diseases of the ovary
DESCRIPTION
Diseases of the ovary. Prof. Dr. Noorhan Shakir. Benign disease of ovary. Are common, frequently asymptomatic, resolve spontaneously. 90 % of all ovarian tumors are benign, although this varies with age, at 20 th only 5% while at postmenopausal age 45 % are malignant. - PowerPoint PPT PresentationTRANSCRIPT
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Diseases of the ovary
Prof. Dr. Noorhan Shakir
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Benign disease of ovary
• Are common, frequently asymptomatic, resolve spontaneously.
• 90% of all ovarian tumors are benign, although this varies with age, at 20th only 5% while at postmenopausal age 45% are malignant.
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The main objectives of management of
benign ovarian diseases To exclude malignancy & to avoid cyst accident without causing undue morbidity & impairing future fertility in young women.
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Causes according to the age
Young ,reproductive age Old age
Fuctional cyst, benign germ cell T.
Benign epithelial T.
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Causes of benign disease of ovary
Functional
Follicular cyst
Corpus luteal cystTheca luteal cyst
Inflammatory Tubo-ovarian abscess
Endometrioma
Germ cell Bengin teratoma
Epithelial Serous cystadenoma
Mucinous cystadenomaBrenner tumour
Sex cord stromalFibroma Thecoma
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Presentations *Asymptomatic; incidental by USS, ANC*Pain: 1-acute; Torsion, rupture, Hg, infection, malignant change. 2-Chronic; Lower abdominal pain as a result of pressure, endometriosis, infection. *Abdominal swelling ; Benign mucinous tumour may fill the entire abdominal cavity. *Pressure effect; GIT, urinary symptoms , oedema, varicosity, hemorrhoid, uterine prolaps. *Menstrual effects; Oestrogen effects as precocious puberty , the endometrial hyperplasia in premenopausal women will cause menorrhagia, in older age, breast enlargement, PMB. *Hormonal effect: Thyrotoxicosis. *Abnormal Pap smear; ovarian T. could be benign.
Benign & malignant diseases usually diagnosed by the presence of pelvi- abdominal mass .
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Common investigations
USS (TVS,TAS), CT scan or MRI Pregnancy test should be performed to exclude pregnancy.Inflammatory markers ; such as CRP and WBC, are D.D as appendicitis, tubo-ovarian abscess.
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Tumour makers used in ovarian carcinoma
Tumour makers Tumour type Uses
Ca 125 Epithelial O. cancer (serous),borderline O.T
Preoperative, follow up
Ca19-9 Epithelial O. cancer (mucinous), borderline O.T
Preoperative, follow up
Inhibin Granulosa cell tumour Follow up
Beta- hCG Dysgerminoma, Choriocarcinoma
Preoperative , follow up
AFP Endodermal yolk sac, teratoma Preoperative , follow up
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Functional cysts *The risk of functional cyst is reduced by use of contraceptive pill (OCCP) .
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Functional cysts
The follicular cyst • diagnosed by USS when size 3cm, • rarely reaches 10 cm in diameter. • It resolved spontaneously depends on
symptoms. • Treatment; if asymptomatic follow up by USS. If symptomatic: Laparoscopic cystectomy
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Functional cysts
Corpus luteal cyst When ovulation occurs bleeding continued so, the presentation; pain typically on late menstrual cycle, due to rapture or hemorrhage. it needs analgesia. • Rarely needs laparoscopic
pelvic washout or cystectomy.
• DD; ectopic pregnancy.
Theca luteal cyst • During pregnancy usually
resolve spontaneously.
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Inflammatory ovarian cyst
Most common in young age group is pelvic inflammatory diseases (PID).
Diagnosed clinically and by laboratory; ↑WBC & C reactive protein become positive.
Antibiotics, drainage, and excision ,while definitive surgery deferred after resolving acute state, because increased risk of systemic infection and difficulty of inflamed tissue.
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Endometrioma
Chocolate cyst; characteristic ground glass appearance by USS. Some time reaches up to 10cm in diameter.
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Germ cell Tumour
1-The ectodermal structures are predominates: its lined by epithelium like dermis (skin & its appendages, teeth, sebaceous material, hair).2-Endodermal (thyroid, intestine)3- Mesoderm (bone, cartilage, SMF).
Mesodermal tumour; means single tissue is present as carcinoid (serotonin) & Stroma ovarii (thyroid tissue hyperthyroidism) which contains hormonally active thyroid tissue.
Treatment ; Surgical excision of cystif torsion is complete---oophorectomy If viable ovary …cysectomy by laparotomy & laparoscopic often
Mature cystic teratoma ( dermoid cyst); It is arise from differentiations in to embryonic tissue & account 50% of all ovarian tumour, age around 30 ys & usually bilateral.
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=
Cystic teratomas (dermoid): second most common
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Epithelial cell tumours
1-Serous cystadenoma :These are the most common type, are cystic lined by cuboidal cell unilateral, at age before 40 years old. 70-75% of ovarian neoplasms are from surface.Serous tumours are more likely to be bilateral (20%) than mucinous(5%)
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2-Mucinous cystadenoma
It is 2nd common epithelial t,Typically are large unilateral multilocular with smooth inner surface,(14 kg) Lined with mucus- secreting columnar cell & thick ,gelatinous fluid in cyst.
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This is a mucinous cystadenoma of the ovary. Impressive.
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3-Brenner
They are small t. accidently found inside the ovary , Secrets estrogen.
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sex cord stromal tumours
All types are solid, hard, unilateral, mobile1-Fibroma: The most common T. arise from stroma cells. Presented with torsion because heavy weight. It might cause Meigs syndrome (ascites, pleural effusion). 2-Theca cell T ( Thecoma ): Occur at postmenopausal age . Almost all are benign produce estrogens which may cause endometrial cancer, DUB, precocious puberty.
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sex cord stromal tumours
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