Recommended
More Related Content
What's hot
What's hot (20)
Viewers also liked
Viewers also liked (20)
Similar to Benign diseases of ovary
Similar to Benign diseases of ovary (20)
More from obgymgmcri
More from obgymgmcri (20)
Recently uploaded
Recently uploaded (19)
Benign diseases of ovary
- 1. BENIGN LESIONS OF OVARY BY DR.JASMINA BEGUM.
- 2. CONTENT - Non neoplastic cyst & benign neoplastic tumours - Clinical features - Diagnosis - Differential diagnosis - Management - Complications
- 3. OVARY THE HUMAN OVARY HAS A STRICKING PROPENSITY TO DEVELOP A WIDE VARITY OF TUMORS MOST OF WHICH ARE BENIGN. 80% OF ALL OVARIAN TUMORS ARE BENIGN,ALTHOUGH THIS VARIES WITH AGE.
- 4. BENIGN LESIONS OF OVARY NON NEOPLASTIC NEOPLASTIC(BENIGN) FUNCTIONAL PATHOLOGY 1.Follicular cyst 1.PCOS A. SURFACE EPITHELIUM 2.Corpus luteal cyst 2.endometrioma 1. Serous 3.Theca lutein & 3. T O mass 2. Mucinous granulosa lutein cyst 3. Endometroid 4. Brenner B.GERM CELL TUMOUR (BENIGN) C. SEX CORD / STROMAL 1. thecoma/fibroma 2. androblastoma
- 5. FOLLICULAR CYST (commonest) CORPUS LUTEUM CYST THECA LUTEIN CYST AGE GROUP Adolescent, reproductive age groups ,can occur in perimenopause Reproductive age Reproductive age CAUSE Hyperestronism Over activity of corpus luteum Excess chorionic gonadotropin secreted in GTD, following to ovulation induction drugs Size Laterality Grow ≥3 & ≤8 cm B/L or U/L 3 – 10 cm U/L Large upto 30 cm B/L
- 6. FOLLICULAR CYST CORPUS LUTEUM CYST THECA LUTEIN CYST GROSS Thin walled , unilocular , filled with straw coloured fluid Pink or haemorrhagic cyst, cut section yellowish orange, filled with blood clots Multicystic, greyish blue colour, filled with straw colour fluid or blood Histology Lining epithelium Granulosa cells Luteinised granulosa cell Theca lutein cells,granulosa lutein cells C/F Usually asymptomatic , diagnosis incidental Dull with U/L pelvic pain Rupture with hemoperitoneum more common Small are asymptomatic, large -discomfort , pain Rupture/torsion (more common)
- 8. Hemorrhagic cyst with unusual appearance simulating a neoplasm
- 9. Shows enlarged uterus in the centre and bilateral Theca lutein cysts. The cyst on the left shows a breach in the capsule and the right cyst with thin hemorrhagic area suggestive of impending rupture
- 10. PCOS: -0.5-4%, infertile women, young reproductive age -excess androgen , chronic anovulation -Pathology: ovaries enlarged, stroma increased, capsule thickened, pearly white -c/s: multiple follicles in cortex -Histo: thickened tunica albuginea, stromal hyperthecosis -insulin resistance (acanthosis nigricans) -CF: amenorrhoea, hirsutism, obesity, enlarged PCO. -Investigations Management – Wt. reduction COCP Tt. Of hirsutism Tt. Of infertility
- 11. BENIGN OVARIAN TUMORS Ovarian neoplasm may be divided generally by cell type of origin into three types: 1.epithelial 2.stromal 3.germ cell
- 12. BENIGN OVARIAN NEOPLASMS EPIDEMOLOGY: -Incidence: 1-3% among outpatient , 75% -benign -Racial factors: higher in white population, lowest in japan -Economic status: higher in industrialised countries -Environmental factors: PATHOLOGY: -Origin: mesoepithelial cells on ovarian surface -Incidence: epithelial tumours—80% of all ovarian tumours serous cystadenoma– 50% of all epithelial tumours mucinous cysts—12-15% endometroid—10% unspecified—25-27%
