Benign Ovarian Tumors

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Benign Ovarian Tumors
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Dr.Pravin Mhatre Associate Professor and Unit
incharge, Nowrosjee Wadia Maternity Hospital and
G.S. Medical college, Parel, Mumbai
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Solid Ovarian Tumors

• Child Germ cell
• Post pub. Germ cell, Dysgerminoma
• 20-35 Germ cell, Dysgerminoma
• 35-45 Thecoma, Metastatic
• Post meno. Thecoma, Metastatic
• Fibroma

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Solid Ovarian Tumors

• SMALL
• Brenner
• Fibroma
• Theca cell tumor
• Arrhenoblastoma
• Dysgerminoma

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Solid Ovarian Tumors

• MEDIUM SIZE
• Brenner
• Fibroma (Capsule)
• Granulosa cell tumor
• Teratoma
• Dysgerminoma (Capsule)
• Sarcoma

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Solid Ovarian Tumors

• LARGE SIZE
• Brenner
• Fibroma (Capsule-Pedicle)
• Krukenberg (Capsule-Pedicle)
• Carcinomata

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Cystic Ovarian Tumors

• Child Terratoma, Granulosa cell
• Post pub. Terrato, FOLL.
• 20-35 Terrato, FOLL. Epith(B/M)
• 35-45 Terrato, FOLL.
• Post meno. Epith(B/M)
• 
  

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Cystic Ovarian Tumors

• SMALL SIZE
• Follicular cyst
• Follicular hematoma
• Corpus Luteual cyst
• Corpus Luteual hematoma
• Dermoid (ped. Capsulated)

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Cystic Ovarian Tumors

• MEDIUM SIZE
• Cystoma simplex
• Granulosa Theca leutin cyst
• Papillary serous cystadenoma
• Granulosa
• Dermoid (ped. Capsulated)

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Cystic Ovarian Tumors

• LARGE SIZE
• Mucinous cystadenoma
• Serous cystadenoma

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Pedunculated Ovarian Tumors

• Child Teratoma
• Post pub. Teratoma
• 20-35 Teratoma, Mucinous
• 35-45 Teratoma, Mucinous
• Post meno. Krukenberg (long pedicle)
• Fibroma

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Capsulated Ovarian Tumors

• Child Terato, Granulosa cell.
• Post pub. Terato, GR.
• 20-35 Terato, GR., Mucin/Serous
• 35-45 Terato, GR., Mucin/serous
• Post meno. GR., Krukenberg, Sertoli.

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Unilateral Ovarian Tumors

• Child Terratoma
• Post pub. Terrato, FOLL.
• 20-35 Terrato, FOLL. Epith(B)
• Germ cell
• 35-45 Terrato, FOLL. Epith(B)
• Germ cell
• Post meno. Epith(B/M)

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Bilateral Ovarian Tumors

• Child Terratoma
• Post pub. Terrato,
• 20-35 Terrato, Epith(B)
• 35-45 Terrato, Epith(B)
• Post meno. Epith(B/M)

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Ovarian Tumors

• Ascites and Metastesis
• Child
• Post pub. Germ cell (M)
• 20-35 Epith(M)
• 35-45 Epith(M)
• Post meno. Epith(M)

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Ovarian Tumors Associations

• Mucinous Fibroma
• Mucinous Terratoma (same/opp)
• Mucinous Brenner

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Ovarian Tumors Associations

• Brenner Terratoma
• Granulosa cell tumor
• Mucinous cystadenoma

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Ovarian Tumors Associations

• Granulosa cell tumor
• Brenner
• Fibroma
• Terratoma
• Fibroid
• Endometrial hyperplasia
• Hyperthecosis

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Ovarian Tumors Associations

• Dermoid (Benign cystic terratoma)
• Granulosa cell tumor
• Thecoma
• Androblastoma

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SPECIMENS

• Dermoid
• Mucinous cystadenoma
• Meigs syndrome
• Dysgerminoma
• Granulosa cell Tumor
• Arrhenoblastoma
• Theca cell Tumor
• Brenner
• Krukenbergh
• fibroma

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Dermoid ( Benign cystic terratoma )

• 10 of all cystic swellings
• 12 bilateral
• Pedunculated
• Well capsulated
• 15 cm
• Common on Right side
• Multicentric

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Dermoid ( Benign cystic terratoma )

• Ectoderm Mesoderm Endoderm
• Supradiaphramatic structures
• Teeth permanent never deciduous
• Teeth canines,molars,incisors
• but never premolars
• No Gonadal tissue
• But assoc. with Granulosa
• Theca
• Androblastoma

