This document discusses benign ovarian tumors, including functional ovarian cysts and benign neoplastic ovarian tumors. It describes the main types of functional cysts such as follicular, lutein and hemorrhagic cysts. It also outlines the main types of benign neoplastic ovarian tumors, including epithelial tumors, sex cord-stromal tumors, germ cell tumors and mixed tumors. The diagnosis, management and treatment options for different types of benign ovarian tumors are provided.

1. Benign ovarian tumors
Supervisor:
Prof. Salah Roshdy
Done by :
Mohamad Falih Al-harby
281100221

2. Types
# Functional ovarian cysts .
# Benign neoplastic ovarian tumors.

3. 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.

4. Functional Ovarian Cysts
A / TYPES:
1 - Follicular cyst.
2 - Lutein cyst.
3- Hemorrhagic cysts.
4- Theca-lutein cysts.
5- Luteoma of pregnancy.
6- PCOS.

5. 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 ?.

6. 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 ) ??

7. 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 ??

8. 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.)

9. 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.)

10. 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.

11. 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.

12. 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 .

13. Functional Ovarian Cysts

14. Functional Ovarian Cysts

15. Functional Ovarian Cysts

16. 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

17. 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 .

18. Functional Ovarian Cysts
D / MANAGMENT :
# if perimenopausal no delays even if
asymptomatic . ( US + CA 125 + RMI )

19. 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 )

20. 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.

21. 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.

22. 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 % ).

23. 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.)
•

24. Functional Ovarian Cysts
Gross appearance of a cut-open Brenner tumor. (Courtesy of Dr.
Sathima Natarajan, Ronald Reagan-UCLA Medical Center.)

25. 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 .

26. 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 .

27. 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 .

28. 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 ?

29. Functional Ovarian Cysts
Gross appearance of an ovarian fi broma. (Courtesy of Dr. Sathima
Natarajan, Ronald Reagan-UCLA Medical Center.)

30. 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.
-

31. 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.)

32. 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 ).

33. 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 !! ).

34. 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.

35. 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

36. 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.

37. 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.

38. 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 “

39. Benign Neoplastic Ovarian Tumors
D / MANAGMENT :
5- Gonadoblastoma :
# bilateral salpingo-oopherectomy perticulalry of
Y chromosome is there.