Benign ovarian tumors
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Benign ovarian tumors

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Benign ovarian tumors Benign ovarian tumors Presentation Transcript

  • Benign ovarian tumors Supervisor: Prof. Salah Roshdy Done by : Mohamad Falih Al-harby 281100221
  • Types # Functional ovarian cysts . # Benign neoplastic ovarian tumors.
  • Functional Ovarian Cysts - Childhood 70% functional. - To be classified as functional cyst most be at least 3 cm diameter. - General signs and symptoms : pelvic pain , dull sensation , heaviness in the pelvis. View slide
  • Functional Ovarian Cysts A / TYPES: 1 - Follicular cyst. 2 - Lutein cyst. 3- Hemorrhagic cysts. 4- Theca-lutein cysts. 5- Luteoma of pregnancy. 6- PCOS. View slide
  • Functional Ovarian Cysts A / TYPES: 1 - Follicular cyst : when the ovarian follicle fails to rupture. 2 - Lutein cyst : when the corpus luteum becomes cystic and fails to regress after 14 days , Solid + small, pain/peritoneal irratation, delayed menses ?.
  • Functional Ovarian Cysts 3- Hemorrhagic cysts : symptoms + rupture. ( proliferative phase ? ). 4- Theca-lutein cysts : associated with high hCG , hydatidform mole, choriocarcinoma , ovulation induction . # bilateral , large ( > 30 cm ) , regress after gonadotrophin levels fall ( massive ascites , systimic fluid imbalance ) ??
  • Functional Ovarian Cysts 5- Luteoma of pregnancy : hyperplastic reaction of ovarian theca cells ( hCG ). # brown to reddish nodules , cystic or solid , associated with multifetal pregnancies , hydraminos. # Cause maternal virilization and ambiguous genitalia in female fetus. # Regreess postpartum ??
  • Functional Ovarian Cysts Gross appearance of a luteoma of pregnancy. Note the multiple brown nodules. (From Voet RL: Color Atlas of Obstetric and Gynecologic Pathology. St. Louis, Mosby, 1997.)
  • Functional Ovarian Cysts Ovary with multiple cysts lining the capsule consistent with polycystic ovary syndrome. (Courtesy of Dr. Sathima Natarajan, Ronald Reagan-UCLA Medical Center.)
  • Functional Ovarian Cysts B / CLINICAL FEATURES : # ASYMPTOMATIC , unilocular , up to 15 cm , regress during the subsequent menstrual cycle. # Torsion ? # Rupture ? ( acute abdominal pain and tenderness + hemperitoneum ) !!!!! # Amenorrhea , AUB , severe pelvic pain ( what to exclude first ?) ( EP , ruptured cyst , torsion and pelvic abscess ) immediate pregnancy test and laparoscopy.
  • Functional Ovarian Cysts C / DIAGNOSIS: # Hx + Ex ( bimanual ) cm ?? ( 5 – 8 cm ) + mobile. ** confirmation of regression by the next cycle. # Not associated with ascites. # More than 8 cm and tender ( rare ) # Hemorrhagic cysts may feel solid.
  • Functional Ovarian Cysts C / DIAGNOSIS: # Imaging : US ** confirms cystic nature only ( cystic VS neoplastic ) ?? # Laboratory: CA 125 # Surgical procedure : *** Laparoscopic cystectomy VS aspiration ?? If suspicious >>>>> RMI .
  • Functional Ovarian Cysts
  • Functional Ovarian Cysts
  • Functional Ovarian Cysts
  • Functional Ovarian Cysts C / DIAGNOSIS: RMI ( Risk for Malignancy Index ) Calculation of RMI for an ovarian mass Criteria Scoring System A- Menopausal Status Premenopausal 1 Postmenopausal 3 B- Ultrasonic Features Multiloculated 1 feature = 1 Solid areas bilaterality ≥ 2 features = 3 ascites C- Serum CA – 125 Titer Absolute value
  • Functional Ovarian Cysts D / MANAGMENT : # Reproductive age +asymptomatic or mild( US + CA 125 + RMI ) 1- if low RMI and possible functional cyst: >>> re-evaluate after next menses . ( low dose COP ? ) 2- if high RMI , solid , painful or fixed : >>> surgical exploration or referral to gynecologic oncologist .
  • Functional Ovarian Cysts D / MANAGMENT : # if perimenopausal no delays even if asymptomatic . ( US + CA 125 + RMI )
  • Benign Neoplastic Ovarian Tumors A / TYPES: 1- Epithelial ovarian neoplasm. ( most common CATEGORY ) 2- Sex cord – Stromal ovarian neoplasm. 3- Germ cell ovarian neoplasm. ( dermoid cyst most common TYPE ) 4- Mixed ovarian neoplasm.( more than one type of cell )
  • Benign Neoplastic Ovarian Tumors 1- Epithelial ovarian neoplasm: # Derived from the mesothelium on the peretionium and the ovary: A- Mucinous. B- Endometriod. C- Serous. D- Brenner tumor.
  • Benign Neoplastic Ovarian Tumors 1- Epithelial ovarian neoplasm: A- Mucinous : resembles the endocervical epithelium. # Attain huge size , multilocular , 85 % benign , associated with mucocele of the appendix , pseudomyxoma perotonei ?? . B- Endometriod : resembles endometrium.
  • Benign Neoplastic Ovarian Tumors 1- Epithelial ovarian neoplasm: C- Serous : resembles fallopian tube. # 70% benign , multilocular, psammoma bodies , bilateral 10% ( most common ). D- Brenner tumor : resembles transiotional cells of the bladder. # Small Smooth Solid and Fibrotic , associated with mucinous epithelial elements? ( 33 % ).
