BENIGN OVARIAN TUMORS

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BENIGN OVARIAN TUMORS

• Dr. Mashael Al-Shebaili
• Asst. Prof. Consultant
• Ob/Gyn Dept.

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• Ovaries are normally not palpable in
  pre-menarche, and after the menopause
• In the reproductive age group ovaries are
  palpable in the lean pts.
• Ovarian size of different age groups
• Premenopause 3.5 x 2 x 1.5 cm
• Early menopause 1 2 yrs
• 2 x 1.5x0.5cm
• Late menopause 2-5yrs 1.5x0.75x0.5cm

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• If the ovaries are palpable in any of the age
  groups when it is not supposed to be through
  investigations and work up should be carried out
• OVARIAN CYSTS CAN BE CLASSIFIED AS FOLLOWS
• I. Functional Benign
• II Neoplastic borderline
• Malignant

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• FUNCTIONAL OVARIAN CYSTS INCLUDES
• a. Follicular cysts
• b. Corpus luteum cysts
• c. Theca luten cysts
• BENIGN OVARIAN NEOPLASM
• 1. Serous cystadenoma
• 2. Mucinous cystadenoma
• 3. Endometrioma
• 4. Dermoid cysts
• 5. Fibroma

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• FUNCTIONAL CYSTS
• These are cysts related to ovarian function i.e.
  the process of ovulation
• They are the most common detected cysts in the
  reproductive age group
• Can be reach up to 10 cm in diameter
• Resolve spontaneously.

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• Follicular cysts results from the growth of a
  follicle that does not rupture
• Corpus luteum cyst results from Hge inside a
  corpus luteum
• Theca luteum cysts result from over stimulation
  of the ovary by HCG. Not common in normal
  pregnancy but common in molar pregnancy,
  choriocarcinoma and reproductive technology

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• Benign ovarian neoplasia
• - 80 of ovarian neoplasm
• are benign
• - Benign ovarian neoplasm can be solid or
  cystic

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• Serous Cystadenoma (Commonest)
• - Usually do not reach very large sizes
• - unilocular or multilocular
• - smooth surface
• - fluid filled

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• MUCINOUS CYSTADENOMA
• - May reach very large size
• - Filled with thick mucinous material
• - Perforation may lead to a serious
  condition called pseudomyxoma peritonei for
  which chemotherapy may be needed.
• ENDOMETRIOMA (Chocolate cysts)
• - Associated with endometriosis

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• DERMOID CYSTS OR BENIGN CYSTIC TERATOMA
• - Usually small and may be bilateral
• - Contain sebum, hair, teeth etc.
• - Contains elements from endoderm
• mesoderm and ectoderm
• - Can change into malignant teratoma
• - Avoid spilling of contents which leads
• to chemical peritonitis

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• FIBROMA
• - Firm in consistency
• Meigs syndrome
• Ovarian fibroma ascites, hydrothorax
• following removal of fibroma, there is
  spontaneous resolution of ascites and hydrothorax

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• Clinical signs and symptoms of ovarian masses
• 1. ? abdominal girth
• 2. Abdominal discomfort
• 3. Pressure symptoms bladder
• bowel
• 4. Acute abdomen due to
• - Hge
• - Rupture
• - Torsion
• 5. Asymptomatic coincidentally diagnosed

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• RADIOLOGICAL FEATURES OF BENIGN OVARIAN MASSES
• 1. Unilocular
• 2. Smooth surface
• 3. No solid elements
• 4. No external or internal outgrowth
• 5. No ascites
• 6. Unilateral
• 7. Normal doppler flow

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• CLINICAL FEATURES OF BENIGN OVARIAN TUMORS
• ? Unilateral
• ? Cystic
• ? Mobile
• ? No ascites
• ? No cul de-sac nodules
• ? Slow or no growth

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• EVALUATION OF THE PATIENT WITH OVA ADNEXAL MASS.
• ? Complete Hx and physical exam
• ? U/S
• ? CT scan with contract or IVP
• ? Ba enema or colonoscopy
• ? Laparoscopy or laparotomy accordingly

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• INDICATIOONS FOR SURGERY
• ? Ovarian cyst gt5 cm followed for 6- 8wks.
• ? Solid lesions
• ? Papillary vegitation
• ? Mass gt10 cm at the time of presentations
• ? Ascites
• ? Palpable mass in premenarchal or post
  menopausal
• ? Suspicion of torsion or rupture