Ovary برای بزرگنمایی عکسها کلیک را روی ان نگه دارید..... Figure 35.1 Streak Gonad in Turner Syndrome. A, Gross appearance; B, microscopic appearance Figure 35.2 Ovotestis in True Hermaphroditism. A, Gross appearance. The testicular component is represented by the solid nodule, whereas the ovarian component has a largely cystic appearance. B, Microscopic appearance of the two components Figure 35.3 Immature testicular tubules in testicular feminization syndrome Figure 35.4 Ovarian Inclusion Cysts. A, Cyst being formed through invagination of the surface epithelium. B, Multiple inclusion cysts within ovarian cortex. The lining is similar to that of the surface epithelium but tends to be taller and more prominent Figure 35.5 Outer appearance of bilateral ovarian follicular cysts Figure 35.6 Microscopic Appearance of Follicular Cyst. A single layer of granulosa cells is resting on a thick theca layer Figure 35.7 Marked bilateral ovarian enlargement due to multiple theca-lutein cysts associated with normal pregnancy. The changes were misinterpreted as representing neoplasms and both ovaries were excised Figure 35.8 Outer aspect and cut surface of ovary in a patient with polycystic ovary syndrome. Note the numerous follicular cysts beneath the ovarian surface and the absence of corpus luteum Figure 35.9 Ovarian Stromal Hyperplasia. A, Gross appearance. The cut surface is solid and has a yellowish hue. B, Microscopic appearance. The ovarian stroma is hypercellular Figure 35.10 Ovary showing a combination of multiple follicular cysts and stromal hyperplasia, providing support for a pathogenetic link between the two processes Figure 35.11 Gross Appearance of Corpus Luteum Cyst. The luminal content is typically hemorrhagic Figure 35.12 Bilateral pregnancy luteomas in a 29-year-old woman that were discovered incidentally at the time of cesarean section performed for cord prolapse. The tumors bled excessively on manipulation by the surgeon and had to be removed Figure 35.13 Solid growth pattern of pregnancy luteoma Figure 35.14 Benign hyperplastic changes in rete ovarii. This alteration is of no clinical significance Figure 35.15 Lymphocytic and plasmacytic infiltrate of a developing follicle in autoimmune oophoritis Figure 35.16 Inner surface of cyst in a case of ovarian endometriosis.The color is typically brown Figure 35.17 Ovarian Endometriosis. A, In this area endometrial tissue faithfully reproduces the appearance of normal endometrium, in terms of both glands and stroma. B, A more common appearance resulting from repeated hemorrhage and accumulation of hemosiderin-laden macrophages Figure 35.18 Necrotic nodule surrounded by histiocytes in pelvic endometriosis Figure 35.19 Atypia of the cells lining an ovarian endometriotic cyst, a change referred to as atypical endometriosis Figure 35.20 Smooth outer and inner surfaces of the cystic formations in a case of ovarian serous cystadenoma Figure 35.21 Inner aspect of serous cystadenoma showing papillary structures protruding within Figure 35.22 Inner aspect of an ovarian serous borderline tumor. Numerous fine papillary projections can be appreciated Figure 35.23 Single layer of bland-looking epithelial cells lining one of the cystic structures of a serous cystadenoma Figure 35.24 Low-Grade Serous Carcinoma. Invasion is evident as micropapillae and individual cells infiltrating the stroma (A) and as macropapillae, with broad central cores, also infiltrating the stroma (B); note the clear space surrounding the invasive cell clusters Figure 35.25 Low-grade serous carcinoma with innumerable psammoma bodies, so-called serous psammocarcinoma Figure 35.26 Low-power (A) and medium-power (B) appearance of ovarian borderline serous neoplasm. The growth is entirely exophytic Figure 35.27 Serous borderline tumor with focal microinvasion represented by clusters of cells with abundant eosinophilic cytoplasm Figure 35.28 Ovarian serous borderline tumor with a micropapillary pattern of growth Figure 35.29 High-grade serous carcinoma with papillary