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Medico Macha
  • 5/15/2025
Transcript
00:00:00Hello everyone, in this session we are going to cover a ultra important topic that is ovarian
00:00:05tumors.
00:00:06In your university exam very frequently you get a long question on ovarian tumors.
00:00:10You get a long question specially on the surface epithelial tumors either cirrus carcinomas
00:00:15or mucinus carcinomas.
00:00:16So, we will be discussing all these in detail or you can get a short note or very short
00:00:20note on one of the germ cell tumor that is dysgerminoma, yolk sac tumor, teratoma.
00:00:25So, we are going to discuss all ovarian tumors in detail.
00:00:33We are starting a very important topic that is ovarian tumors.
00:00:36So, this is the overview, these are the headings under which I am going to describe this topic.
00:00:40So, first of all I will let you know the classification of all ovarian tumors.
00:00:44I will divide the ovarian tumors under four categories.
00:00:47Out of them we will discuss the details of few.
00:00:49So, the details of the few which are important in our syllabus and frequently asked in university
00:00:54exam.
00:00:55So, I will be discussing two important tumors among the surface epithelial tumors.
00:00:59I will be discussing cirrus tumor and mucinus tumor in detail.
00:01:02So, I will let you know for each of them the introduction, types, age, bilaterality, risk
00:01:08factors, growth, microscopy, clinical features and tumor markers.
00:01:11So, if the question is coming on cirrus, so write down all these things for the cirrus.
00:01:15If the question is coming on mucinus, write down all these things for mucinus.
00:01:18If the question is coming on overall surface epithelial tumors of the ovary, you have to
00:01:21write down both.
00:01:22In a comparative manner you can compare them also, we will compare them in a comparative
00:01:26manner.
00:01:27After that we will see the germ cell tumor.
00:01:28There are six germ cell tumor, I will tell you the classification all six, but three
00:01:33of them are ultra important for which we will see the details.
00:01:35So, out of six we will see the details of the three.
00:01:37Which three?
00:01:38Dysgerminoma, Yorksack tumor and Teratoma.
00:01:40They are frequently asked separately as a short or very short note and rarely for the
00:01:44long note also.
00:01:45So, for them also we will make a comparative table between them, we will compare them under
00:01:49the following headings.
00:01:51Introduction for each of them, most common for each of them, age group, tumor markers,
00:01:55gross, microscopy and prognosis for each of them.
00:01:57So, we will make two comparative tables, one among the cirrus, surface epithelial tumor
00:02:02and one among the germ cell tumor.
00:02:04So, at the end you have to learn these two comparative tables.
00:02:07Okay.
00:02:08So, let us start it.
00:02:09First of all, let me tell you the classification of ovarian tumors.
00:02:12To understand the classification of ovarian tumor, you have to understand the diagram
00:02:16of the ovary.
00:02:17Have a look on the diagram of the ovary.
00:02:19Can you see the diagram of the ovary?
00:02:20In the diagram of the ovary, you all can understand this lining is known as coelomic epithelial
00:02:26lining.
00:02:27This lining is known as coelomic epithelial lining.
00:02:29Okay.
00:02:30The lining of the ovaries is known as coelomic epithelial lining.
00:02:34Inside the ovary, there are many follicles.
00:02:36Every month one follicle mature in one of the ovary.
00:02:38There are two ovaries right and left.
00:02:40So, every month alternatively one of the follicle gets mature.
00:02:43The mature follicle is known as grapian follicle.
00:02:45So, here you can see this is grapian follicle.
00:02:48So, this is grapian follicle and grapian follicle contain the germ cell.
00:02:51So, this is the germ cell present inside the grapian follicle.
00:02:53Can you see the stroma in the background?
00:02:55The background is known as stroma.
00:02:57This is the background which is known as stroma.
00:02:59So, how many types of tumors are present in ovary?
00:03:01So, it depends on the origin.
00:03:03If the tumor is arising from the coelomic epithelia, they are known as surface epithelial
00:03:08tumor.
00:03:09They are surface epithelial tumor, they are arising from the epithelium.
00:03:12If the tumor is arising from the germ cell present inside the grapian follicle, they
00:03:16are arising from the germ cell present in the grapian follicle, these are known as germ
00:03:20cell tumors.
00:03:21If the tumor is arising from the background, can you see the background?
00:03:25The tumor is arising from the background, these are known as stromal tumors because
00:03:28they are arising from the stroma.
00:03:30So, they are known as sex cord stromal tumors and the metastatic, these are the primary
00:03:34tumors in the ovary and apart from that metastatic tumors can occur in which the primary tumor
00:03:38is present in some other organ and secondarily via blood or lymphatics it is involving the
00:03:43ovary or via trans coelomic route it is involving the ovary.
00:03:46So, that is metastatic tumors.
00:03:48So, there are four type of tumors in the ovary.
00:03:51What are the four type of tumors in the ovary?
00:03:52Learn the diagram.
00:03:53So, in the ovary, this lining is known as coelomic epithelia.
00:03:57So, tumor can arise from the coelomic epithelia, these are known as surface epithelial tumors.
00:04:02So, inside the ovary many follicles are there, every month one follicle mature that is known
00:04:06as grapian follicle.
00:04:07Grapian follicle contain the germ cell.
00:04:09So, tumor arising from the germ cell or germ cell tumor and the background is known as
00:04:13stroma.
00:04:14So, tumor arising from the stroma are sex cord stromal tumors.
00:04:16So, these are the three important primary tumors present in the ovary.
00:04:19So, these are the surface epithelial tumors, these are the stromal tumors, sex cord stromal
00:04:27tumors to say it correctly and completely, say it sex cord stromal tumors and finally
00:04:36the tumor arising from the germ cell is known as germ cell tumor GCT.
00:04:40So, these are the three primary apart from that the metastatic tumors can occur, the
00:04:44secondary tumors in which the primary is present in some other organ, but the tumor is involving
00:04:48the ovaries secondarily, these are the metastatic tumors.
00:04:50So, these are the four type of tumors present in the ovary.
00:04:54Now, let me tell you the classification under each category one by one.
00:04:58So, let us take the first category surface epithelial tumors.
00:05:02Under the surface epithelial tumor, there are five type of tumor.
00:05:04What are the five type?
00:05:05Cirrus, mucinus, endometroid, clear cell and branner.
00:05:09So, I am having a mnemonic to learn that.
00:05:11The mnemonic is students master every clinical breakthrough or background.
00:05:15Student master every clinical background.
00:05:17S for student, S for cirrus, M stand for mucinus, E stand for endometroid, C stand for clear
00:05:25cell and B stand for branner.
00:05:27So, please learn student master every clinical background that is cirrus, mucinus, endometroid,
00:05:33clear cell and branner.
00:05:35So, these are the five surface epithelial tumors.
00:05:37You can see they all arise from the surface epithelia.
00:05:41This is the surface epithelia.
00:05:42So, the surface epithelial tumors are of five types.
00:05:45The mnemonic is also with you.
00:05:47The second type of the tumors are the germ cell tumor.
00:05:49They arises from the germ cell which is present inside the graafian follicle.
00:05:52So, they arises from the germ cell.
00:05:54They are of six type.
00:05:55They are of six type.
00:05:56The mnemonic is YED-PCT.
00:05:58You can make some other mnemonic also YED-PCT.
00:06:00So, it is Yorkshire tumor, Y stand for Yorkshire tumor, E for embryonal.
00:06:06This was endometrioid.
00:06:07Here, E is embryonal.
00:06:09D is dysgerminoma, P is polyembryoma, C is choriocarcinoma and T is teratoma.
00:06:16So, you can learn YED-PCT.
00:06:17So, I told you two.
00:06:19So, I told you ovarian tumors are divided in four categories.
00:06:24What are the four categories?
00:06:25Three of them are primary and one is metastatic.
00:06:27So, what are the four categories?
00:06:28So, we have surface epithelial tumors, we have germ cell tumors, we have sex cord stromal
00:06:39tumors and we have secondary or metastatic tumors.
00:06:42So, there are five type of surface epithelial tumor.
00:06:46The mnemonic is student master every clinical background.
00:06:50So, what is the full form?
00:06:51You can see the full form also.
00:06:52Student master every clinical background.
00:06:55So, that is the mnemonic.
00:06:56See the full form.
00:06:57So, S stand for cirrus, M stand for mucinous, E for endometroid, C for clear cell, B for
00:07:02Branner.
00:07:03Learn it.
00:07:04These are the five cirrus.
00:07:05Among them, I will give you the details of only two that is cirrus and mucinous that
00:07:07are ultra important.
00:07:08Others, I will not give you the detail, but you can learn the classification.
00:07:11The germ cell tumor are divided in six categories 1, 2, 3, 4, 5, 6.
00:07:15The mnemonic is YES-PCT.
00:07:19Instead of S, you can say D also because saminoma and dysgerminoma are same.
00:07:22In males, it is known as saminoma.
00:07:24In females, it is known as dysgerminoma.
00:07:26So, you can learn YES-PCT is the mnemonic.
00:07:28So, Y stand for, here Y stand for Yorksac tumor, E for embryonal carcinoma, S is saminoma,
00:07:36D is dysgerminoma.
00:07:37So, currently, we are studying ovarian tumor.
00:07:39So, we will talk about dysgerminoma, not saminoma, but they are same.
