal origin for high-grade serous ovarian carcinoma. A study comparing standard risk-reducing salpingo-oophorectomy with the combination of early risk-reducing salpingectomy and delayed oophorectomy in BRCA carriers is currently recruiting participants.

These tumors cause great anxiety to patients, and the concept of LMP sometimes is difficult to explain. The mean age of diagnosis is younger than for invasive epithelial ovarian cancer, at approximately 48 years, and no large peak of incidence is observed. In contrast to epithelial ovarian cancer, however, most LMP tumors are stage I at presentation, with a distribution as follows:LMP tumors can cause a range of symptoms similar to epithelial ovarian cancer, including increasing abdominal girth, phineas gage abdominal mass, abdominal pain, abnormal uterine bleeding, urinary symptoms, and gastrointestinal symptoms.

They may be asymptomatic and found on routine physical examination or ultrasound scan. For more information, see Borderline Ovarian Cancer. Malignant germ cell tumors (GCTs), which include dysgerminoma, endodermal sinus tumor, malignant teratoma, embryonal carcinoma, and choriocarcinoma, are thought to derive from primitive germ cells in the embryonic gonad. GCT of the ovary is much rarer than GCT of the testis in males, and much of the development of the management approach has been based on experience with male GCT.

Common characteristics of these tumors include rapid growth, a predilection for lymphatic spread, frequent mixtures of tumor types, and a predominantly unilateral pattern of ovarian involvement (except for dysgerminoma).

GCT is much more common in young women but occasionally occurs in infants and older women. Many GCTs produce tumor markers that can be measured in the blood and then used to monitor response to treatment and for follow-up care.

Endodermal sinus tumors secrete alpha-fetoprotein and choriocarcinoma, and dysgerminomas occasionally secrete beta human chorionic gonadotropin (bHCG).

Dysgerminoma may secrete lactate dehydrogenase and placental alkaline phosphatase. No factors have been established related to etiology, apart from an increased incidence associated with dysgenetic gonads. Although these tumors may be asymptomatic and present as a palpable mass, many patients present with abdominal pain.

The mass Sodium Chloride-Sodium Bicarbonate and Potassium Chloride (HalfLytely and Bisacodyl Tablets)- Multum lead to acute pain due to torsion, rupture, or hemorrhage, or, patients may have abdominal distension, vaginal bleeding, or fever. Five percent occur in phenotypic females with abnormal gonads. They may have a 46XY karyotype with pure gonadal dysgenesis or androgen insensitivity syndrome, or, they may have a 45X, 46XY karyotype with mixed gonadal dysgenesis.

Dysgerminomas may be large and usually are solid, with a smooth external surface and a fleshy pink-tan color inside. For more information, see Ovarian Dysgerminomas. Teratomas are germ cell tumors commonly composed of multiple cell types derived from one or more of the 3 germ layers. Inconsistent nomenclature often confuses discussions of various subtypes of teratomas.

The word is derived from the Greek teras, meaning monster, which Virchow coined in the first edition of his book on tumors published in 1863. Additionally, teratomas may be monodermal and highly specialized. Rarely, within some mature teratomas certain elements (most commonly squamous components) undergo malignant transformation. The earliest implications were that dermoids comprised elements similar to skin and its appendages, whereas teratomas had no such limits.

Dermoids now preteen model recognized as often being trigeminal and containing practically any type of tissue.

For those who continue to make a distinction, dermoids are tumors that maintain rather orderly arrangements, with well-differentiated ectodermal and mesodermal tissues surrounding endodermal components. This is the second most common GCT. It occurs mostly in females aged 10-20 years but may occur after menopause. The tumor spreads most commonly to peritoneal spot treatment. Endodermal sinus tumor occurs at infp a mean age of 18 years, and one third occur before puberty.

Embryonal carcinoma and choriocarcinoma are extremely rare. Although granulosa cell tumors are malignant and Sertoli-Leydig cell tumors less so, they behave in a much less malignant fashion than epithelial ovarian cancers. Benign tumors in the group include thecoma and fibroma. Granulosa cell tumors and pure Sertoli cell tumors commonly secrete estrogen, Sodium Chloride-Sodium Bicarbonate and Potassium Chloride (HalfLytely and Bisacodyl Tablets)- Multum Leydig cell tumors and combined Sertoli-Leydig tumors often secrete Sodium Chloride-Sodium Bicarbonate and Potassium Chloride (HalfLytely and Bisacodyl Tablets)- Multum. This is the most common malignant sex-cord stromal tumor.

Ninety percent of granulosa cell tumors are stage I at the time of diagnosis. Juvenile granulosa cell tumor is a variant of granulosa cell tumor that is rarely malignant.

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