This document discusses ovarian tumours, including their incidence, types, clinical features, and complications. It provides information on common varieties such as mucinous cyst adenoma, serous cyst adenoma, and dermoid cyst. For each variety, it describes origin, pathology, naked eye appearance, microscopic examination, and clinical features. It also discusses complications like torsion of the pedicle and covers differential diagnosis, investigations, and management of ovarian tumours.

1. 6/14/2017 OVARIAN TUMOUR 1
DR SALINI MANDAL B.G.
ASST PROFESSOR
DEPT OF OBG
FMHMC

2. Incidence
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 In total the tumours affect 1-3% of the
gynaecologic admissions..
 About 75% of these are benign…

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 Abnormalities of the ovary or fallopian tubes
may result from physiologic changes, infectious
processes, or benign or malignant neoplasms.
 Patients may exhibit a pelvic mass with or
without other signs or symptoms. These
disorders may occur at any age from childhood
to old age.

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 Depending on patient age, the physiologic and
pathologic manifestations and implications may
differ.
 For example, teenage patients with a pelvic
mass most likely will have a benign germ cell
or epithelial ovarian tumor, whereas
postmenopausal women have a significantly
greater risk of epithelial ovarian carcinoma.

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 Numerous types of ovarian neoplasms exist, of
which approximately 80% are benign. Ovarian
neoplasms are typically divided into three
major groups: epithelial, germ cell, and sex
cord-stromal tumors .
 The ovary can also be a site of metastatic
cancer, particularly from the breast or the
gastrointestinal tract (Krukenberg's tumors).

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 Epithelial Tumour..
Serous tumour
Mucinous cyst adenoma
Endometrial tumours
Mesonephroid or Clear cell tumours
Brenner tumours
Mixed epithelial tumours
Undifferentiated carcinoma
Unclassified epithelial tumours

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 Sex cord stromal tumours..
 Granulosa cell tumour
 Tumours of thecoma-fibroma group
 Thecoma
 Fibroma
 Unclassified
 Androblastoma
 Sertoli cell tumour
 Sertoli leydig cell tumour
 Hilus cell tumour
 Gynandroblastoma
 Unclassified

10. 10
 Lipid cell tumour
 Germ cell tumours of the ovary
 Germ cell tumours
 Dysgerminoma
 Endodermal sinus tumour
 Embryonal cell carcinoma
 Polyembryoma
 Choriocarcinoma
 Teratoma
 Mixed forms
 Tumours composed of germ cell and sex cord stroma
 Gonadoblastoma
 Mixed germ cell – sex cord stromal tumour

11. 11
 Gonadoblastoma
 Unclassified
 Secondary metastasis

12. COMMON VARIETIES
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1. MUCINOUS CYST ADENOMA
2. SEROUS CYST ADENOMA
3. DERMOID CYST

13. MUCINOUS CYST ADENOMA.
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 ORIGIN:-
 It arises from the totipotent surface epithelium of the
ovary.
 It arises from the teratoma in which, the epithelium of
epidermal origin have probably overgrown than the
other elements.

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 PATHOLOGY
 QUITE COMMON : 20-25% OF ALL OVARIAN
TUMOURS…
 USUALLY BILATERAL IN 10% CASES
 MALIGNANCY CHANCES : 5-10%

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 NAKED EYE APPEARANCE
 MAYATTAIN HUGE SIZE IF LEFT UNCARED
FOR…
 WALL IS SMOOTH, LOBULATED WITH WHITISH
OR BLUISH WHITE HUE..
 AT PLACES, IT IS THIN SO AS TO BE
TRANSLUCENT…

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 ON CUT SECTION
 CONTENT IS THICK, VISCID, MUCIN…
 COLOURLESS IF DEVOID OF HAEMORRHAGE…
 CYST IS MULTILOCULATED SOMETIMES WITH
PAPILLARY GROWTH ARISING FROM THE
SEPTUM…

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 MICROSCOPIC EXAMINATION
 LINED BY SINGLE LAYER OF TALL COLUMNAR
EPITHELIUM WITH DARK STAINING BASAL
NUCLEUS BUT WITHOUT CILIA