00:07:42They are the counterpart of each other.
00:07:44In testes, there is saminoma.
00:07:46In ovaries, there is dysgerminoma.
00:07:47They are exactly replica.
00:07:48They are same.
00:07:49They are counterpart.
00:07:50P for polyembryoma, C for choriocarcinoma and T for teratoma.
00:07:53So, here you can see.
00:07:56So, for the sex cortisomal tumor, we divide them in three categories.
00:07:58What are the three categories?
00:07:59Granulosa's thicker cell tumor, Sertoli lytic cell tumor and gynandroblastoma.
00:08:05So, granulosa cell tumor, gynandroblastoma and Sertoli lytic cell.
00:08:10So, you can learn a mnemonic GGS.
00:08:13Okay.
00:08:14And after that, metastatic tumor.
00:08:15Metastatic tumor, the best example is the Krukenberg.
00:08:17I hope you know what is Krukenberg.
00:08:19Let me tell you what is Krukenberg.
00:08:21Imagine she is a female.
00:08:23Imagine she is a female.
00:08:26And unfortunately, this female have gastric carcinoma.
00:08:30Yes, this female have gastric tumor, the stomach tumor, gastric carcinoma.
00:08:34Let me draw it.
00:08:35Okay.
00:08:36So, I will draw the gastric carcinoma here and these are the ovaries in the pelvis of
00:08:40this female.
00:08:41So, this female have gastric carcinoma.
00:08:44You can see the stomach tumor.
00:08:46Now, there are three ways of spread of tumor.
00:08:49One via blood, one via lymphatic and third is the transthalamic.
00:08:53What do you mean by transthalamic?
00:08:54Here, tumors don't go in the blood.
00:08:55They don't go in the lymphatic.
00:08:56They are shared in the cavity, in the abdominal cavity and they just float here and there.
00:09:00They go in the pelvic cavity.
00:09:01After going in the pelvic cavity, they involve bilateral ovaries.
00:09:04So, here the female present with three tumors.
00:09:07One primary, this is the primary tumor and two secondaries, two secondaries in both the
00:09:11ovaries.
00:09:12So, ovaries are involved secondarily.
00:09:14It is a metastatic tumor.
00:09:16So, this syndrome in which the three tumors occur together, one primary and two secondary.
00:09:22One primary in the stomach and two secondaries in the ovaries.
00:09:26That is known as Krukenberg syndrome.
00:09:29Krukenberg, Krukenberg syndrome.
00:09:31So, in Krukenberg syndrome, the lady presents with three tumors.
00:09:35One primary in the stomach and two secondaries in the ovaries.
00:09:38So, the metastatic, the best example is the Krukenberg tumor.
00:09:40So, finally, we are done with the classification.
00:09:43Can we revise the classification together once?
00:09:44So, tell me ovarian, ovarian carcinomas.
00:09:48How many ovarian carcinomas you know?
00:09:50We know there are four type of ovarian carcinoma depending on their origin.
00:09:54So, first one, the one which arises from the surface epithelia, they are known as surface
00:10:00epithelial tumors.
00:10:01The second which arises from germ cell, they are known as germ cell tumor or GCT.
00:10:06The third one, they arises from stroma, they are known as sex cord stromal tumor and finally,
00:10:13the last one are the metastatic, the secondaries.
00:10:15Now, tell me, we divide surface epithelial into five categories.
00:10:201, 2, 3, 4, 5.
00:10:21We divide germ cell under six categories.
00:10:221, 2, 3, 4, 5, 6.
00:10:24Sex cord have three categories and metastatic only one example is there.
00:10:27Can we fill it together?
00:10:28Can you say something?
00:10:29So, I am having mnemonics.
00:10:31So, the mnemonic here, student master every clinical background.
00:10:36So, you can learn the mnemonic.
00:10:38Here the mnemonic is yes, YES, yes, PCT, PCT, but you have to learn here instead of seminoma,
00:10:44it is disgerminoma.
00:10:45So, YED, PCT, either you learn or you learn yes, PCT, it is your choice.
00:10:48Here the mnemonic is GGS and here it is Krukenberg.
00:10:52So, can you see the full form once?
00:10:54So, here S is cirrus, M is mucinus, E is endometroid, C is clear cell, B is Brenner.
00:10:58Please learn it at the tip of your tongue.
00:11:00Germ cell, the mnemonic is Y stand for yoxec, E stand for embryonal.
00:11:06Here E was endometroid, here E is embryonal minded and D is disgerminoma.
00:11:11So, we do not say seminoma here because in ovarian tumor, we say disgerminoma, P is polyembryoma,
00:11:17C is scoliocarcinoma, here C was clear cell, here C is scoliocarcinoma and T is teratoma.
00:11:21So, do not get confused.
00:11:22Here 1G is granulosa cell, 1G is gynandroblastoma and 1S is Sertoli cell, K is Krukenberg.
00:11:30I hope the classification is crystal clear.
00:11:32Sometime you get a short question in your exam, write on the classification of ovarian
00:11:36tumor.
00:11:37So, please write down all four categories like this.
00:11:39Now among all these, among the surface one, there are five surface one, the mnemonic is
00:11:43student, master, every clinical, clinical background.
00:11:47So, among them, the two are important, I will teach you two in detail.
00:11:50So, I will teach you cirrus and mucinus in detail, very frequently you get long questions
00:11:55on them.
00:11:56So, I will discuss them under a fixed set of headings.
00:11:57So, I will discuss introduction for each of them, types, they both of them are 3-3 type,
00:12:02benign borderline malignant, benign borderline malignant.
00:12:06So, we will discuss the types of them, the age for them, the bilaterality percentage
00:12:10of them, which of them is bilateral, which of them is unilateral, risk factors for them,
00:12:14growth for all three categories, benign borderline malignant, microscopy of all three categories,
00:12:19benign borderline malignant, the clinical features are common and human markers are
00:12:22common.
00:12:23So, let us discuss it and then we will fill this table.
00:12:25So, people take out your notebooks, what are you waiting?
00:12:27Take out your notebooks, take out your pen, start filling simultaneously while watching
00:12:30the session, utilize the time.
00:12:32So, start with the cirrus tumor, please start with the cirrus tumor.
00:12:36So, in the introduction, what you will write down?
00:12:39In the introduction, write down it is the most common malignant ovarian tumor, it is
00:12:43the most common, it creates 50% of all ovarian tumors.
00:12:46So, whatever ovarian tumors I am teaching you, the surface, the germ cell, the sex cord,
00:12:53stromal and the metastatic.
00:12:54So, among the primary tumors, most common is surface and among the surface, there are
00:12:585 categories in the surface, most common is the cirrus.
00:13:00So, overall most common tumor in the ovary is the cirrus, it alone constitute 50% of
00:13:06all ovarian tumors and remaining all constitute the remaining 50%.
00:13:09So, it is the biggest category, it is the most common malignant ovarian tumor, 50% of
00:13:14all ovarian cancers.
00:13:15It is constituting the cirrus one, the cirrus tumors.
00:13:19Coming on the types, as I told you, there are 3 types, benign, borderline, malignant.
00:13:22Cirrus is also 3 type, mucinous is also 3 type, benign, borderline and malignant.
00:13:27Age group, the benign and borderline are common 20 to 45 years and the malignant one, the
00:13:33carcinomas one, they occur in late life.
00:13:36So, benign and borderline occurs in young and middle age and the malignant one occurs
00:13:40later in life.
00:13:41That is the age group.
00:13:42Bilaterality, benign one, in 20% case they are bilateral, in 80% they are unilateral
00:13:47only.
00:13:48Borderline, they are 30% cases they are bilateral, they occurs in 2 ovaries together, the right
00:13:52and left.
00:13:53And malignant, they are 70%, nearly 60 or 70% they are bilateral.
00:13:56So, learn 20%, 30% and 66%.
00:14:01The benign bilaterality is 20%, borderline bilaterality is 30% and malignant bilaterality
00:14:06is 66%.
00:14:07If a malignant tumor, malignant cirrus tumor, there are high chances it will be bilateral.
00:14:12Coming on the risk factors, so family history, if the mother or the sister, I mean the first
00:14:17degree relative, the mother or the sister or the daughter, the first degree relative
00:14:21have a cirrus cancer or cirrus tumor, there are high chances that lady will have cirrus
00:14:26tumor as compared to others.
00:14:28Parity, nulliparous females are at high risk as compared to multiparous, nulliparous because
00:14:34they have high estrogen exposure throughout their life.
00:14:36So, nulliparous at high risk.
00:14:38So, family history, nulliparity, gonadal dysgenesis in the children.
00:14:42In the children, if there is a gonadal dysgenesis, they are at high risk of developing ovarian
00:14:46cancers like cirrus tumor in future.
00:14:49Genetic factors, the BRCA1, BRCA2 gene mutation.
00:14:51If BRCA1 or BRCA2 is mutated, so they are at high risk of developing ovarian cancers
00:14:56in future.
00:14:57BRCA stands for breast carcinoma.
00:14:58So, the one lady who is having BRCA1 or BRCA2 mutation, they have breast cancer as well
00:15:03as ovarian cancer.
00:15:04So, BRCA mutation increases the risk of two cancers, breast and ovary in female.
00:15:09In males, if BRCA is mutated, it increases the risk of prostate cancer, okay.