architecture Figure 35.30 High-grade serous carcinoma with slit-like spaces Figure 35.31 High-Grade Serous Carcinoma With Gland Formation. This is a common finding in high-grade serous carcinoma and is not evidence of a component of endometrioid carcinoma Figure 35.32 A and B, High-grade serous carcinoma with solid and transitional-like architecture Figure 35.33 A and B, Outer and inner aspect of mucinous cystadenoma Figure 35.34 Gross appearance of a mucinous ovarian neoplasm that had borderline features at the microscopic level Figure 35.35 Gross Appearance of Mucinous Cystadenocarcinoma. The neoplasm is predominantly solid, but some mucin-containing cystic spaces can still be appreciated Figure 35.36 Lining of Mucinous Cystadenoma. Goblet cells are evident Figure 35.37 A and B, Mucinous borderline tumor of intestinal type, with focal intraepithelial carcinoma Figure 35.38 Mucinous carcinoma with expansile pattern of invasion; there is minimal stroma between the closely packed glands Figure 35.39 Seromucinous Borderline Tumor. At lower magnification (A) it resembles serous borderline tumor, but with prominent edema of the stroma in papillae. At higher magnification there is prominent intracellular mucin in some of the cells (B) Figure 35.40 A and B, Gross appearances of ovarian endometrioid carcinoma. Both tumors show a combination of solid and cystic appearances Figure 35.41 Well-differentiated endometrioid ovarian carcinoma with extensive squamous differentiation Figure 35.42 A and B, Gross and microscopic appearance of endo- metrioid adenofibroma Figure 35.43 Ovarian endometrioid borderline tumor, with glandular architectural complexity Figure 35.44 Gross Appearance of Clear Cell Carcinoma of Ovary. The tumor is predominantly cystic, but it contains several mural nodules Figure 35.45 A highly papillary configuration is seen in this low-power view of ovarian clear cell carcinoma Figure 35.46 Clear Cell Carcinoma of Ovary. Note the high nuclear grade and the hobnail configuration Figure 35.47 Oxyphilic variant of clear cell carcinoma Figure 35.48 Clear cell carcinoma of ovary showing short papillae with hyalinized cores lined by highly atypical cells Figure 35.49 Clear cell borderline tumor; the epithelial cells of this adenofibroma show mild to moderate nuclear atypia Figure 35.50 Large Brenner Tumor Involving the Right Ovary. The gross appearance of this neoplasm is very similar to that of fibroma or thecoma Figure 35.51 Brenner tumor of ovary showing solid and cystic epithelial cell nests embedded within fibrous tissue Figure 35.52 The epithelial nests of Brenner tumor are composed of cells with oval nuclei, many of which exhibit longitudinal grooves Figure 35.53 Borderline Brenner Tumor Figure 35.54 Borderline Brenner tumor showing solid area with papillary formations, associated with a large cystic space Figure 35.55 Brenner tumor with typical solid appearance coexisting with mucinous cystadenoma. This is a well-recognized combination Figure 35.56 A and B, Gross appearances of carcinosarcoma of ovary. The neoplasms are large, variegated, solid and cystic, with hemorrhagic and necrotic areas Figure 35.57 Carcinosarcoma of Ovary. The tumor shown in A is of the so-called homologous type, whereas the others exhibit heterologous foci in the form of bone and cartilage (B) or skeletal muscle (C) Figure 35.58 Typical lobulated outer aspect of ovarian dysgerminoma Figure 35.59 Cut Surface of Ovarian Dysgerminoma. The multinodular solid quality and the tan color are characteristic features Figure 35.60 Typical nesting appearance of ovarian dysgerminoma. The septa contain numerous inflammatory cells Figure 35.61 The thin trabecular pattern that dysgerminomas sometimes exhibit may be the source of diagnostic errors Figure 35.62 Isolated multinucleated cells of trophoblastic type in ovarian dysgerminoma Figure 35.63 Ovarian Dysgerminoma With Early Yolk Sac Differentiation. A, H&E appearance. The foci of early yolk sac differentiation are represented by the small gland-like