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Dermoid ( Benign cystic terratoma )

• Complications
• Torsion 10
• Rupture 1
• Infection
• Hemolytic anemia-splenomegaly
• Malignancy

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Dermoid ( Benign cystic terratoma )

• Radiological Signs
• Presence of teeth and bone
• Halo sign due to thick capsule
• Calcification in capsule
• Commonest tumor _ pregnancy

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Dermoid ( Benign cystic terratoma )

• Dales sign
• Kustners sign

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Mucinous Cystadenoma

• 10 Bilat, 6 malignant
• Pedicle large size Complications
• Pseudomyxoma Peritonei -2-5
• Mucin- ppt by alcohol
• Pesudomucin-sol in water dil acid
• - stained by Hematoxyline.
• - high con of neutral polysaccharide.
• Silomucin res. to sialase Malign.
• Enzymes-Hyal, tryp, amyl, pep, peroxidase

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Meigs Syndrome

• Demons (Fra) Lawson Tait (Briton)
• Criteria for Meigs Syndrome (3)
• Psuedo-Meigs
• Theca/Granulosa Tumor
• Hyperstimulaion
• Ovarian malig.
• Struma ovari 10
• Serous/Mucinous

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Dysgerminoma

• 1906-Chevassu Dis neutral/disgermal
• 1911-Chenot Dys primitive germ cell
• yolk sac
  gonadal ridge
• same sex
  as host
• Japan India high incidence
• Age 20
• 50 unilateral Rt sided, 20 bilateral
• Size 3-50 cm ,common size 15cm.
• Intersex-xo,xy,xxx Fathalla /Mayers
• Teratoma, Gonadoblastoma, End.sinus

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Dysgerminoma

• Precos puberty
• Hirsut/virilisation due to Exosteroid
• Common assoc. with Pregnancy
• ve pregnancy test
• LDH monitoring
• Spread 20-30locally
• Lymphatic main
• Hematogenous -late

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Dysgerminoma

• Greshams criteria conservative treat.
• Unilat.,non adherent, Encapsulated
• Less than 10 cm
• Pure
• No ascities / Lymph node / spread
• No dysgenetic gonads / 46 xy
• Desired Fertility
• Close follow up

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Dysgerminoma

• Brodys survival
• Encapsulated 95
• Adherent
  75
• Rupture
  60
• Metastasis
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• Recurrence
• Con. Surg.
  22
• Radiation
  18
• Rad. Surg. 10

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Granulosa Cell Tumor

• Age 2 prepubertal
• 37 childbearing
• 61 postmenopausal
• Test /dhea /Androd5-estrone, estradiol
• Pregnanolone/progest-absent
• 50 malig. Granulosa cell carcinoma

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Granulosa Cell Tumor

• Poor Prognosis
• Age gt40
• Size gt15cm
• Abd. Symptoms
• Palpable mass
• Bilat. Tumor
• Solid tumor
• Extraovarian spread
• Neumerous mitotic figure

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Arrenhoblastoma

• Sertoli Leydig Mixed
• Rare rare rare
• 5cm lt5cm gt5cm
• Capsule no capsule
• 37 decade 34 decade
• Lob/solid/elastic fleshy / soft
• Peripheral hilar hilar
• Benign benign benign

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Arrenhoblastoma

• Sertoli Leydig Mixed
• Hormone
• 70 estr 80andr. 75andr.
• 20andr. 10estr.
• Assoc.
• Ut.anom streak gonad cort. hyper.
• End.hyp. Brgrmuci. Adenocar.

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Theca cell tumor

• Rare
• After menopause
• Always unilat.
• Benign
• Non capsulated
• 8cm
• Oestradiol secretion
• Assoc- der / fibroid / fibroma

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Brenner Tumor

• Rare
• Solid
• Postmenopausal
• Benign , ?malignant
• 99unilateral
• Walthard inclu. (origin) Werth1887, walthard1903
• Area of central liquif.,resembels Graff. foll.
  Oophoroma folli.
• Similar to theca cell, Estrogenic
• Lined by transitional cells.

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Krukenberg Tumor

• Large ,solid, long pedicle, capsulated.
• Waxy, ovarian shape, signet ring,
• Usually sec. Stomach 70
• Large bowel 18
• Breast 6
• Prim. Kruken. 5yr. Survival
• Autopsy no primary.
• 18 cases
• Retrograde spread.

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Fibroma

• Commonest solid benign ov. Tumor
• 15cm
• Torsion
• 3 Types - Surface pappillary growth
• - Small encap.Normal ov. Tissue
• - Fibroma replaces ovary