00:15:12And OCPs, OCPs reduces the risk, OCPs reduces the risk, it do not increase the risk.
00:15:18Sterilization reduces the risk.
00:15:19So, family history, nulliparity, gonadal dysgenesis and BRCA genetic, they increases the risk
00:15:26but OCP and sterilization reduces the risk.
00:15:28That is the risk factor.
00:15:29So, what we have learned, tell me the factors which increases the risk and tell me the factors
00:15:32which reduces the risk.
00:15:33So, the one which increases, the one which increases the risk is the family history.
00:15:39If there is a family history, if there is a nulliparity, okay and after that gonadal
00:15:44dysgenesis in childhood or genetic factors.
00:15:49In genetic factors, it is BRCA1 or BRCA2 which is mutated.
00:15:52So, they increases the risk.
00:15:54OCP reduces the risk and sterilization reduces the risk.
00:15:56So, learn the factors like this.
00:15:58The one which increases the risk, the one which reduces the risk.
00:16:00So, we are done with the risk factors.
00:16:01Now coming on the GRAS.
00:16:02We have to say three GRAS.
00:16:03GRAS of Benign Serous Tumor, Borderline Benign Serous Tumor and Malignant Serous Tumor.
00:16:09The Benign Serous Tumor are known as Cyst Adenoma.
00:16:12See the suffix.
00:16:13It is Cyst Adenoma.
00:16:14The Malignant one are known as Adenocarcinoma.
00:16:16So, the Benign one are Adenoma and the Malignant one are Adenocarcinoma.
00:16:23See the suffix.
00:16:24I mean here the suffix is Oma.
00:16:26If you have watched my video on Neoplasia, the nomenclature of the Neoplasia, you may
00:16:31be knowing the suffix.
00:16:32Benign Tumor have a suffix Oma and the Malignant Tumor have a suffix Carcinoma.
00:16:36So, here the suffix is Oma, Cyst Adenoma and here the suffix is Adenocarcinoma.
00:16:40So, that is the Malignant.
00:16:42So, please learn their names.
00:16:43You can get a question on Cyst Adenoma, you must understand they are talking about the
00:16:46Benign Tumor.
00:16:47You get a question on Adenocarcinoma, you must understand they are talking about the
00:16:51Malignant.
00:16:52So, please read your question in the previous year, whether they are asking Cyst Adenoma
00:16:55or whether they are asking Cyst Adenocarcinoma.
00:16:58Be very careful while reading the question in your question paper, okay.
00:17:02So, the Cyst Adenoma, they are Cystic.
00:17:06Complete Cyst filled with clear water.
00:17:07Can you see?
00:17:08Complete Cyst filled with clear water.
00:17:10The Borderline also Cystic, but they are not filled with water.
00:17:13They are solid, they have some solid component inside, but they are completely Cystic and
00:17:18the Malignant one, they are mixed.
00:17:20So, they are slightly Cystic and slightly solid.
00:17:23So, this one is Cystic, this one is Cystic, this one is solid, Cystic plus solid both
00:17:27I mean.
00:17:28Okay.
00:17:29So, first learn the appearance.
00:17:30The Benign one, they are completely filled with water.
00:17:33So, they are completely, so they are the Cyst filled with clear water, clear water and from
00:17:38inside if you cut them from inside, you will see a smooth lining, smooth internal lining.
00:17:43The Borderline one, the Borderline one are also Cystic, but if you cut them, you can
00:17:47see Cauliflower like papillary projections inside them.
00:17:50Can you see the Cauliflower like papillary projections?
00:17:52So, it is not smooth lining from inside and the Malignant one, they have a solid and Cystic
00:17:56component both.
00:17:57The solid component can have areas of Necrosis and Hemorrhage.
00:18:00You can see the areas of Necrosis and Hemorrhage.
00:18:02So, please say the growth of the three Benign, Borderline, Malignant.
00:18:07This is Benign, this is Borderline, this is Malignant.
00:18:10We are talking about the Cirrus Tumors.
00:18:11So, the Benign Cirrus Tumor is known as Cirrus Cyst Adenoma and the Malignant one is known
00:18:19as Cirrus Cyst Adenocarcinoma, Adenocarcinoma.
00:18:24So, please understand the difference because the terminologies may look alike to you, but
00:18:29there is a difference.
00:18:30If they are asking Cirrus Cyst Adenoma, you have to write down this.
00:18:32If they are asking Cirrus Cyst Adenocarcinoma, you have to write down this.
00:18:35Now, see the growth.
00:18:36This one is Cystic, this one is Cystic, this one is Cystic plus Solid, that is a mixed
00:18:39tumor.
00:18:40So, here on cutting, internal surface is smooth.
00:18:43Here on cutting, the internal surface may have papillary projections at places, looking
00:18:47like cauliflower like masses.
00:18:49Here on cutting, solid masses have areas of Necrosis plus Hemorrhage.
00:18:53So, learn simplified like this and try to draw these diagrams, that is a draw.
00:18:56Now, I will tell you the three microscopy one by one.
00:18:58We will see all three microscopy.
00:19:00Let's start the microscopy of the Benign.
00:19:02Let's start with the microscopy of the Benign.
00:19:04Here you can see the Benign one is the tumor cells are arranged in papillary projections.
00:19:08Can you see, first see the arrangement.
00:19:11Here the tumor cells are arranged in papillary projections.
00:19:13The papillary are like finger like projections.
00:19:14So, tumor cells, the cyst wall is lined, the cyst wall is lined by the Cuboidal or Columnar
00:19:20epithelial cells in papillary projection.
00:19:22So, can you see, these are the papilla, appreciate the papilla.
00:19:25Let me show you the papilla.
00:19:26So, this is a papilla, this is a papilla.
00:19:29The papilla have a core inside.
00:19:30Can you appreciate the core of the papilla?
00:19:32This core, I am talking about this core.
00:19:34Can you see, this is a core, this is a core.
00:19:36So, the papilla have a core inside.
00:19:38So, the core inside the papilla is made up of blood vessels and fibrosis.
00:19:42So, let me highlight the papilla first.
00:19:45See the lower diagram.
00:19:46So, this is the surface lining.
00:19:47So, it is having the papilla.
00:19:49This is the surface lining.
00:19:50These are surface tumors, not surface epithelial.
00:19:53This is the papilla, this is the surface epithelial.
00:19:55So, see the cells are columnar, cuboidal or columnar.
00:19:58The tumor cells are cuboidal or columnar, number one.
00:20:01And wherever there is a papilla, there is a blood vessel inside that core of the papilla.
00:20:05Can you see the blood vessel?
00:20:07See the blood vessel and behind the blood vessel, there is fibrosis.
00:20:09So, it is known as fibrovascular core, fibrovascular core.
00:20:14So, how to draw it?
00:20:15How I will draw the benign?
00:20:16I will draw the surface epithelia and multiple papilla, the papillary projection.
00:20:21The surface epithelia have the papilla.
00:20:23So, I will draw the tumor cells over it.
00:20:25So, these are the normal tumor cells and they convert into cirrhosis adenoma like this.
00:20:30So, the tumor cells are cuboidal or columnar.
00:20:33So, tumor cells are cuboidal or columnar.
00:20:36They are arranged in papillary projections.
00:20:37The papillary projections are present in the cyst lining.
00:20:40They are arising from the surface epithelia.
00:20:42They have a fibrovascular core.
00:20:44Vascular means the blood vessels are there.
00:20:45This is the blood vessel.
00:20:46So, from the blood vessel, the core is arising.
00:20:49So, this is the blood vessel, you can see.
00:20:50So, this is vascular core and behind vascular core, you can draw a little bit of fibrosis
00:20:55everywhere.
00:20:56So, I will call this core as fibrovascular, this is fibrosis, fibrovascular core.
00:21:00So, this is the diagram you have to draw.
00:21:02There is no atpia.
00:21:03There is no mitosis, no pleomorphism, no atpia at all.
00:21:06This is benign.
00:21:07Now, coming on the second one, borderline.
00:21:09Have a look here.
00:21:10This one is borderline.
00:21:11So, this is also looking like this, you may be thinking.
00:21:13Now, here also tumor cells are arranged in papilla.
00:21:15So, here the papilla are not very big.
00:21:17If you can appreciate the papilla, here the papilla are big.
00:21:21Can you see the papilla?
00:21:23These are the papilla.
00:21:24These are the papilla.
00:21:25These are the papilla.
00:21:26Big, big papilla are present.
00:21:27Here, it is known as micro papillary fashion.
00:21:29Here also papilla, but small, small, small, small.
00:21:31So, rather say micro papillary fashion.
00:21:33I will call it micro papillary.
00:21:35It's not big papilla like this.
00:21:37It is micro papillary fashion.
00:21:38So, number one, there is micro papillary fashion.
00:21:41That is the difference.
00:21:42Can you see?
00:21:43There is micro papillary fashion, okay, and after that small, small budding or tufting
00:21:47is there.
00:21:48Can you see small, small budding or tufting?
00:21:50Appreciate.
00:21:51Tumor cells are arranged over small, small budding, small, small tufting, small, small
00:21:54budding, small, small tufting.
00:21:55So, small budding and tufting and they are compactly, tightly clustered with each other.
00:22:00Can you see the clustering?
00:22:01They are compactly, tightly clustered with each other.