structures near the center. B, This formation is strongly immunoreactive for keratin, in contrast with the rest of the neoplasm. (Courtesy of Dr. Vinita Parash, New Haven, CT.) Figure 35.64 Gross appearance of yolk sac tumor. The cut surface is remarkably heterogeneous due to extensive hemorrhage, necrosis, and cystic degeneration Figure 35.65 A and B, Low- and high-power views of ovarian yolk sac tumor. Numerous hyaline globules are seen in the cytoplasm of the tumor cells lining the papillae Figure 35.66 Yolk sac tumor with endometrioid features Figure 35.67 A and B, Gross and microscopic appearance of embryonal carcinoma of ovary Figure 35.68 Gross appearance of ovarian immature teratoma Figure 35.69 Ovarian immature teratoma with predominance of primitive neuroepithelial elements Figure 35.70 Admixture of sebum and hair within the cavity of an ovarian mature cystic teratoma Figure 35.71 Well-developed teeth in ovarian mature cystic teratoma Figure 35.72 Various Tissue Components of Mature Cystic Teratoma of Ovary. A, Skin adnexa, glial tissue, and choroid plexus; B, gastric mucosa of pyloric type; C, anterior pituitary gland Figure 35.73 Exuberant foreign body-type giant cell response to contents of ruptured ovarian mature cystic teratoma. These changes may simulate grossly the appearance of tuberculous peritonitis or metastatic carcinoma Figure 35.74 Peritoneal implant of mature glial tissue associated with an ovarian teratoma (so-called gliomatosis peritone) Figure 35.75 Peritoneal implants secondary to immature ovarian teratoma. When the appearance of the implants is immature, as shown here, the prognosis is more guarded than in gliomatosis peritonel (compare with Fig. 35.74) Figure 35.76 Struma Ovarii. The thyroid tissue, which has a microscopi- cally unremarkable appearance, is sharply delimited from the ovarian stroma Figure 35.77 Gross Appearance of Struma Ovarii. The thyroid tissue is represented by the solid areas Figure 35.78 Cut surface of carcinoid tumor of ovary showing typical solid appearance and white to yellowish color Figure 35.79 Primary Ovarian Carcinoid Tumor With a Trabecular Pattern of Growth. There is a close resemblance to carcinoid tumors of lung and rectum Figure 35.80 A, Gross appearance of strumal carcinoid showing a variegated appearance resulting from the admixture of carcinoid tumor and struma ovarii. B, Microscopic appearance, showing intimate admixture of thyroid follicles and carcinoid trabecula Figure 35.81 Adult granulosa cell tumor with solid cut surface Figure 35.82 Adult granulosa cell tumor showing admixture of solid and cystic areas Figure 35.83 Predominantly cystic adult granulosa cell tumor Figure 35.84 Adult granulosa cell tumor with an entirely cystic gross appearance Figure 35.85 A and B, Microscopic appearance of adult granulosa cell tumor. Call-Exner bodies are seen in B Figure 35.86 Coffee-bean nuclei in adult granulosa cell tumor Figure 35.87 Strong immunoreactivity for inhibin in adult granulosa cel tumor Figure 35.88 Gross appearance of juvenile granulosa cell tumor Figure 35.89 Juvenile Granulosa Cell Tumor. The follicle-like spaces seen on low-power examination (A) are a common feature of this neoplasm. On high power (B) the tumor cells are seen to lack the coffee bean nuclei seen in the adult type Figure 35.90 Cut surface of thecoma showing a predominance of yellow areas alternating with whitish foci Figure 35.91 Bland microscopic appearance of thecoma, with some variability in cellularity Figure 35.92 A and B, Outer aspect and cut surface of ovarian fibroma. The white color contrasts with the yellow hue of thecoma (compare with Fig. 35.90) Figure 35.93 Ovarian fibroma showing, bland nuclear features, and a suggestion of a storiform pattern of growth Figure 35.94 Cellular fibroma. The tumor is hypercellular, but pleomor- phism and mitotic activity are minimal Figure 35.95 Fibrosarcoma of Ovary. Hypercellularity, nuclear hyper- chromasia, and brisk mitotic activity are present. The latter is the most important feature