Book 4 - Self Instructional Manual for Cancer Registrars - SEER ...

OvariesThe ovaries, female gonads1, are the shape and size of large almonds and are located one oneither side of the uterus, below and behind the fallopian tubes. Each ovary lies between the foldsof the broad ligament and is attached to its posterior surface by the mesovarian ligament. Theovarian ligament anchors it to the uterus. The distal portion of the fallopian tube curves about theovary so that a fimbriated cup hangs over each ovary but is not actually attached to it. The ovary isan example of a gland whose duct is detached from it.Microscopically, the ovary consists of a layer of germinal epithelial cells and a layer of connectivetissue in which structures known as graafian follicles are embedded. When a graafian follicle matures(usually one per month alternating between right and left ovaries), it expels an ovum. This processis called ovulation. After ovulation, the wall of the follicle is transformed into an endocrine gland,the corpus luteum, which secretes progesterone and some estradiol. The corpus luteum lasts onlyabout 12-14 days if the ovum is not fertilized; it then deteriorates into a small fibrous cicatrix.2When the ovum has been fertilized, it travels to the uterus and becomes embedded in endometrialtissue. The developing trophoblast3 produces hormones (chorionic gonadotrophins) which stimulatethe corpus luteum to increase in size and to prolong its production of progesterone which furthersthe developing of the endometrium and the anchoring and nurturing of the embryo. Near the endof pregnancy, the corpus luteum shrinks and over a period of months undergoes the samedegenerative changes as when the ovum is not fertilized.The development and activities of the graafian follicle and of the corpus luteum are triggered byhormones secreted by the pituitary gland. However, as indicated above, the ovary itself has ahormonal function. During the maturation of the graafian follicle, certain ceils (thecal andgranulosal) surrounding or sheathing the developing ovum produce estrogenic hormones, mainlyestradiol and estrone. These cells are replaced by the luteai cells after ovulation. The normal cyclicalprocess of menstruation, with development and degeneration of endometrial cells, is governed bythese hormonal activities of the pituitary and the ovaries.Regional Lymph NodesRegional lymph node metastasis from the ovary is infrequent, but when it occurs it is primarily tothe para-aortic nodes. However, any of the following may be considered regional lymph nodesdraining the ovaries:Pelvic lymph nodes:Common iliacInternal iliac (hypogastric, including obturator)External iliacLateral sacralAortic (para-, peri-, lateral)Inguinal (rare)1gonads--organs which produce sex cells--ovaries and testes.2cicatrix--scar resulting from formation and contraction of fibrous tissue.3trophoblast--the ectodermal layer covering and attaching the embryo to the uterine wall andsupplying nutrition for it.281