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What is Call exner bodies are seen in: and explain in detail?
Ans: (a) Granulosa cell tumorBerek and Novak's Gynecology, 14th editionWHO classification of ovarian tumoursCommon epithelial tumorsSex cord (gonadal stroma) tumorsGerm cell tumors*. Serous tumors*. Mucinous tumors*. Endometrioid tumors*. Clear cell (mesonephroid tumors)*. Brenner tumors (Transitional cell tumor)*. Mixed epithelial tumors*. Undifferentiated carcinoma*. Unclassified epithelial tumors*. Granulose-stromal cell tumors, theca cell tumors*. Androblastomas: Sertoli-Leydig cell tumors*. Gynandroblastomas*. UnclassifiedGonadoblastoma*. Pure*. Mixed with dysgerminoma or other germ cell tumors.*. Dysgerminoma*. Endodermal sinus tumors (yolk sac tumour)*. Embryonal carcinoma*. Polyembryoma*. Choriocarcinoma*. Teratoma*. Mixed formsLipid (lipoid) cell tumorsSoft tissue tumors not specific to ovaryUnclassified tumorsFamilial ovarian cancers: HNPCC (LYNCH-2), BRCA1 and BRCA2NOTE:Ovarian cancers are the most common cause of death among all gynecological malignancies.Ovarian cyst adeno carcinoma is most common malignant tumor of ovary (33-50% of epithelial cancers)Most common benign tumour of ovary: Dermoid cystMost common benign epithelial tumor: Serous cystadenomaLargest benign ovarian tumor: Mucinous cyst adenomaMost common ovarian tumour in <20 years of age group - germ cell tumourMost common germ cell tumour (GCT): Mature teratomaMost common malignant germ cell tumour (GCT): DysgerminomaOvarian tumor whose incidence is increased during pregnancy: Dermoid cystMost common ovarian tumor to undergo torsion in pregnancy: Dermoid cystMost common ovarian tumour to involve opposite side: Granulosa cell tumourSerous cyst adenoma is overall most common tumour of ovary.Of all the malignant tumors, 90% are epithelial in orgin, 80% are in primary in the ovary and 20% secondary from breasts, gastrointestinal tract and colon.Mucinous cyst becomes malignant in 5% but papillary cystadenoma becomes malignant in 50% if left untreated.Most common ovarian tumor associated with pseudomyxoma peritoni: Mucinous cystadeno Ca.Most common ovarian tumor associated with hyperthyroidism: Germ cell tumour with struma ovarii (struma ovarii is a teratoma with thyroid tissue).Ovarian tumors with calcification:Cystic teratoma / dermoid cyst (bone + teeth)GonadoblastomaFibromaTorsion of ovarian cyst in the most common complication and seen in teratoma/dermoid cyst most commonly.Tumors with lymphocytic infiltration: DysgerminomaOvarian serous tumors, both low- and high-grade, have a propensity to spread to the peritoneal surfaces and omentum and are commonly associated with the presence of ascites.Meig s syndrome: Combination of ovarian Fibroma + Ascites + right sided hemothoraxPseudo Meig's syndrome: Brenner's tumor, Granulosa Cell tumor, ThecomaRisk factorsProtective factors*. Repeated ovulation*. Old age*. Nullipara*. Early menarche, late menopause*. White race*. Late marriage, infertility*. Perineal exposure to talc*. OC pills*. Pregnancy*. Breastfeeding*. Chronic anovulation*. Bilateral salpingo oophorectomy*. Tubal sterilization*. HysterectomyAge Group:Malignant epithelial tumors40-60 yearsBenign cystic teratoma10-20 yearsDysgerminoma<20 yearsEndodermal sinus tumour15-20 yearsGranulose cell tumourPost-menopausalSertoli leydig cell20-30 yearsThecomaPost-menopausalGERM CELL TUMOURSAccount for 15-20% of all ovarian tumors.95% are benign cystic teratoma, also called as dermoids.Below the age of 20 years, 60% of the tumors are of germ cell origin.<10 years: 85% belong to this group and are malignant.Tumour markers of ovarian cancer:CA-125:>35U/ml indicates malignant and residual ovarian tumour. It is also raised in abdominal tuberculosis and endometriosis.CEA: >5 mg/dl seen in Mucinous ovarian tumour.Endodermal sinus tumors produce AFP.a fetoprotein and alpha-1-antitrypsin: Endodermal sinus tumorAFP and HCG: Embryonal carcinomaHCG: ChoriocarcinomaDysgerminomas and other germinomas: No markers, but secrete LDH Krukenberg's TumourPrimary site: Stomach (70%), large intestine (15%) and breast (6%), spread by retrograde lymphatics.Characteristic features: Signet ring cellsInvolvement of ovary by: Retrograde lymphatics.Always bilateral with smooth surface, slightly bossy and freely mobile over the pelvis.Maintains the shape of ovary and has a peculiar solid waxy consistency.No tendency of adhesion and no infiltration of nearby tissues.Ovarian Tumours and Their Specific FeaturesSchiller Duval bodies - Endodermal sinus tumourSignet ring cells - Krukenberg's tumourCoffee bean cells/Call Exner bodies - Granulosa cell tumourSertoli and Leydig cells - ArrhenoblastomaPsammoma bodies - Papillary Serous CystadenomaRokitansky's protuberance - Dermoid cyst (Mature teratoma)Hobnail cells - Clear cell Ca (mesonephroid Ca)Reinke's crystal - Hilus cell tumourWalthard cell nest - Brenner tumour