Page 533 - Concise Pathology for Exam Preparation ( PDFDrive )

518 SECTION II Diseases of Organ Systems

• Fatal within two years of diagnosis
Morphology: See testicular neoplasms
(d) Choriocarcinoma
• Arises in the first three decades of life
• Always unilateral
• Primary focus may disintegrate leaving only metastatic deposits
• Primary may be represented by a small haemorrhagic focus
• Consists of two types of cells, cytotrophoblasts and syncytiotrophoblasts
• Metastasize early and widely
3. Sex cord tumours
(a) Granulosa theca tumours
• Majority arise in postmenopausal women, but may occur at any age.
• Unilateral small to large, yellow, with cystic spaces.
• Composed of cuboidal granulosa cells in cords, sheets or strands along with
spindled or plump lipid-laden theca cells, which elaborate large amounts of
oestrogen.
• May recapitulate primitive ovarian follicles called Call–Exner bodies.
(b) Thecoma-fibroma
• May affect any age
• Unilateral, solid grey with spindled fibrous cells to plump lipid-laden theca cells
• Most are hormonally inactive; few secrete oestrogens
• About 40% produce ascites and hydrothorax (Meigs syndrome)
• Rarely malignant
(c) Sertoli–Leydig cell tumours
• Affect all ages
• Unilateral, small grey to red brown, solid masculinizing tumours, which reca-
pitulate the development of testes
• Rarely malignant
4. Metastasis to the ovary
• Seen in older age group
• Mostly bilateral
• Large, solid, grey-white tumours with cords, glands and individual malignant cells
dispersed in the ovarian stroma, eg, Krukenberg tumour.

Q. Describe the clinicopathological features of Krukenberg tumour.

Ans. Krukenberg tumour generally affects women more than 45 years.

Pathogenesis
• Most commonly, it is a diffuse type of gastric cancer, which metastasizes to ovaries.
• Two theories have been offered to explain metastasis of tumour from GIT to ovary:
• Spread due to shedding of cells into peritoneum (transcoelomic spread)
• Lymphatic spread
• Other cancers associated with Krukenberg tumour are carcinoma of breast, uterus,
colon and lung.

Gross Morphology
Bilateral, symmetrically enlarged ovaries, which retain their shape and architecture.

Microscopy
Signet ring cells (cells with abundant mucin, which pushes the nucleus to periphery) are
arranged in a diffusely infiltrative growth pattern, that is, cords and singly lying cells with
very few glands.

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