12.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.
  • 12.Benign Tumors

    1. 1. Benign Tumors of the Ovaries and Fallopian Tubes
    2. 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. 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. 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. 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. 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. 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. 8. Epithelial Ovarian Neoplasms mesothelial cells cervical epithelium endometrium ciliated endosalpinx serous mucinous endometrioid
    9. 9. Epithelial Ovarian Neoplasms <ul><li>Serous: 10% bilateral, </li></ul><ul><li>70% benign, </li></ul><ul><li>5-10% borderline, </li></ul><ul><li>20-25% malignant </li></ul>Histologic Features: <ul><li>Mucinous: huge size, </li></ul><ul><li>multilocular, </li></ul><ul><li>85% benign </li></ul><ul><li>Brenner : solid </li></ul><ul><li>benign </li></ul>
    10. 11. Sex Cord-Stromal Ovarian Neoplasms  fibromas  granulosa-theca cell tumors  Sertoli-Leydig cell tumors  gynandroblastomas
    11. 12. Sex Cord-Stromal Ovarian Neoplasms Granulosatheca Cell Neoplasms : any age group feminizing effects Sertoli-Leydig cell tumors : virilizing effects Ovarian Fibroma : Meigs’ syndrome
    12. 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.
    13. 15. Diagnosis of Benign Ovarian Tumors Clinical Features: nonspecific Symptoms most benign ovarian neoplasms are asymptomatic  Torsion: pain, nausea, vomiting  Rupture:
    14. 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:
    15. 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
    16. 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
    17. 19. Management of Ovarian Neoplasms child-bearing women: salpingo-oophorectomy Stromal-Cell Neoplasms postmenopausal women: hysterectomy & bilateral salpingo-oophorectomy
    18. 20. Management of Ovarian Neoplasms Germ-Cell Tumors ovarian cystectomy unilateral salpingo-oophorectomy carefully inspect the contralateral Cystic teratomas
    19. 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
    20. 24. Parovarian Neoplasms Parovarian neoplasms generally small located within the broad ligament derived from paramesonephric structures resect the cystic mass