- 13. Benign ovarian tumors MUCINOUS CYST ADENOMA SEROUS CYST ADENOMA BRENNER BENIGN CYSTIC TERATOMA INCIDENCE 12-15 % of Epithelial tumors 20-25% of all OV.tumors 50 % of all Epithelial tumors 40% of all ovarian tumors 2 – 3 % of all Epithelial tumors 1 -2% of all ovarian tumors 95 % of Germ cell tumors 15 – 20% of all ovarian tumors Bilateral Malignant chance 10% 5 –10% 40% 40% 8 -10% rare 15 -20% 1 -2% 20- 40 % of all ov. Tumors in pregnancy
- 14. TUMOR MUCINOUS SEROUS DERMOID ORIGIN Totipotent surface epithelium of ovary Totipotent surface epithelium of ovary germ cells arrested after 1st meoitic division PATHOLOGY naked eye : huge size & wt 5-10 kg pedunculated, largest. smooth, lobulated with whitish or bluish white , translucent tumor. c/s: thick, visid mucin (glycoprotein) colourless multiloculated with papillary. honey combed appearance naked eye: smooth, shiny, greyish white exuberant papillary projections . c/s:multilobulated clear fluid (serum) proteins (albumin & globulin) naked eye: moderate size, capsule tense & smooth c/s: trabeculated appearance , sebaceous material with hair , clear rokitansky’s protruberance
- 15. -microscopy: lined by 1 layer of tall coloumnar epithelium with dark staining basal nuclei without any cilia. Epithelium resemble to those of endocervix. -complication: rupture pseudomyxoma peritonei & shows adhesions with visera . microscopy:- lined by cubical epithelium - papillary structures – dense fibrous stroma covered by single or multiple layers of columnar epithelium. ciliated secretory & peg cells. Epithelium resemble to those of endosalpingeal epithelium micro: stratified squamous epithelium,granulat ion tissue, may be transitional/ columnar .
- 18. SEROUS /MUCINOUS CYSTADENOMA Gross appearance of a mucinous (A) and serous (B) cystadenoma of the ovary. The mucinous type is generally multiloculated and can be quite large.
- 19. BRENNER TUMOUR -U/l , small to moderate, seen after 50 years -Gross: resembles fibroma, smooth solid tumour -C/s: gritty, yellowish grey -Histology: fibrous tissue with transitional epithelium ( walthard cell nests) -Cf: pmb, pseudo meig ENDOMETROID TUMOUR: -2% of all ovarian tumours -Lined by glandular epithelium -Moderate size, solid, with cystic areas with haemorrhagic fluid.
- 20. Gross appearance of a cut-open Brenner tumor.
- 21. 2. SEX CORD STROMAL OVARIAN NEOPLASMS Hormone secreting tumors of the ovary. These tumors include fibromas, Sertoli-Leydig cell tumors (Arrheno–blastomas or androblastomas).
- 22. FIBROMA: -origin: stromal cells of ovarian cortex -small sessile nodule, long pedicle ,solid,smooth surfaced tumour -c/s: white -microscopy: interlacing bundles of spindle shaped cells -complication: torsion ,meig syndrome ANDROBLASTOMA/SERTOLI-LEYDIG CELL TUMOR -testicular adenoma -androgen secreting tumour -seen in women less than 30 year -gynandroblastoma (granulosa + androblastoma cells) -cf: amennorhoea, atrophy of breasts, enlargement of clitoris, body hair growth, deepening of voice.
- 23. Gross appearance of an ovarian fibroma.
