BENIGN OVARIAN BENIGN OVARIAN TUMORSTUMORS

Dr. Mashael Al-ShebailiDr. Mashael Al-Shebaili

Asst. Prof. & ConsultantAsst. Prof. & Consultant

Ob/Gyn Dept.Ob/Gyn Dept.

Ovaries are normally not palpable in Ovaries are normally not palpable in pre-menarche, and after the pre-menarche, and after the menopausemenopause

In the reproductive age group In the reproductive age group ovaries are palpable in the lean pts.ovaries are palpable in the lean pts.

Ovarian size of different age groupsOvarian size of different age groups

Premenopause 3.5 x 2 x 1.5 cmPremenopause 3.5 x 2 x 1.5 cm

Early menopause 1 – 2 yrs Early menopause 1 – 2 yrs

2 x 1.5x0.5cm2 x 1.5x0.5cm

Late menopause 2-5yrs Late menopause 2-5yrs 1.5x0.75x0.5cm1.5x0.75x0.5cm

If the ovaries are palpable in any of If the ovaries are palpable in any of the age groups when it is not the age groups when it is not supposed to be through supposed to be through investigations and work up should be investigations and work up should be carried outcarried out

OVARIAN CYSTS CAN BE CLASSIFIED OVARIAN CYSTS CAN BE CLASSIFIED AS FOLLOWS:AS FOLLOWS:

I.I. FunctionalFunctional BenignBenign

IIII NeoplasticNeoplastic borderlineborderline

MalignantMalignant

FUNCTIONAL OVARIAN CYSTS FUNCTIONAL OVARIAN CYSTS INCLUDES:INCLUDES:a.a. Follicular cystsFollicular cystsb. Corpus luteum cystsb. Corpus luteum cystsc. Theca luten cystsc. Theca luten cysts

BENIGN OVARIAN NEOPLASMBENIGN OVARIAN NEOPLASM1.1. Serous cystadenomaSerous cystadenoma2. Mucinous cystadenoma2. Mucinous cystadenoma3. Endometrioma3. Endometrioma4. Dermoid cysts4. Dermoid cysts5. Fibroma5. Fibroma

FUNCTIONAL CYSTSFUNCTIONAL CYSTS- These are cysts related to ovarian These are cysts related to ovarian

function i.e. the process of ovulationfunction i.e. the process of ovulation

- They are the most common detected They are the most common detected cysts in the reproductive age groupcysts in the reproductive age group

- Can be reach up to 10 cm in diameterCan be reach up to 10 cm in diameter

- Resolve spontaneously.Resolve spontaneously.

Follicular cysts results from the Follicular cysts results from the growth of a follicle that does not growth of a follicle that does not rupturerupture

Corpus luteum cyst results from Corpus luteum cyst results from Hge inside a corpus luteumHge inside a corpus luteum

Theca luteum cysts result from Theca luteum cysts result from over stimulation of the ovary by over stimulation of the ovary by HCG. Not common in normal HCG. Not common in normal pregnancy but common in molar pregnancy but common in molar pregnancy, choriocarcinoma and pregnancy, choriocarcinoma and reproductive technologyreproductive technology

Benign ovarian neoplasiaBenign ovarian neoplasia

- 80% of ovarian - 80% of ovarian neoplasm neoplasm

are benignare benign

- Benign ovarian neoplasm - Benign ovarian neoplasm can be solid or cysticcan be solid or cystic

I.I. Serous Cystadenoma Serous Cystadenoma (Commonest(Commonest))

- Usually do not reach very - Usually do not reach very large sizes large sizes

- unilocular or multilocular- unilocular or multilocular

- smooth surface- smooth surface

- fluid filled- fluid filled

II.II. MUCINOUS CYSTADENOMAMUCINOUS CYSTADENOMA

- May reach very large size- May reach very large size

- Filled with thick mucinous material- Filled with thick mucinous material

- Perforation may lead to a serious - Perforation may lead to a serious condition called pseudomyxoma condition called pseudomyxoma

peritonei for which peritonei for which chemotherapy chemotherapy may be needed.may be needed.

III.III. ENDOMETRIOMA (Chocolate ENDOMETRIOMA (Chocolate cysts)cysts)-- Associated with endometriosisAssociated with endometriosis

IV.IV. DERMOID CYSTS OR BENIGN DERMOID CYSTS OR BENIGN CYSTIC TERATOMACYSTIC TERATOMA

- Usually small and may be bilateral- Usually small and may be bilateral

- Contain sebum, hair, teeth etc.- Contain sebum, hair, teeth etc.

- Contains elements from endoderm- Contains elements from endoderm

mesoderm and ectodermmesoderm and ectoderm

- Can change into malignant teratoma- Can change into malignant teratoma

- Avoid spilling of contents which leads- Avoid spilling of contents which leads

to chemical peritonitisto chemical peritonitis

V.V. FIBROMAFIBROMA

- Firm in consistency- Firm in consistency

* Meigs syndrome* Meigs syndrome

Ovarian fibroma + ascites, Ovarian fibroma + ascites, hydrothoraxhydrothorax

following removal of fibroma, following removal of fibroma, there is spontaneous resolution there is spontaneous resolution of ascites and hydrothoraxof ascites and hydrothorax

• Clinical signs and symptoms of ovarian Clinical signs and symptoms of ovarian masses:masses:

1.1. abdominal girth abdominal girth

2. Abdominal discomfort2. Abdominal discomfort

3. Pressure symptoms3. Pressure symptoms bladderbladder

bowelbowel

4. Acute abdomen due to4. Acute abdomen due to

-- HgeHge

-- RuptureRupture

-- TorsionTorsion

5. Asymptomatic coincidentally 5. Asymptomatic coincidentally diagnoseddiagnosed

• RADIOLOGICAL FEATURES OF RADIOLOGICAL FEATURES OF BENIGN OVARIAN MASSES:BENIGN OVARIAN MASSES:

1.1. UnilocularUnilocular

2.2. Smooth surfaceSmooth surface

3.3. No solid elementsNo solid elements

4.4. No external or internal No external or internal outgrowthoutgrowth

5.5. No ascitesNo ascites

6.6. UnilateralUnilateral

7. Normal doppler flow7. Normal doppler flow

• CLINICAL FEATURES OF BENIGN CLINICAL FEATURES OF BENIGN OVARIAN TUMORSOVARIAN TUMORS

UnilateralUnilateral

CysticCystic

MobileMobile

No ascitesNo ascites

No cul de-sac nodulesNo cul de-sac nodules

Slow or no growthSlow or no growth

EVALUATION OF THE PATIENT EVALUATION OF THE PATIENT WITH OVA ADNEXAL MASS.WITH OVA ADNEXAL MASS.

Complete Hx and physical Complete Hx and physical examexam

U/SU/S

CT scan with contract or IVPCT scan with contract or IVP

Ba enema or colonoscopyBa enema or colonoscopy

Laparoscopy or laparotomy Laparoscopy or laparotomy accordinglyaccordingly

• INDICATIOONS FOR SURGERYINDICATIOONS FOR SURGERY

Ovarian cyst >5 cm followed Ovarian cyst >5 cm followed for 6-for 6- 8wks.8wks. Solid lesionsSolid lesions Papillary vegitationPapillary vegitation Mass >10 cm at the time of Mass >10 cm at the time of

presentationspresentations AscitesAscites Palpable mass in Palpable mass in premenarchal or premenarchal or post post menopausalmenopausal Suspicion of torsion or ruptureSuspicion of torsion or rupture