in the differential diagnosis with cellular fibroma Figure 35.96 Multinodular quality of cut surface of sclerosing stromal tumor Figure 35.97 Sclerosing Stromal Tumor of Ovary. The hemangioperi- cytoma-like foci and the alternation of hypocellular and hypercellular areas are important diagnostic clues Figure 35.98 Bulging cut surface of ovary involved by massive edema Figure 35.99 Massive edema of ovary typically surrounding dilated follicles Figure 35.100 Solid cut surface with hemorrhagic foci in ovarian small cell carcinoma of hypercalcemic type Figure 35.101 Small Cell Carcinoma, Hypercalcemic Type. The presence of follicle-like formations is an important diagnostic feature Figure 35.102 Small Cell Carcinoma of Pulmonary Type. The sharply outlined foci of necrosis are a common feature of this tumor, which has a microscopic appearance very similar to its pulmonary counterpart Figure 35.103 Variegated appearance of cut surface of ovarian Sertoli- Leydig cell tumor Figure 35.104 Well-differentiated Sertoli-Leydig cell tumor Figure 35.105 Moderately differentiated Sertoli-Leydig cell tumor Figure 35.106 Poorly differentiated Sertoli-Leydig cell tumor Figure 35.107 Sertoli-Leydig cell tumor with heterologous elements represented by well-differentiated mucin-secreting glands Figure 35.108 Gross appearance of Sertoli-Leydig cell tumor of the retiform variant Figure 35.109 Retiform variant of Sertoli-Leydig cell tumor as seen on low-power examination. The retiform areas are represented by the micropapillary foci Figure 35.110 When the retiform type of Sertoli-Leydig cell tumor is made up predominantly or exclusively of retiform elements without conventional foci of Sertoli-Leydig cells, as seen here, the diagnosis can be easily missed Figure 35.111 Cut Surface of Ovarian Steroid Cell Tumor. The deep brown color is reminiscent of a renal or thyroid oncocytoma Figure 35.112 Two cases of steroid cell tumor showing acidophilic (A) and clear (B) appearances of the cytoplasm of the tumor cells Figure 35.113 Sex Cord Tumor With Annular Tubules. The patient was affected by Peutz-Jeghers syndrome Figure 35.114 Wolffian Tumor of Ovary. Elongated glandular structures are admixed with solid foci composed of oval to spindle cells Figure 35.115 Streak gonad microscopically shown to contain gonado- blastoma. The tumor was barely apparent grossly Figure 35.116 Ovarian Gonadoblastoma. Note the sharply outlined tumor nests and the heavy calcification Figure 35.117 Malignant lymphoma of Burkitt type with massive ovarian involvement Figure 35.118 A and B, Colonic carcinoma metastatic to ovary. This may be misdiagnosed as a primary ovarian tumor both grossly and microscopically Figure 35.119 Colonic carcinoma metastatic to ovary Figure 35.120 Ovarian Metastasis From Pancreatic Adenocarcinoma. As in the primary tumor, this ovarian metastasis shows the disparity between the extremely well-differentiated architecture and the high degree of nuclear atypia that is characteristic of pancreatobiliary neoplasms Figure 35.121 Typical Gross Appearance of Krukenberg Tumors of Ovary. The involvement is bilateral and the tumors are characterized by a multinodular outer appearance. (Courtesy of Dr. RA Cooke, Brisbane, Australia; from Cooke RA, Stewart B. Colour Atlas of Anatomical Pathology. Edinburgh: Churchill Livingstone; 2004.) Figure 35.122 Krukenberg Tumor of Ovary. A, Microscopic appearance. Numerous signet ring cells are present in a highly fibrous stroma, either individually or in small nests. B, Presence of intracellular mucin evidenced by Meyer mucicarmine stain Figure 35.123 Tubular variant of Krukenberg cell tumor Figure 35.124 Ovarian metastasis of lobular carcinoma of breast Figure 35.125 Gross appearance of ovarian metastasis of a malignant melanoma Figure 35.126 A and B, Low- and high-power appearances of ovarian metastasis from malignant melanoma. The follicle-like formations seen in A may result in a misdiagnosis of juvenile granulosa cell tumor or hypercalcemic-type small cell carcinoma
