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Benign ovarian masses include functional cysts and tumors; most are asymptomatic.Most functional cysts and benign tumors are asymptomatic. Sometimes they cause menstrual abnormalities. Hemorrhagic corpus luteum cysts may cause pain or signs of peritonitis, particularly when they rupture. Occasionally, severe abdominal pain results from adnexal torsion of a cyst or mass, usually > 4 cm. Treatment varies depending on the patient's reproductive status.
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Presentation on the description of normal and abnormal uterine bleeding, menstrual cycle, FIGO classification with PALM-COEIN, common differentials of AUB, assessment, diagnosis, and management.
Benign ovarian masses include functional cysts and tumors; most are asymptomatic.Most functional cysts and benign tumors are asymptomatic. Sometimes they cause menstrual abnormalities. Hemorrhagic corpus luteum cysts may cause pain or signs of peritonitis, particularly when they rupture. Occasionally, severe abdominal pain results from adnexal torsion of a cyst or mass, usually > 4 cm. Treatment varies depending on the patient's reproductive status.
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Are you struggling to get rid of your ovarian cysts? Are you in pain, or feeling anxious for not being able to properly cure your ovarian cysts despite all your efforts ? Are you experiencing irregular periods, pain in your lower abdomen or bloating? Are you afraid of developing cancer or from not being able to have children? If you answered yes, then you have come to the Right place for a solution!
Most ovarian cysts develop as a result of the normal function of your menstrual cycle. These are known as functional cysts. Other types of cysts are much less common.
Your ovaries normally grow cyst-like structures called follicles each month. Follicles produce the hormones estrogen and progesterone and release an egg when you ovulate. Sometimes a normal monthly follicle keeps growing. When that happens, it is known as a functional cyst. There are two types of functional cysts:
Follicular cyst. Around the midpoint of your menstrual cycle, an egg bursts out of its follicle and travels down the fallopian tube in search of sperm and fertilization. A follicular cyst begins when something goes wrong and the follicle doesn't rupture or release its egg. Instead it grows and turns into a cyst.
Corpus luteum cyst. When a follicle releases its egg, the ruptured follicle begins producing large quantities of estrogen and progesterone for conception. This follicle is now called the corpus luteum. Sometimes, however, the escape opening of the egg seals off and fluid accumulates inside the follicle, causing the corpus luteum to expand into a cyst.
The fertility drug clomiphene (Clomid, Serophene), which is used to induce ovulation, increases the risk of a corpus luteum cyst developing after ovulation. These cysts don't prevent or threaten a resulting pregnancy.
Functional cysts are usually harmless, rarely cause pain, and often disappear on their own within two or three menstrual cycles.
Other cysts
Some types of cysts are not related to the normal function of your menstrual cycle. These cysts include:
Dermoid cysts. These cysts may contain tissue, such as hair, skin or teeth, because they form from cells that produce human eggs. They are rarely cancerous.
Cystadenomas. These cysts develop from ovarian tissue and may be filled with a watery liquid or a mucous material.
Endometriomas. These cysts develop as a result of endometriosis, a condition in which uterine endometrial cells grow outside your uterus. Some of that tissue may attach to your ovary and form a growth.
Dermoid cysts and cystadenomas can become large, causing the ovary to move out of its usual position in the pelvis. This increases the chance of painful twisting of your ovary, called ovarian torsion.
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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)
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
.
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.
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.
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’
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
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