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Benign Tumors

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  • Human ovary has a remarkable propensity develop a wide variety of tumors, the majority of which are benign. Indeed, most ovarian tumors are non-neoplastic.
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    • 1. Benign Tumors of the Ovaries and Fallopian Tubes
    • 2. Introduction Differential Diagnosis of Ovarian Tumors Pathogenesis Specific Type Functional Follicular Cysts Lutein Cysts Theca-lutein cysts Inflammatory Oophoritis Salpingo-oophoritis Metaplastic Endometriosis Neoplastic Epithelial Sex Cord-Stromal Germ-Cell
    • 3. Functional Ovarian Tumors high gonadotropin Theca-lutein cysts (ovulation induction) (hydatidiform mole) (invasive mole) (choriocarcinoma) Pathogenesis ovarian follicle follicular cyst corpus luteum lutein cyst
    • 4. Functional Ovarian Tumors lutein cyst: Clinical Features asymptomatic, unilocular, < 6 cm in diameter, regress ovarian follicle cyst: more firm / solid,delay period undergo torsion: pain, tenderness and rebound ten-derness, moderate leukocytosis. rupture: pain, tenderness, hemoperitoneum. Theca-lutein cyst: high gonadotropin level, bilateral (10-15 cm) , regress
    • 5. Functional Ovarian Tumors Diagnosis Presumptive Diagnosis: 4 to 8 cm cystic adnexal mass is noted on bimanual examination mobile, unilateral, no ascites, < 8 cm Confirmed Diagnosis: regresses ovarian follicle cyst: in the middle of the menstruation lutein cyst: before the upcoming period Ultrasound Study: confirm the cystic nature of the mass, cannot excludes neoplastic tumor delayed menses / abnormal uterine bleeding / abdominal pain differentiate with ectopic pregnancy, salpingo-oophoritis, or torsion of a neoplastic cyst.
    • 6. Functional Ovarian Tumors painful, multilocular / Surgical Exploration partially solid Management child-bearing, <6 cm Reexamination (oral contraceptive) 6 cm to 8 cm / fixed / Ultrasound study feels solid > 40 years Observation not recommanded
    • 7. Functional Ovarian Tumors Management Surgical Exploration: Laparoscopy Laparotomy ovarian cystectomy Laparoscopic inspection may not be helpful in differentiating between a functional and a neoplastic ovarian cyst. An aspiration of a unilocular cyst and cytologic examination of the fluid may be misleading, and slow leakage of the fluid will disseminate cancer quite rapidly if the cyst is malignant.
    • 8. Epithelial Ovarian Neoplasms mesothelial cells cervical epithelium endometrium ciliated endosalpinx serous mucinous endometrioid
    • 9. Epithelial Ovarian Neoplasms
      • Serous: 10% bilateral,
      • 70% benign,
      • 5-10% borderline,
      • 20-25% malignant
      Histologic Features:
      • Mucinous: huge size,
      • multilocular,
      • 85% benign
      • Brenner : solid
      • benign
    • 10.  
    • 11. Sex Cord-Stromal Ovarian Neoplasms  fibromas  granulosa-theca cell tumors  Sertoli-Leydig cell tumors  gynandroblastomas
    • 12. Sex Cord-Stromal Ovarian Neoplasms Granulosatheca Cell Neoplasms : any age group feminizing effects Sertoli-Leydig cell tumors : virilizing effects Ovarian Fibroma : Meigs’ syndrome
    • 13. Germ-Cell Tumors Benign Cystic Teratoma 15-20% bilateral all adult tissues primarily of skin and the dermal appendages sweat and sebaceous glands hair follicles Other tissue components: mature brain, bronchus, thyroid, cartilage, bone.
    • 14.  
    • 15. Diagnosis of Benign Ovarian Tumors Clinical Features: nonspecific Symptoms most benign ovarian neoplasms are asymptomatic  Torsion: pain, nausea, vomiting  Rupture:
    • 16. Diagnosis of Benign Ovarian Tumors Bimanual pelvic examination: adnexal mass Signs and Investigations Abdominal examination: lower abdominal mass peritoneal irritation Pelvic Ultra-Sonography: exclude malignancy Serum CA 125:
    • 17. Management of Ovarian Neoplasms Confirmed Diagnosis of an Ovarian Neoplasm Definitive Treatment : by surgical exploration and microscopic examination  the type of neoplasm  the patient's age  her desire for future child bearing
    • 18. Management of Ovarian Neoplasms Epithelial ovarian neoplasms: Epithelial ovarian neoplasms young and nulliparous, unilocular, no excrescences unilateral salpingo-oophorectomy carefully inspect the contralateral ovarian cystectomy
    • 19. Management of Ovarian Neoplasms child-bearing women: salpingo-oophorectomy Stromal-Cell Neoplasms postmenopausal women: hysterectomy & bilateral salpingo-oophorectomy
    • 20. Management of Ovarian Neoplasms Germ-Cell Tumors ovarian cystectomy unilateral salpingo-oophorectomy carefully inspect the contralateral Cystic teratomas
    • 21. Benign Tumors of the Fallopian Tubes Benign Tumors of the Fallopian Tubes: inflammatory (hydrosalpinx or pyosalpinx) benign neoplasms of the oviducts difficult to differentiate on examination definitive treatment: salpingectomy represents
    • 22.  
    • 23.  
    • 24. Parovarian Neoplasms Parovarian neoplasms generally small located within the broad ligament derived from paramesonephric structures resect the cystic mass
    • 25.  
    • 26.  
    • 27.