00:22:04Some of the tumor cells can float freely also.
00:22:06They are detaching from the papilla and you can see they are freely floating here.
00:22:10They are freely floating and there is mild atopia.
00:22:13There is little bit mitosis and some of the body can be present in all of them, but there
00:22:17is no invasion.
00:22:18The invasion will be a hallmark of malignancy.
00:22:21This one is borderline.
00:22:22So, this is a way to differentiate borderline from the malignant.
00:22:24In the malignant, I will show you the invasion.
00:22:25If there is no invasion, still they are present on the surface.
00:22:28So, benign also present on the surface.
00:22:30They arise the papilla like this, the benign one.
00:22:33These are the benign one.
00:22:34Malignant also present on the surface, but here the little, little papilla are present,
00:22:37micro papillary fashion.
00:22:38So, I will call them budding or tufting and complexity, a little bit complexity.
00:22:42See they are looking simple and they are looking complex.
00:22:46These are the benign one.
00:22:48These are the malignant one.
00:22:49Here also tumor cells are columnar or cuboidal, but there is no atopia in them.
00:22:54They all are normal like this.
00:22:56Here also tumor cells are columnar or cuboidal like this only, but they have atopia.
00:23:01Some of them show pleomorphism, some of them show little bit mitosis and some of them,
00:23:05in some of the tumor cells you can show mitosis here.
00:23:07So, mild atopia.
00:23:08So, here no atopia, here mild atopia, but still there is no invasion inside, still there
00:23:13is no invasion inside.
00:23:14So, that is the borderline.
00:23:15Coming on the third and the last, the malignant one, here complexity increases much higher.
00:23:20It is very complex.
00:23:21The solid masses are also there.
00:23:22So, at places you see the papilla.
00:23:24You see this is the papilla, this is the papilla, again micropapillary fashion, but
00:23:28you can see the solid masses are also there.
00:23:30Here we do not have solid masses.
00:23:31You can see only micropapillary fashion.
00:23:34Here along with micropapillary fashion, micropapillary fashion, papillary fashion is here also, but
00:23:38we can get the solid masses.
00:23:39So, it is very difficult to differentiate the borderline from the malignant.
00:23:43We have to take many thorough sections of the entire tumor so that we are not missing
00:23:47anything.
00:23:48So, that you have to see it is micropapillary.
00:23:50Here ATP is very high, high degree of preomorphism, high degree of hyperchromatism, high degree
00:23:55of mitosis, some of my body, but the most important feature which differentiate malignant
00:23:59from borderline and benign is the invasion.
00:24:02Here invasion, deeper invasion is there.
00:24:04From the surface, the tumors are going deeper.
00:24:05So, let me show you the three diagram.
00:24:07The benign I will draw like this, the simple papilla arising from the surface.
00:24:12Borderline I will draw like this, the tufting, the budding, but still they are present.
00:24:16This is the pattern, they are present here, they are not going deeper.
00:24:19But the malignant one, I will draw on the surface, but after drawing on the surface,
00:24:23I will draw the solid masses also and they are going deeper inside and showing the invasion.
00:24:27I hope you are getting my point, you are looking at three images and you got the meaning of
00:24:31the invasion.
00:24:32Here they are the surface tumor, they are the surface, see the tumors are present only
00:24:36on the surface.
00:24:37Here they are arranged in papilla, here they are arranged in micropapilla, micropapilla.
00:24:42Here also they are arranged in papilla or micropapilla and solid sheets also, but the
00:24:46tumors are going deeper and showing the invasion.
00:24:49Here no invasion, here no invasion and here invasion is present.
00:24:51So, please understand the difference, this is benign cirrus, this is borderline cirrus
00:24:56and this is malignant cirrus.
00:24:57So, what is actually differentiating the malignant from the other two is the borderline.
00:25:01It is difficult to differentiate as I told you borderline and benign.
00:25:03So, whenever we get a case and we get the micropapillary pattern, so we section the
00:25:08entire ovarian tumor.
00:25:10So, if it is a very big tumor, every 0.1 or 0.2 centimeter, we take the section and we
00:25:15see many slides, so that we do not miss.
00:25:17So, whenever you are looking some slides, it is looking like this and you have not sectioned
00:25:20it properly and you are missing the invasion somewhere.
00:25:22So, you cannot do that.
00:25:23So, you have to thoroughly dissect the tumor, every slide you have to convert into HNE slide
00:25:28and you have to look it.
00:25:29So, this is the difference.
00:25:30So, here there is no atpia, here there is about the atpia, no atpia, here there is mild
00:25:36atpia and here there is severe or very high atpia, very high atpia is there.
00:25:43Here there is no invasion, here there is no invasion, invasion is a feature of malignancy.
00:25:46The same thing is shown to you here also.
00:25:48Can you see here, the simple simple papilla, they are present on the surface, this one
00:25:52is benign.
00:25:53Here also complexity is there, I mean micropapilla, but they are present still on the surface.
00:25:57So, this is benign, this one is borderline, but see the third one.
00:26:02Here also papillary pattern is there, but it is showing invasion deeper, appreciate
00:26:05the invasion deeper.
00:26:06So, this one is malignant.
00:26:07So, this diagram is just to show you the invasion, here no invasion, no invasion and this one
00:26:11is invasion.
00:26:12So, you can understand.
00:26:13So, we are done with the gross and the microscopy of the cirrhosis, clinical features I will
00:26:18tell you together, tumor marker I will tell you together.
00:26:20So, we are done basically with the cirrhosis one.
00:26:22Now, I will start the mucinous one.
00:26:23Can we revise the cirrhosis one quickly?
00:26:25So, we will move on the mucinous.
00:26:27In the introduction, you have to write down this is the most common ovarian tumor, the
00:26:30cirrhosis one.
00:26:31They alone constitute 50% of the ovarian tumors and the remaining all constitute the 50%.
00:26:37They are of three types, benign, borderline and malignant.
00:26:42So, the benign and borderline occurs in young age 20 to 45 years and the malignant one occurs
00:26:46in old age, relatively old age.
00:26:49Bilaterality, if you talk about the bilaterality, so benign one is 20% bilateral, borderline
00:26:54one is 30% bilateral and malignant one is 66% bilateral.
00:26:59Imagine a lady who is diagnosed with bilateral malignant cirrhosis tumor.
00:27:01So, it's a pity.
00:27:02Okay.
00:27:03It's they are very usually bilateral.
00:27:04Coming on the risk factors.
00:27:05In the risk factors, the factors which increase the risk, the factors which reduce the risk.
00:27:09The factors which increase the risk is family history, parity, nulliparity and gonadal dysgenesis
00:27:15and Barkavan-Barkati mutation.
00:27:16The one which decreases the risk is OCP and sterilization.
00:27:19So, you have to enumerate them.
00:27:20Now, coming on the gross, you have to say the gross of all three, benign, borderline,
00:27:24malignant.
00:27:25Benign are cystic, borderline also cystic, malignant are cystic plus solid.
00:27:28So, here cyst is lined by internally smooth lining.
00:27:31Here cyst is having cauliflower like projections and here the solid areas have areas of necrosis
00:27:36and haemorrhage.
00:27:37The microscopy also I have shown you the three microscopy, please draw that.
00:27:40I am not saying it again, but benign, borderline, malignant, you have to draw the three boxes
00:27:44and clinical feature tumor markers, I will let you know later on.
00:27:47So, microscopy you want me to draw, I will draw it.
00:27:50Okay.
00:27:51I am not skipping it.
00:27:52So, you can see benign, borderline, malignant.
00:27:54I am drawing the three cirrhosis tumor.
00:27:55Here I will draw the benign, here I will draw the borderline, here I will draw the malignant.
00:27:59How I will draw?
00:28:00So, here I will draw the surface tumor like this.
00:28:03I will draw the surface tumor like this with fibrovascular pores.
00:28:06So, here I will arrange the tumor cells like this.
00:28:08This is the papillary arrangement.
00:28:10The tumor cells are columnar, they are cuboidal, they do not have any ATPR, no invasion, no
00:28:14ATPR and the core is fibrovascular core, there are blood vessels and the background have
00:28:19the fibrosis.
00:28:20So, fibrovascular core, I will leave it.
00:28:23This is benign.
00:28:24There is no invasion, I will write down and there is no ATPR, I will write down.
00:28:27In the borderline, the pattern is, the pattern is micro papillary, they have tufting, they
00:28:31have budding and they have a complexity, mild complexity and there is back to back
00:28:35arrangement.
00:28:36So, this is the thing.
00:28:37Still there is no invasion, the cells are still cuboidal or columnar, but there is mild
00:28:41ATPR.
00:28:42Instead of saying no, say mild ATPR, but invasion is definitely not present.
00:28:45In malignant one, you have to draw again micro papillary pattern.
00:28:48The pattern is still micro papillary, tufting, budding.
00:28:52Complexity will further increase, but the tumor cells will go deeper and they will show
00:28:55the invasion.
00:28:56At places they will form the sheets also and here high degree of ATPR is there.
00:29:00So, this is how I will try to draw, label them properly, write their properties.
00:29:03So, that is the cirrus tumor.
00:29:05Coming on the mucinous tumor, let's start the mucinous tumor.
00:29:08So, let's come on the mucinous tumor.
00:29:10They are less common than the cirrus.