  • Functional Ovarian Cysts Gross appearance of a mucinous (A) and serous (B) cystadenoma of the ovary. The mucinous type is generally multiloculated and can be quite large. (A, From Voet RL: Color Atlas of Obstetric and Gynecologic Pathology. St. Louis, Mosby, 1997, Fig. 6.31; B, from Voet RL: Color Atlas of Obstetric and Gynecologic Pathology. St. Louis, Mosby, 1997, Fig. 6.20.) •
  • Functional Ovarian Cysts Gross appearance of a cut-open Brenner tumor. (Courtesy of Dr. Sathima Natarajan, Ronald Reagan-UCLA Medical Center.)
  • Benign Neoplastic Ovarian Tumors 2- Sex cord – Stromal ovarian neoplasm: # Derived from the sex cords and specialized stroma of the developing gonads : A- Functioning ovarian tumors : 1- Granulosa – Theca cell tumors. 2- Sertoli – Leydig cell tumors. 3- Gynandroblastomas . ***Ultimate differentiation B- Ovarian Fibromas .
  • Benign Neoplastic Ovarian Tumors 2- Sex cord – Stromal ovarian neoplasm: A- Functioning ovarian tumors : 1- Granulosa – Theca cell tumors: # Feminizing : precocious puberty , thelarche , premenarchal uterine bleeding , menorrhagia/amenorrhea , endometrial hyperplasia/cancer , breast tenderness , fluid retention , postmenoposal bleeding .
  • Benign Neoplastic Ovarian Tumors 2- Sex cord – Stromal ovarian neoplasm: A- Functioning ovarian tumors : 2- Sertoli – Leydig cell tumors: # Virilizing : hirsutism , temporal baldness , deepening of the voice , clitromegaly , musculinazation .
  • Benign Neoplastic Ovarian Tumors 2- Sex cord – Stromal ovarian neoplasm: B- Ovarian Fibromas: # mature fibroblasts of the ovarian stroma. # Smooth , Solid , Encapsulated , not hormonally active. # ascites/ meigs syndrome ? # fibrothecoma ? . # Pure thecoma – ednocrinologic effects ?
  • Functional Ovarian Cysts Gross appearance of an ovarian fi broma. (Courtesy of Dr. Sathima Natarajan, Ronald Reagan-UCLA Medical Center.)
  • Benign Neoplastic Ovarian Tumors 3- Germ cell ovarian neoplasm: # Dermoid cyst ( Benign cystic teratoma ) : - Ectodermal + mesodermal ± endodermal tussue. -Slow growing , less than 10 cm. -10-15% are bilateral . -Well differentiated tissue indicates to more benign teratoma. -
  • Functional Ovarian Cysts Gross appearance of a cut-open dermoid cyst. Note the presence of hair-bearing skin. (From Voet RL: Color Atlas of Obstetric and Gynecologic Pathology. St. Louis, Mosby, 1997.)
  • Benign Neoplastic Ovarian Tumors 4- Mixed ovarian neoplasm: # Most common of this category is the cystadenofibroma which is mostly epithelial component. # Ganoadoblastoma : resembles dysgerminoma , granulosa and sertoli. - calcific concretions , almost all patients have dysgenetic gonads + Y chromosome , half develop dysgerminomas ( malignancy ).
  • Benign Neoplastic Ovarian Tumors C / DIAGNOSIS: # Hx + Ex ( bimanual ). # Mostly asymptomatic ( except functioning ovarian tumors ) untill torsion or rupture : - sever abdominal pain , peritoneal irritation , abdominal regidity and paralytic ilus. - Cysts can rupture during bimanual Ex or intercourse. ( contents of the cyst maybe troublesome !! ).
  • Benign Neoplastic Ovarian Tumors C / DIAGNOSIS: - Bimanual Ex: If the mass is separate from the uterus ; adnexal mass is probable . - Abdominal Ex : if too large can be palpable , cysts are dull to percussion ( anteriorly ) and tympany of the bowel on the flanks.
  • Benign Neoplastic Ovarian Tumors C / DIAGNOSIS: # Imaging US ( Transvaginal and pelvic ): ** tooth like calcification ?? # Lab : Serum CA 125 ** RMI # Surgical procedures : - Laparoscopy ** distinguish B/W uterine myoma , hydrosalpinx and ovarian tumor but not B/W functional cyst , benign ovarian neoplasm and encapsulated malignant ovarian tumor. - Laparatomy ** preferable for definitive evaluation and resection
  • Benign Neoplastic Ovarian Tumors D / MANAGMENT : # No persistant ovarian neoplasm sould be assumed to be benign untill proved so by surgical exploration and pathalogic examination**. # Laparatomy indicated ** drain ascites , take biopsy and send to lab.
  • Benign Neoplastic Ovarian Tumors D / MANAGMENT : 1- Benign epithelial : # unilateral salpingo-oopheroctomy+ inspect contralateral ovary ?? Bilateral lesion and coexistant appendiceal mucocele and do appendictomy. # If young and nullipara: - ovarian cystectomy. # If older women : - total abdominal hysterectomy and bilateral salpingooopherectomy.
  • Benign Neoplastic Ovarian Tumors D / MANAGMENT : 2- Benign stromal : # unilateral salpingo-oopheroctomy. 3- Benign fibromas : # ovarian cystectomy. 4- Dermoids : # ovarian cystectomy + inspect the contralateral ovary “ carefully “
  • Benign Neoplastic Ovarian Tumors D / MANAGMENT : 5- Gonadoblastoma : # bilateral salpingo-oopherectomy perticulalry of Y chromosome is there.