Pelvic mass of ovarian/adenexal origin


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Pelvic mass of ovarian/adenexal origin

  2. 2. Differentials Diagnosis Ovarian Adnexal Uterine Gastrointestinal Bladder,Kidney,Peritoneal
  3. 3. OVARIANBenign Ovarian Malignant Ovarian Neoplasm Neoplasm Physiological Cysts
  4. 4. Physiological cyst This groups includes follicular,corpus lteal and theca luteal cyst Usu <5cm, have thin wall and well encapsulated Usu unilocular & contain clear fluid Follicular cyst Results from unruptured Graafian follicle/failure of atresia in non-dominant follicle Seldom >5cm (May achieve up to 10cm) Thin wall + well encapsulated May resolve spontaneously f/up every month for 3 months; US guided asp/ laparoscopy Corpus luteum cyst – progesterone prod  Occurs when corpus luteum cyst become ruptured or bleeding occurs into it and subsequently fails to regress  Size similar to follicular cyst and usually regresses with time  Patient can present with acute abdomen if bleeding occurs and the cyst rupture.  Treatment:Analgelsia /surgery Theca luteal cyst-associated with multiple pregnancy.Most resolved spontaneously.
  5. 5. OVARIAN TUMOURSBenign epithelial tumours Malignant Serous & mucinous PRIMARY: cystadenoma  Epithelial cell Brenner tumour  Germ cell Endometriod cystadenoma  Sex Cord StromaBenign germ cell T SECONDARY: Mature teratoma  Metastatic eg: Krukenberg Dermoid cyst tumourB. Sex cord stromal T. Theca cell Sertoli- leydig tumour Granulosa cell
  6. 6. 40+ years
  7. 7. Epithelial TumoursArise from the simple cuboidal surface epithelium of the ovaryAccount for 80-85% of all ovarian tumoursClassified according to the following histological subtypeo serouso mucinouso endometrioido clear cello Brennero undifferentiated.Each subtype can be classified as benign, borderline (low malignantpotential, LMP), or malignant (invasive).Usu found in postmenopausal women (mean presentation age is 56 years )
  8. 8. serous tumours mucinous tumours Benign (60%)  Benign (25%) - unilocular  Single layer of tall, columnar  single layer of flattened or cells cuboidal epithelium and the  Unilateral, multilocular absence of mitoses.  The cyst fluid is thick, yellow  Cyst fluid is clear, thin and ,glutinous + mucin-producing colourless. cells  Papillae formation  Malignant Malignant (25%)  Solid CA in the wall  multiloculated  Columnar cell, mitoses  partially cystic, partially solid tumours with friable papillae.  Capsule smooth or irregular or show papillary projections.
  9. 9. Papillary serous cystadenocarcinoma. Note the many papillations on the inner surface. Papillary serous cystadenocarcinomaComposed of solid tissue and hasinvaded outside of the ovary, withpapillations seen over the surface.
  10. 10. Germ Cell Tumours Derived from primitive germ cells of the embryonic gonad, and may undergo germinomatous or embryonic differentiation. Affecting young women (peak incidence is early 20s accounting for more than 50 % ovarian tumour of this age group)
  11. 11. TERATOMA (dermoid cysts)•Unilocular cyst (<15cm)•Contain sebaceous glands, teeth, hair, nervous tissue, cartilage, bone,resp & intestinal & thyroid tissue•Long pedicle, heavy & easily undergo torsion•Histologically, a variety of mature tissue elements may be found.•Most common presentaion is acute onset of pain &sudden onset nausea Bilateral mature cystic teratoma Opened mature cystic of ovary. A ball of hair & mixture of tissue
  12. 12. Sex Cord Stromal TumoursDevelop from the gonadal stromaAccount for 5-10 % of all ovarian neoplasmsSubdivided into the following clinicopathological entities: Granulosa cell tumour estrogen producing tumour Theca cell tumour androgen producing tumour Sertoli-Leydig cell tumour - Ovarian Fibroma – Meig’s syndrome: ascites, pleural eff, fibroma – 1%
  13. 13. •Derived frm the ovarian stroma and mostly malignant. •Produce large amounts of estrogen. •Accelerated skeletal growth & appearance of sex hair •5% (children) – precocious puberty •60% (childbearing age) – irreg menses •30% (post-menopausal) – PM bleedingGranulosa cell tumour withvariegated cut surface. Estrogen excess causes hyperplasia of: 1. Myometrium ~ enlarged uterus 2. Endometrium ~ irreg Granulosa cell tumour has bleeding. Occ amenorrhea nests of cells which are forming primitive follicles. 3. Mammary gland tissue ~ enlargement, tender
  14. 14. Metastatic TumoursMost common: from breast carcinomaalso from: colon ca endometrial caKrukenberg tumour 1° growth : stomach, Age 30 – 40 yrs Clinically silent Bilat, equal size, mobile, smooth & lobulated HPE : very cellular stroma : signet-ring appearance + clear mucin- filled cytoplasm
  15. 15. Krukenberg tumor of ovaryMetastatic adenocarcinoma to ovary appears as a large mass andresembles a primary tumor:Seen here extending out of the pelvis at autopsy is a large right ovarianmass. Metastases are also present in the lower right portion of liver.
  16. 16. Adnexal/Tubal Endometrioma Hydrosalphinx Tubo-Ovarian Abcess
  17. 17. Endometrioma/ endometrioidcyst Part of the condition known as endometriosis. Commonly seen in nulliparaous/women of reproductive years.It may cause pelvic pain associated with menstruation. ‘Chocolate cyst’, often filled with dark, reddish- brown blood, may range in size from 0.75-8 inches Th cyst arise from recurrent bleeding from endometric foci placed within substance of ovary.
  18. 18. Hydrosalphinx Tubal masses that – a long-term sequale of pelvic inflammatory disease. The tubes are dilated & distended with clear fluid. Hydrosalpinx fluid is highly embryotoxic and is a likely cause for the decreased fertility in women with a hydrosalpinx. In fact, spontaneous abortion risk is doubled.
  19. 19. Tubo-Ovarian Abcess Collection of pus and bacteria within the part of the fallopian tube. Symptoms include lower abdominal pain, back pain, vaginal discharge and fever. Treatment includes antibiotic and NSAIDS.In severe abcess may require narcotic pain medication and drainage of abcess/surgery.