00:29:12Cirrus constitute 50%, they constitute 30%.
00:29:14So, still it's a big number.
00:29:16You can say they are the second most common tumors.
00:29:17So, they constitute 30% of all ovarian tumor.
00:29:20Cirrus constitute 50, they constitute 30 and remaining all together constitute 20.
00:29:24They are also of three type benign borderline malignant like the cirrus only.
00:29:27Age group, they occur in middle age, like 30 to 50s, middle age and rarely after puberty,
00:29:34before puberty or after menopause.
00:29:36So, they occur in reproductive age.
00:29:37The reproductive age in a female is 15 to 45.
00:29:40So, most common age group you can see is the middle or the middle age or the reproductive
00:29:44age.
00:29:45So, age group is reproductive.
00:29:46Before puberty or after menopause, they don't occur.
00:29:48They require oestrogen because, so 15 to 45 years, that is the age group.
00:29:52Bilaterality, only 5% of them, 5% of them are bilateral, not much.
00:29:58So, in cirrus, the bilaterality is more.
00:30:00In cirrus, the benign one are 20% bilateral, the borderline one are 30% bilateral and the
00:30:05malignant one are 66% bilateral.
00:30:07Here all of them are only 5% bilateral.
00:30:09So, here bilaterality is much less.
00:30:11So, if there is a mucinous tumor in one of the ovary in a lady, more commonly 95% chance
00:30:15it will be unilateral, 5% it can be bilateral.
00:30:18Risk factors are only two, smoking and KRAS mutation.
00:30:21What was the gene there?
00:30:22For cirrus tumor, the gene is BRCA and for mucinous tumor, the gene which is mutated
00:30:26is KRAS.
00:30:28Now, coming on the GRAS.
00:30:29In the GRAS, you can see this tumor is multilocular.
00:30:32The tumor is multilocular, thin walled, it is not single locular.
00:30:37If you see the GRAS of the cirrus one, I told you in the benign cirrus one, they are cystic
00:30:42and they have uniloculation, no compartment.
00:30:45Here these are also cystic, these are also cystic, but it is having multiple compartments
00:30:49inside, multiple compartments, they are thin walled, they are multilocular, locular means
00:30:53compartment and they contain a sticky substance inside them, mucinous, I am teaching you mucinous,
00:30:58so it will contain mucin.
00:30:59What is the description of mucin?
00:31:00You have to write down a sticky substance, sticky, sticky substance, that is the description
00:31:04of the mucin.
00:31:05So, if you cut them, a sticky, sticky substance will come out and if you see it is cystic
00:31:08and it is having multiple compartments.
00:31:09So, there is an ovarian tumor, I will cut it, I see it is a cystic, it is not solid
00:31:14and whenever I cut it, there is a flood of mucinous substance that come out.
00:31:18In cirrus one, when I cut them, number one, they are unilocular, they do not have any
00:31:22compartment inside and whenever I cut them, a watery fluid come out.
00:31:25The cirrus means watery and mucinous means sticky.
00:31:28Borderline is same as that of benign only and the malignant one also cystic, but it
00:31:33is having the areas of solid areas also, which shows necrosis and haemorrhage.
00:31:36So, basically the gross is same.
00:31:38So, I told you the gross of the cirrus and the gross of the mucinous, I told you the
00:31:43gross of both of them, I told you the gross of benign in both of them, the gross of borderline
00:31:49in both of them and gross of malignant in both of them.
00:31:51So, here I told you they are cystic and cyst is unilocular, they are also cystic, its unilocular
00:31:57and these are cystic plus solid.
00:31:59Here I am saying it is cystic, but it's multilocular.
00:32:02Here also cystic, but multilocular, here also cystic plus solid.
00:32:05So, the solid component in both of them, the solid component here also, here also shows
00:32:10areas of haemorrhage and necrosis, here also haemorrhage and necrosis, haemorrhage and
00:32:14necrosis.
00:32:15Here when you cut the cirrus fluid oozes out, the cirrus fluid oozes out.
00:32:18when you cut the mucinous sticky fluid oozes out. So learn the gross very easily
00:32:23like the stibulated form you can learn and you can describe in your own words
00:32:26and draw the diagram. So that is the gross. Now we will see the three
00:32:29microscopy benign, borderline and malignant. So let's start with the benign
00:32:32microscopy. The microscopy of the benign. They are not arranged in papilla. They
00:32:36are not arranged. They are simple cysts and glands. You can see they are arranged
00:32:39simple. They are lined by non stratified tall ciliated columnar epithelia or
00:32:44non ciliated columnar epithelia. You can see they are lined simply by the
00:32:48columnar cells. This is the lining tumor cells. They are present over the surface.
00:32:51Now I am teaching you surface tumor. So simply the surface tumor converted into
00:32:55mucinous cyst adenoma and you can see the tumor cells. The tumor cells are
00:33:01non ciliated. They are columnar. So that is the thing. So it's very simple.
00:33:05Non stratified tall non ciliated columnar cells and if you can see this
00:33:11is the diagram. Can you see the tumor cells? In the tumor cell the nucleus is
00:33:14shifted to the basement membrane. Let me show you. So in this diagram you can see
00:33:18this is the basement membrane. Appreciate the basement membrane. So these are the
00:33:22tumor cells. These are the tumor cells. So you can see the nucleus is shifted
00:33:25towards the basement membrane. The nucleus is shifted towards the basement
00:33:29membrane. You can see the nucleus is shifted towards. So because the
00:33:32cytoplasm contain the mucin, apical mucin and that is pushing the nucleus to
00:33:36the basement membrane. So what is the description of the benign? The benign are
00:33:39lining the cysts like this. Okay. They are lining the cysts lining like this.
00:33:43They are the columnar cells. So what are the cells? They are tall non ciliated
00:33:48non stratified columnar cells like this. There is no ATP and that. So mucin is
00:33:53present in the cytoplasm and it is shifting the nucleus toward the basement
00:33:57membrane. It is shifting the nucleus towards the basement membrane like this.
00:34:01Shifting the nucleus towards the basement membrane because here mucin is
00:34:04present inside that. It's mucinous. This is a description of the benign one. I
00:34:07hope you got it. Coming on the borderline one. So in the borderline one there will
00:34:10be complexity. So they are arranged in little bit papillary fashion. You can see
00:34:15again they are in papillary fashion and there is multi-layer. Stratification
00:34:19means multi-layer. Here I told you there is no stratification. I told you they
00:34:23are non-stratified. Non-stratified means single layer. Stratification means
00:34:27multi-layer. So multi-layer is absent here. You can see only single layer of
00:34:31tumor cell. Appreciate the single layer. Here you can see multi-layers is there.
00:34:34So multiple layers are there. One, two, three. Multiple stratification is there.
00:34:38Multi-layering is there. Budding is there. Tufting is there. Small, small
00:34:41papillary projections is there. Mild atpia, mild mitosis but no invasion. Here
00:34:46also we don't have invasion. Here also we don't have invasion. That is the thing.
00:34:49Okay and finally the third one, the malignant one. You can see the malignant
00:34:53one. Here also stratification is there. Atpia is there. Necrosis is there. But
00:34:57the point is that invasion is there. So how to draw the three? I will draw
00:35:00simplified diagrams for you. Don't worry. So let me draw the cirrus one. Let me
00:35:05draw the three cirrus one. I will draw benign, borderline and malignant. I'm
00:35:11trying my best to explain you. Okay and the mucinous one. Here also I will draw
00:35:15benign, borderline, malignant. So here I will draw the three diagrams and here
00:35:20also I will draw the three diagrams. Benign, borderline and malignant. I hope
00:35:25you are getting it. So let's first revise the cirrus. In the cirrus, the benign
00:35:28one are arranged in papilla with a fibrovascular core. Tumor cells
00:35:34are columnar or cuboidal. Okay and there is no invasion. There is no
00:35:40atpia. Simple tumor cells are there. The core is made up of fibrovascular core.
00:35:44The blood vessel is there. The borderline one show the micro papillary pattern
00:35:48with the budding, with the tufting. So budding is there, tufting is there,
00:35:52micro papillary pattern. But there is no, there is no invasion and tumor cells
00:35:57show mild atpia. Okay but still no invasion. Malignant one also show budding,
00:36:02also show tufting, more complexity. At places there are solid sheets also but
00:36:07they invade deeper and go inside the stroma. They invade and here high degree
00:36:13of atpia. So we have already seen them. We will give the description also. Coming
00:36:16on the mucinous one. In the mucinous one, the benign one, the benign one they are
00:36:20just lining the cyst. They are tall columnar cells. They are non-selated,
00:36:24non-stratified. Stratification means multilayering. There is no multilayering
00:36:27in them. They are tall columnar cells. There is no multilayering in them. Where
00:36:30is the nucleus? The nucleus is shifted towards the basement membrane. That is
00:36:34an important point. Because the apex contain the mucin and the mucin is
00:36:39shifting the nucleus towards the basement membrane. So it's simple. It's like this.
00:36:43It is the mucinous one. The borderline one show the micro papillary pattern like this,
00:36:48budding, tufting, like this only, like this only. But here multilayering is there. So I will draw
00:36:54one layer of cell. I will draw one more layer of cell. I will draw one more layer of cell.
00:36:57So I will draw multilayering, multilayering stratification. But still here also no invasion.