- 24. 3. GERM CELL TUMORS TUMORS OF GERM CELL ORIGIN MAY REPLICATE STAGES RESEMBLING THE EARLY EMBRYO CAN OCCUR AT ANY AGE 12-15% OF OVARIAN NEOPLASM 60% OF GCTS OCCURS IN CHILDREN MOST COMMON BENIGN TYPE IS ‘BENIGN CYSTIC TERATOMA’
- 25. DERMOID CYST
- 26. On clinical examination Character 1. Age 2. Laterality 3. Mobility 4. Feel 5. Surface 6. Ascites 7. Growth 8. nodules Malignant • older • Bilateral • Fixed • Solid • Irregular • Present • Rapid • Present Benign younger unilateral Mobile Cystic Smooth Absent Slow Absent
- 27. Criteria on USG BENIGN • U/L ,uni/multi locular Cystic areas with regular thin wall thin septa and nonechogenic cavity • TVS(doppler) shows regular vascular branching MALIGNANT • B/L, thick wall, thick septa, echogenic areas in cavity Irregular heterogenous parts • TVS neovascularisation • Low RI & PI
- 28. USG: • Benign • Malignant
- 29. CLINICAL FEATURES AGE:- late child bearing age -dermoid, mucinous adenoma common in reproductive -dermoid common in pregnancy symptoms: -asymptomatic - detected accidently -heaviness in lower abdomen, mass - dull aching pain, - cardiorespiratory & gastrointestinal upset (nausea, indigestion) -menstrual pattern unaffected except in hormone producing tumours signs: cachetic , pitting edema legs
- 30. ABD EXAMINATION Inspection -- bulging of lower abdomen mass – central/ one side/ whole abdomen visible veins , flanks – flat Palpation -- cystic / tense cystic freely mobile from side to side with restricted in above down, smooth surface , nontender Percussion -- dull in center resonant in flanks fluid thrill + Auscultation -- friction rub + Bimanual pelvic examination -- uterus separated from mass groove + between uterus & mass movement of mass p/a fails to move cx lower pole of cyst felt through fornix absence of pulsation of ut vessels thro fornix
- 31. D.D 1.Full bladder 2. Pregnancy 3. Pregnancy with fibroid 4. Ascites 5. Fibroid uterus 6. Encysted peritonitis
- 32. INVESTIGATION To confirm diagnosis USG Tumor markers Straight x-ray abdomen Paracentesis Laproscopy
- 33. COMPLICATIONS 1. Torsion 2. Intracystic hge 3. Infection 4. Rupture 5. Malignancy 6. Pseudomyxoma peritonei Torsion: (axial rotation) • 10 – 15% • moderate size & wt • free mobility & long pedicle • common in dermoid or serous cystadenoma Causes: -Trauma, violent physical movement, contraction of preg uterus, intestinal peristalsis.
- 34. • Hemodynamic theory • Symptoms- acute pain + lump, vomiting, fever, shock , tachycardia. P/A: tense, tender, cystic mass with restricted mobility P/v: mass abd separate from uterus DD: 1. Disturbed ectopic preg 2. Acute hydramnios 3. Perforating h mole 4. Torsion of subserous pedunculated fibroid Rx: Pain– morphine Laparotomy ( cystectomy/ salpingoophorectomy)
- 35. INTRACYSTIC HGE: -serous cystadenoma, malignancy. -venous congestion. INFECTION: -following torsion -organisms – from intestine, uterine tubes. RUPTURE: -big & tense cyst -trauma, malignancy, papillary type. PSEUDOMYXOMA PERTONEI: -mucinous ascites -asso with mucinous cyst adenoma ovary, mucocele appendix & gall bladder, intestinal malignancy. -spontaneous perforation -recurrence high, prognosis poor ( infection, intestinal obstr) -Rx: hystrectomy, BSO with removal of mucin, peritoneal implants with appendix.
- 36. OVARIAN CYST premenopause women Cystic teratoma Simple cyst size 5-8 cm Benign morphology CA-125 ≤35IU/L All other cyst Laproscopic surgery Follow up 3-6 month or COCP Laproscopy / laparotomy Increase in size symptomatic Yes No Laproscopic cystectomy Follow up
- 37. Ovarian cyst postmenapause Simple cyst size 3-5 cm, Benign morphology CA-125≤ 35IU/L Doppler RI ≥0.4 Size ≥ 5 cm Morphology suspicious CA-125 ≥35IU/L Follow up 6 weeks Increase in size CA-125 Rising Laparotomy Yes No Laparotomy Follow up
- 38. SURGERY: young women- ovarian cystectomy Oophorectomy (salpingoophorectomy) parous women- TAH+BSO others- individualisation. laparoscopic cystectomy / ovariotomy laparoscopy/ USG guided aspiration of cyst.
- 39. THANK YOU