00:37:02Here also no invasion. Here no atpia. Here you can say mild atpia. And the third one,
00:37:07the malignant one, here also the micro papillary pattern, budding, tufting, more complexity.
00:37:11But here the tumor cells form the sheets also and stratification is also high. Multilayering
00:37:16is still there and here also invasion is there. So tumor cells invade deeper into the stroma
00:37:21and there is a high degree of atpia. So you can compare. More or less they are same but you have
00:37:25to learn the diagram. So we are done with the cirrus and the mucinous. I hope it's crystal clear
00:37:29to you. The three type of the cirrus, the diagrams are in front of you. The three type of mucinous
00:37:33diagrams are in front of you. So draw a rough diagram in your exam, label it properly and
00:37:37write down the features what you want to show, what do you want to show in that. So that is
00:37:40important. Clinical features are common for both of them. Whether it is cirrus or mucinous,
00:37:44the clinical features are common. So benign and borderline of both of them, cirrus and mucinous,
00:37:49the female present with abdominal pain and distention, vaginal bleeding, urinary frequency
00:37:55and dysuria can be there. So these are the common features for benign and borderline.
00:37:59The malignant one will present when they spread to other parts of the body, when they show the
00:38:03metastasis. So when they show the metastasis, patient can have weakness, weight loss,
00:38:07cachexia, massive ascites can be there. So these are the clinical features. Tumor marker,
00:38:10learn one tumor marker CA125. So CA125 is a tumor marker for the epithelial tumors,
00:38:16not for germ cell tumor. If CA125 is positive, it's a epithelial tumor. So that is we are done
00:38:21with cirrus as well as mucinous completely. So we are done with the epithelial tumors.
00:38:26We are done with the epithelial tumors. Now we will start germ cell tumors. Can we revise it
00:38:29together? So cirrus tumor are the most common. They constitute 50% of ovarian tumor. They are
00:38:34less common. They constitute 30% of all ovarian tumor. Types, this one is also three type benign,
00:38:39borderline, malignant. This one is also three type benign, borderline, malignant.
00:38:44I told you the age group, the benign and borderline occur in young age,
00:38:4720 to 45. The malignant one occur in old age. Here all of them occur in reproductive age,
00:38:52that is 15 to 45. They don't occur before puberty or they don't occur after menopause.
00:38:57Bilaterality is important. Sometimes they ask you bilaterality. So here in cirrus one,
00:39:01the benign are 20% bilateral. The borderline are 30% bilateral and malignant are 66 or 70%
00:39:06bilateral. Here all of them are only 5% bilateral. All three are only 5% bilateral.
00:39:12See the risk factors, enumerate the risk factors. The factors which increase the risk,
00:39:15the factors which reduce the risk. So here the factors is family history,
00:39:20gonadal dysgenesis in childhood, nulliparity and Burka gene. And here the factors which reduces
00:39:26the risk is OCP and sterilization. Here we have only factors which increases the risk,
00:39:29that is smoking and KRAS. Please mind here the gene is Burka and here the gene is KRAS.
00:39:35KRAS. Here we don't have factors which reduces the risk. No. Gross, I told you the gross of all
00:39:40three, benign, borderline, malignant. Here also benign, borderline, malignant. So here the benign
00:39:45in both of them are cystic. The borderline in both of them are also cystic. But the malignant one,
00:39:50the malignant one is solid plus cystic in both of them, whether it is cirrus, whether it is
00:39:54mucinous. But the point is that here the cyst is uniloculated. Cyst is uniloculated. Here cyst is
00:40:00multiloculated, multiple compartment. And second thing here cyst, when you cut the cyst, the cirrus
00:40:05fluid will oozes out. The cirrus fluid means the watery fluid. And here once you cut the
00:40:10tumor, the mucinous, the sticky material will ooze out. The solid areas in both the malignant
00:40:15version show necrosis plus hemorrhage here also, necrosis plus hemorrhage here also. This is the
00:40:19easiest way you can learn and you have to draw the diagrams also. Now microscopy, I have just
00:40:22drawn it. So I'm not drawing it again, but I have just told you the microscopy, the benign,
00:40:27borderline, malignant here, benign, borderline, malignant here. So you can draw like that.
00:40:30Clinical features, the benign and borderline patient have abdominal pain, patient have
00:40:35distention, dysuria, like that, and urinary frequency. And the malignant one will present
00:40:41with ascites, multiple organ involvement. Tumor marker is only 1CA125. We are done.
00:40:47So if you are getting a long note, either on cirrus or on mucinous, you are prepared to write
00:40:51on four to five pages on each of them. Sometimes you can get an overall long note on the epithelial
00:40:56tumors. Then in that case, you have to write on both. Okay, so manage your time in the exam.
00:41:00Now we are done with the epithelial tumors. I told you there are five types of epithelial tumors.
00:41:04The mnemonic is students master every clinical background. So out of the five, I told you two,
00:41:12that is cirrus and mucinous, but I'm not giving you the details of endometroid, clear cell and
00:41:16Brenner. They are not important. They are not asked in your exam. Now let's move to the germ
00:41:20cell tumor. So how many germ cell tumors are there in the syllabus? There are six germ cell tumor.
00:41:24What is the mnemonic? The mnemonic is YES. Instead of YED, you can say YES,
00:41:29PCT, but S is seminoma. In males, it is disgerminoma in females. So actually I make
00:41:33this mnemonic for the male version, but the female version, I replaced the S with the D.
00:41:37So the mnemonic is YED, PCT. The Y stand for Yorksac, E stand for embryonal carcinoma,
00:41:43D stand for disgerminoma, P stand for polyembryonoma, C stand for choriocarcinoma,
00:41:47and T stand for teratoma. So out of this, I will teach you three in detail. Which three,
00:41:51which are ultra important for your exam and repeatedly asked in your exam. I will teach
00:41:54you only three. I will teach you Yorksac, disgerminoma and teratoma. So let's make a
00:41:59comparative table between the three. So in the classification, you have to write down all six,
00:42:03but the details will be asked only of these of them. If you're getting a long question on overall
00:42:07germ cell tumors, write down the classification and give the details of three or else you will
00:42:10get individual question on either disgerminoma or Yorksac or teratoma. I will compare them in a
00:42:15fixed set of heading. I will let you know the introduction of each of them. Most common,
00:42:19they are most common what? Most common what? Most common. So most common is the heading,
00:42:23age group in which they present, tumor marker, most important is glass and microscopy and
00:42:27prognosis. So take out your notebooks and pens, start filling it while watching. Let's start with
00:42:31the first one, disgerminoma. Can I start under these headings? Start filling in the table,
00:42:36disgerminoma. So in the introduction, write down, it is the ovarian counterpart of the seminoma.
00:42:41In males, we call it seminoma. In the females, we call it disgerminoma. It is the ovarian
00:42:47counterpart of the seminoma of the testes. All disgerminomas are malignant. They are not benign.
00:42:51They are malignant, but they are extremely radiosensitive. They respond to radiation,
00:42:56radiotherapy. So we give radiotherapy to them. They are very radiosensitive. They are malignant.
00:43:00They are always malignant. They are the most common germ cell tumor. So among the six germ
00:43:04cell tumor, they are in front of you. How many germ cell tumors in our syllabus? They are six.
00:43:09Among the germ cell tumor, which is most common, it's disgerminoma. It is not most common ovarian
00:43:13tumor. Please mind my words. The most common ovarian tumors are the cirrus tumors. Among the
00:43:18cirrus, it's surface epithelial tumors. Among the surface epithelial, cirrus followed by mucinus.
00:43:23Cirrus constitute 50%, mucinus constitute 30%. Among the germ cell, the six germ cell,
00:43:28disgerminoma is most common. So disgerminoma is the most common among these six, not the overall
00:43:32ovarian tumor. So it's the most common malignant germ cell tumor. It is the most common malignancy,
00:43:38which is detected during pregnancy. It is the most common malignancy, which is detected during
00:43:42pregnancy. So learn two most common. It is the most common germ cell tumor, not ovarian tumor,
00:43:47overall ovarian tumor. Overall ovarian tumor is the cirrus one. But among the germ cell,
00:43:51this is the most common. And it is the most common malignancy detected during pregnancy.
00:43:54It occurs in adolescent and young females, 20 to 30 years of age. So it occurs in young age. And
00:44:00tumor marker, PLAP and LDH. PLAP is placental alkaline phosphatase. Placental alkaline
00:44:06phosphatase. Placental alkaline. It is not placental acid phosphatase. Please mind.
00:44:10Sometime you get MCQ and MCQ. One of the option is placental acid phosphatase. Don't go with that.
00:44:15It is placental alkaline phosphatase and LDH. And here, alpha-petoprotein and beta-SCG are
00:44:21not raised, which are raised in another germ cell tumor, but it is negative here. So LDH and PLAP.
00:44:26Grossly, it is lobulated. Yellow color, lobulated. Highlight the word lobulated.
00:44:32It's unilateral. It's oval. It's encapsulated. You can see it's unilateral. It's oval. It's
00:44:37encapsulated and cut surface is yellow, lobulated. Highlight the word lobulated.
00:44:43See the microscopy. In the microscopy also, you can see the tumor cells are arranged in lobules.
00:44:47Can I highlight the lobules? Yes. These are the lobules. So the entire tumor, can you see the
00:44:52lobules in the gross? The same lobules in the microscopy. So the tumors, the entire tumor is
00:44:57divided into multiple lobules. You can appreciate the lobules I'm drawing here. These are the
00:45:01lobules. So who's drawing, who's separating the tumor into the lobules? What is this yellow color
00:45:06I have marked here? What is this yellow color? It is the fibrous septa. So with the help of fibrous
00:45:11septa, the entire tumor is divided into lobules. First, you learn the tumor is divided into
00:45:17lobules by fibrous septa, fibrous stroma or fibrous septa. The yellow color I have drawn
00:45:23here is the fibrous septa or fibrous stroma. Now say about one tumor cell. Take any of the tumor
00:45:28cell and you can zoom it out. You can see any tumor cell. See this one. See this one. Tumor
00:45:32cells are uniform. They all are looking same. They are large. They have a central vesicular nucleus
00:45:37and they have a clear cytoplasm. Cytoplasm is not pink. You can see the tumor cell. You can see the
00:45:41nucleus. You can see the tumor cell, central nucleus. Okay. So they have a, they are large cell.
00:45:48They are clear. They have clear cytoplasm. Cytoplasm is not pink. So that is the description
00:45:52of the tumor cell. Now there is a, there is a peculiarity in this tumor. What is the peculiarity?
00:45:56Can you see the fibrous stroma which is separating the tumor into lobules? The yellow color I mean in
00:46:01this diagram. I have highlighted with yellow marker. Can you see that? Can you see the tumor
00:46:05cells in the stroma also? Can you see these tumor cells? Tumor cells present in the fibrous septa.
00:46:11The tumor cells present in the fibrous stroma or fibrous septa. The tumor cells which are highlighted
00:46:15with yellow color. They are not tumor cells. They are lymphocyte. Please see. You can see the
00:46:19difference I guess. I am removing the highlighter. Have a look here. Appreciate. The tumor cells are
00:46:25different. You can see the big polygonal cell with clear cytoplasm. They are different.
00:46:29And these cells which are present in the fibrous stroma. Can you see these cells which are present
00:46:33in the fibrous stroma? These cells. These are different. They are not tumor cells. They are
00:46:37lymphocyte. So the highlighting feature is lymphocytic infiltration of the fibrous septa
00:46:41which is the very highlighting peculiar feature here. So that is the dysgerminoma. Prognosis is
00:46:46very good. Five year survival is 100% after radio and chemo. They are responsive to radio and chemo.
00:46:52So we give radio and chemo and we do the surgery also. Although they are malignant,
00:46:56but prognosis is very good. 100% survival after five years. So prognosis is very good. So we are
00:47:01done with the first one dysgerminoma. Can we revise it? In the introduction, write down among
00:47:05the germ cell tumor. This one is the most common. It is always malignant. So write down two things
00:47:12here. In the introduction, you can write down it is very radio sensitive. Okay. So we give
00:47:17radiotherapy as a treatment and it is the counterpart of seminoma. In males, it is
00:47:21seminoma. It is the counterpart of seminoma in females. That is dysgerminoma. In the most common,
00:47:26write down two most common. Among the GCT, it is the most common GCT. And it is the most common
00:47:31tumor which is detected during pregnancy. It is the most common ovarian tumor which is detected
00:47:35during pregnancy. Age group, it occurs in young female 20 to 30 years. Tumor marker, it is
00:47:40positive for PLAP and LDH. It is negative for HCG and alpha-beta protein. Gross, write down
00:47:49one word. Lobulated, it is divided into multiple lobules. Yellowish, lobulated, well circumscribed,
00:47:54oval in appearance. Microscopy, I will draw. Prognosis is very good. 100% survival after
00:47:59five years. After radiotherapy, chemotherapy and surgery. Microscopy, you have to draw like this.
00:48:05You have to draw the tumor into multiple small, small lobules with fibrous sector.
00:48:10These are the fibrous sector I am drawing. Draw the tumor cells inside them. Draw the tumor cells
00:48:14are big, polygonal, with a central enlarged vesicular nucleus and clear cytoplasm. Don't
00:48:19fill the color in the cytoplasm. So, this is the tumor cell, they are looking uniform. So,
00:48:23they are uniform, they are enlarged, they are polygonal, they have a central vesicular nucleus
00:48:27and clear cytoplasm. You have to mention like that. But the highlighting feature is the fibrous
00:48:32sector. The fibrous sector contain lymphocyte, many lymphocytes in that. So, I will draw the
00:48:37lymphocytes in the fibrous sector, I will label it as lymphocytic infiltration. So,
00:48:40that is the highlighting feature. So, that is we are done with Dysgerminoma.
00:48:44So, coming on the next one, York Sack Tumor. Coming on the next one, York Sack Tumor.
00:48:48Learn the other name. York Sack Tumor, also known as Endodermal Sinus Tumor. It is very malignant,
00:48:53very aggressive and rapidly growing tumor. Learn the introduction. Very malignant, very rapidly
00:48:58growing, very aggressive tumor and learn its other name. Sometimes you can get a question
00:49:01on Endodermal Sinus Tumor. So, even if you don't know, it is the other name of the York Sack Tumor,
00:49:06even you know the answer, you cannot write it. So, it is the other name given to the York Sack,
00:49:10please mind it, learn all synonyms. What is the most common? It is the second most common
00:49:15germ cell tumor. How many germ cell tumor are there? There are 6. YEDE, PCT. Among these 6
00:49:20most common is Dysgerminoma and second most common is York Sack. So, it is not most common,
00:49:25but second most common. And it is the most deadly, I mean most aggressive among all the
00:49:31ovarian tumors. It is very deadly, prognosis is very poor. It is the most deadly tumor
00:49:35among all germ cell tumor. Although it is second most common, but among all germ cell tumor,
00:49:40most aggressive is this one, I mean to say. Here Dysgerminoma is most common, but prognosis is
00:49:44very good, 100% survival after 5 years. It occurs in children or young female, children or young
00:49:49female. The tumor markers alpha-fetoprotein and alpha-1-antitrypsin. Alpha-fetoprotein
00:49:53or alpha-1-antitrypsin, learn the two tumor markers. It is not plaque, it is not LDH like the
00:49:59Dysgerminoma, please learn. Grossly, it is unilateral and having high areas of hemorrhage
00:50:04and necrosis. High areas of hemorrhage and necrosis, it is very dirty looking tumor.
00:50:09Microscopically, there is a very important feature. The tumor cells are arranged in multiple
00:50:15pattern, most important reticular pattern. Reticular is like a sieve. Can you see the
00:50:19arrangement of the tumor cell? They are arranged like a sieve like pattern. They are arranged,
00:50:25can you see the spaces in between? Have you seen a sieve? So, sieve like pattern is known
00:50:29as reticular arrangement. The tumor cells are arranged in a sieve like pattern. Number one,
00:50:32the tumor cells are small cuboidal, okay and there is a very peculiar feature. The tumor
00:50:37cells are arranged around the blood vessels. See, this is a blood vessel at the center,
00:50:40the blood vessel at the center and see the tumor cells. Let me draw the tumor cells.
00:50:43The tumor cells are arranged around the blood vessel, number one, perivascular arrangement,
00:50:49number one, okay and after forming perivascular arrangement, they show the papillary projections
00:50:54in the blood vessel. This, this particular feature, this particular body in which there is a
00:50:59blood vessel at the center and tumor cells are arranged around that, sending the papillary
00:51:02projections to the blood vessel, it is known as Schiller dual body. What it is known as?
00:51:07Schiller dual body. So, Schiller dual body is a highlight here. So, if you are writing this
00:51:11answer in your exam, you have to highlight it so that the examiner can see it, you know about the
00:51:15Schiller dual body. You have to draw it, you have to label it. What is Schiller dual body?
00:51:19See the description, see the description. It is a glomerulus like body having a central
00:51:23blood vessel. It is surrounded by the tumor cells and they are showing, throwing the papillary
00:51:28projections in the blood vessel and the tumor cells show highline droplets also. Let me show
00:51:32you the next image. It's not there. So, in this image only, you can see some of the tumor cells
00:51:36having, not all, but some of the tumor cells have pink color material inside them in the
00:51:40sidulosome that is highline droplets. So, sometime highline droplets are also present in the tumor
00:51:44cell. So, that is about, and prognosis is very aggressive, they are poor. The prognosis is very
00:51:48bad. So, that is all about the Yorksac tumor. We are done with the germinoma, we are done with
00:51:52Yorksac, we will do teratoma also, then we will revise the three together. Coming on the last one,
00:51:56teratoma. Teratoma arises from the totipotent cell. In human body, there are three germ cell.
00:52:01Entire human body is made up of one of the three germ cell layer, actoderm, mesoderm and endoderm.
00:52:05So, one organ is made up of one germ cell. So, all the tumors have one germ cell, but teratoma
00:52:10are unique tumor. The teratoma arise from the totipotent cell. The totipotent cell have the
00:52:15capacity, they can differentiate in all three germ cell layers. So, they can differentiate in
00:52:19actoderm as well as mesoderm as well as endoderm. So, here it is a tumor which contain all three
00:52:23component. It contain actoderm component also, mesoderm component also and endoderm component
00:52:28also. So, please learn that is a very important highlight you have to learn in the introduction.
00:52:32It is the most common benign tumor of the ovary, benign tumor of the ovary in reproductive age
00:52:36group. It is most common benign tumor diagnosed during pregnancy. Most common tumor diagnosed
00:52:41during pregnancy is this germinoma, I told you, but that is malignant. Most common benign tumor
00:52:45diagnosed during pregnancy is teratoma. It is the most common germ cell tumor. So, I told you six
00:52:50germ cell tumor. YEDPCT. YEDPCT. Please understand, if I say most common germ cell tumor,
00:52:58answer is teratoma, but it's benign. Most common malignant germ cell tumor, answer is dysgerminoma.
00:53:03It is the most common. So, most common benign germ cell tumor is teratoma. Most common malignant
00:53:08germ cell tumor is dysgerminoma and second most common malignant tumor is the yolk sac. I have
00:53:13told you these three I am teaching you. Okay. It is the most common tumor which undergo torsion also.
00:53:17So, please learn, please learn. So, how many tumors we have germ cell tumor? YEDPCT. So, if I
00:53:24say most common benign tumor among the germ cell, it's teratoma. Most common malignant tumor among
00:53:31the germ cell, among these six we are talking, it's dysgerminoma. Second most common malignant
00:53:35tumor is the yolk sac also known as endodermal sinus tumor. Okay. The first thing you have to
00:53:40learn that most common benign tumor diagnosed during pregnancy is teratoma and most common
00:53:45malignant tumor diagnosed during pregnancy is dysgerminoma. Not only this, teratoma is the
00:53:50most common tumor which undergo torsion also. So, please learn the most common. I have written all
00:53:54most common at one place. It occurs at reproductive age 40 to 50 years. Here alpha-fetoprotein will
00:53:59rise. The tumor marker is the alpha-fetoprotein. Please learn the tumor marker of all three at one
00:54:03place. Okay. It is of three types. The teratomas are of three types, benign, malignant. The benign
00:54:09is known as mature teratoma. The malignant is known as immature teratoma and the third is a
00:54:13special teratoma known as monodermal teratoma. So, I will teach you the gross of all three and
00:54:17the microscopy of all three. So, we have to see the gross and microscopy of all three one by one.
00:54:22Let's start the mature teratoma known as benign teratoma. Mature teratoma is benign teratoma. It
00:54:27is also known as dermoid cyst. It contains only ectodermal elements. So, inside the tumor,
00:54:32it is grossly cystic. It is cystic and it is having one solid component. It is entirely cystic.
00:54:38Can you see? Complete cyst and it is having a one solid component, only one. The one solid
00:54:43component is known as Rokitensky protuberance. It's a catchy word you have to learn. So,
00:54:47it's completely cystic and inside the complete cyst, only one solid prominent area is there.
00:54:53That solid prominent area is known as Rokitensky protuberance and it contains only ectodermal
00:54:57elements. It contains teeth and hair. You know the teeth and the hair. Yes, the teeth and hair
00:55:02inside the ovarian tumors. So, teeth and hair, the ectodermal elements inside the ovarian tumor,
00:55:06the teratoma, the benign teratoma. It contains the teeth, hair, bone, cartilage, the ectodermal
00:55:11elements. But if you see the microscopy, they all are benign. So, in the microscopy, you can
00:55:15see ectodermal elements also, mesodermal also, endodermal also. So, technically, you can find
00:55:20anything. Mostly it is ectodermal, but mesodermal and endodermal can also be found. So, you can see
00:55:25the cartilage, you can see the glands. So, you can see the skin, you can see the lining, columnar
00:55:31lining. So, technically, you can find anything. Whatever you draw, you will be correct.
00:55:36Now, in your university exam, most of the time you draw anything, but you don't get marks. But
00:55:39benign teratoma is such a thing, you draw anything, I will give you marks. You draw anything,
00:55:43anything. You draw skin, you draw brain, you draw smooth muscle, you draw cartilage, you draw bone,
00:55:48you draw respiratory tract, you draw GIT, you draw throat, whatever you wish, you draw it.
00:55:53You draw it, I will give you marks. It's teratoma. It can contain anything. So,
00:55:56there is no fixed pattern. I must explain this is a fixed pattern. No, there is no fixed pattern.
00:56:00It can contain anything. So, whatever you know how to draw, just draw it, but it should be benign.
00:56:04It shouldn't have any ATP. The malignant one, the immature teratoma, they contain the embryonal
00:56:09structures. They contain the embryonal structures. Grossly, they are the solid
00:56:12masses having variegated appearance and microscopically here also all three
00:56:17actoderm, mesoderm and adoderm, the three germ cell layer elements are there.
00:56:20So, here also you can see the glands, salivary glands, neural tissue, nerves, you can see
00:56:25everything, but they are immature. Immature element also, embryonal element also you will find. So,
00:56:30that is the malignant one. And third are important, the monodermal one. They are known
00:56:35as specialized teratoma. They contain only thyroid inside them. Yes, grossly also, microscopically
00:56:40also, they contain only thyroid inside them. So, the ovary is looking like the thyroid.
00:56:45It's an ovarian tumor. If you cut, you will find thyroid inside the ovary. Oh my God,
00:56:48microscopically also you are getting the thyroid. Can you see it's the follicles?
00:56:52You know how to draw normal thyroid. It's looking like a thyroid tissue. Actually,
00:56:55it's a thyroid tissue only. You can see the follicles containing the colloid inside them.
00:56:59So, the follicles containing the colloid inside them. It's a follicular adenoma like pattern
00:57:04and grossly also it's cystic containing the thyroid tissue. So, that's all about it. See
00:57:08the three types of teratoma in front of you. So, there are three types of teratoma, the mature,
00:57:12immature and monodermal. The mature one are the benign, the immature one are the malignant
00:57:17and monodermal are the specialized teratoma. Have a look on the draws of all three.
00:57:21So, the mature one are cystic in appearance. They are completely cystic. Okay, let me use
00:57:28another color. So, they are completely cystic in appearance, you can see, but they have one
00:57:34solid area. You can see they have one solid area, which contain all the ectodermal element. It
00:57:39contains teeth, hair, bone, cartilage. So, it is known as Rokitensky protuberance. In the immature
00:57:44one, the cut surface is completely solid. This one was cystic with one solid area, one solid area.
00:57:50This one is completely solid, having high areas of necrosis, hemorrhage, variegated appearance.
00:57:55This one have the thyroid tissue. It is solid and having thyroid, solid cystic having thyroid
00:57:59tissue. So, see the bronze is very peculiar. Now, have a look on the microscopy. Here you draw
00:58:03anything, but that should be benign. Here you draw anything, but along with the immature element,
00:58:08the malignant element and here you draw the thyroid. So, it's very easy to draw the microscopy
00:58:13also. Prognosis, mature teratoma are benign, they have good prognosis. Immature or malignant,
00:58:17they have poor prognosis. So, that is a prognosis. So, we are done with the germ cell tumor.
00:58:22I taught you three germ cell tumor, dysgerminoma, yolk sac tumor and teratoma.
00:58:26I told you the most common for each of them. So, most common germ cell tumor,
00:58:30the benign germ cell tumor is teratoma. Most common malignant germ cell tumor is dysgerminoma
00:58:35and second most common malignant germ cell tumor is yolk sac tumor. You have to learn the most
00:58:39common. Most common tumor diagnosed during pregnancy, the benign one is teratoma and the
00:58:43malignant one, the same dysgerminoma. Most common tumor which undergo torsion is the teratoma. So,
00:58:48learn the most common of all of them. Learn the age group. This occur 20 to 30 year,
00:58:52this occur in children and young female, this occurs again 20 to 40 year. So, the age group
00:58:58is this. Okay. Tumor markers are very peculiar. You have to learn the tumor markers. What are the
00:59:02tumor markers of dysgerminoma? Yolk sac, also known as endodermal sinus tumor and teratoma.
00:59:09Can you tell me the tumor markers? Dysgerminoma have PLAP. PLAP, placental alkaline phosphatase,
00:59:15PLAP. And along with PLAP, it is LDH. Okay. In the yolk sac, it is alpha-fetoprotein. You can
00:59:21learn alpha-fetoprotein, AFP. We say it as AFP or alpha-1-endotrypsin. Learn both the alphas.
00:59:28Okay. And in the teratoma, it's AFP, which is elevated along with LDH. Okay. So, you can learn
00:59:33like that. So, learn the tumor markers thoroughly people, please. And in the cirrus tumor, I told
00:59:38you it was CA125. Okay. That is a tumor marker. And growth and microscopy, I have shown you. So,
00:59:43see the growth of dysgerminoma, see the growth of yolk sac tumor, growth and microscopy, I have
00:59:50just discussed. Okay. So, that's all about it. So, we have discussed the cirrus tumor, I mean,
00:59:56epithelial tumors. Among the epithelial tumors, I discussed two tumors, cirrus and mucinus. So,
01:00:00please make this comparative table. I mean, it is already there. Just fill it so that it fit in your
01:00:04memory permanently. And I discussed the germ cell tumor. Among the six germ cell tumor, I discussed
01:00:09three in detail, dysgerminoma, yolk sac tumor and teratoma. That's all about it. Thank you.
01:00:13Don't forget to have a look on all the long, short, very short questions along with the
01:00:17answers of this topic given in the notes as well as question bank. Thank you.