20. SEROUS CYST ADENOMA
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 ORIGIN
 ARISES FROM THE TOTIPOTENT SURFACE
EPITHELIUM OF THE OVARY…
 40% OF THE CASES
 BILATERAL- 40%
 MALIGNANCY CHANCES – 40%

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 PATHOLOGY
 LESS IN SIZE THAN THAT OF MUCINOUS TYPE
 LESS SECRETION. SO MORE CHANCE OF
PROLIFERATION OF THE LINING EPITHELIUM TO
FORM PAPILLARY PROJECTION
 INTRACYSTIC HAEMORRAHGE IS MORE LIKELY.
 PAPILLARY GROWTH OFTEN PROJECT
OUTWARDS AND PERFORATE THE CYST WALL IN
ABOUT 15%

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 NAKED EYE APPEARANCE
 WALL IS SMOOTH, SHINY AND GREYISH
WHITE.
 PAPILLARY PROJECTION AT TIMES
 MAY BE MULTILOBULATED ON CUT SECTION
 FLUID IS CLEAR, RICH IN SERUM PROTEINS –
ALBUMIN AND GLOBULIN…

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 MICROSCOPIC EXAMINATION
 LINED BY A SINGLE LAYER OF CUBICAL
EPITHELIUM.
 PAPILLARY STRUCTURES CONSISTS OF
BROAD DENSE FIBROUS STROMA COVERED
BY SINGLE OR MUTIPLE LAYERS OF
COLUMNAR EPITHELIUM..

27. DERMOID CYST
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 ORIGIN
 ARISES FROM THE GERM CELLS ARRESTED
AFTER THE FIRST MEIOTIC DIVISION…

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 PATHOLOGY
 97% OF TERATOMA
 15-20% AMONGST ALL OVARIAN TUMOURS
 BILATERAL IN ABOUT IN MOST CASES
 CONSTITUTES ABOUT 20-40% OF ALL OVARIAN
TUMOURS IN PREGNANCY.
 TORSION IS COMMON.
 MALIGNANCY CHANCES- 1-2%
 SQUAMOUS CELL CARCINOMA IS THE
COMMONEST

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 NAKED EYE APPEARANCE-
 CYST IS MODERATE IN SIZE
 CAPSULE IS TENSE AND SMOOTH
 CUT SECTION: SEBACEOUS MATERIAL WITH
HAIR.
 CLEAR FLUID DERIVED FROM NEURAL
TISSUES (CHOROID PLEXUS)
 AREA OF SOLID PROJECTION….
ROKITANSKY’S PROTUBERANCE COVERED
BY SKIN WITH SWEAT AND SEBACEOUS
GLANDS…
 TEETH AND BONES ARE FOUND HERE
 RARE ONE… THYROID TISSUE… STRUMA
OVARII ASSO WITH HYPERTHYROIDISM.

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 MICROSCOPIC EXAMINATION…
 WALLIS LINEDBY STRATIFIEDSQUAMOUS EPITHELIUM; AND AT
PLACES BY GRANULATIONTISSUE
 EPITHELIUMMAY BE TRANSITIONALAND COLUMNAR…
 BONE, CARTILAGE, NEURALTISSUE, THYROIDAND SALIVARY
GLANDTISSUES ARE OFTENPRESENT…

33. CLINICAL FEATURES…
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 AGE:
 LATE CHILDBEARING PERIOD
 DERMOID WITH MUCINOUS CYST ADENOMA:
REPRODUCTIVE PERIOD
 DERMOID IS MORE COMMON DURING
PREGNANCY.

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 PARITY-
 NO RELATION WITH THE PARITY OF THE
PATIENT

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 SYMPTOMS-
 MOSTLY ASYMPTOMATIC
 USUALLY DETECTED ACCIDENTLY- FINDING A
LUMP IN THE LOWER ABDOMEN DURING
ROUTINE ABDOMINAL PALPATION /
GYNAECOLOGIST TO FIND TUMOUR DURING
PELVIC EXAMINATION, LAPAROSCOPY OR
LAPAROTOMY

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 HEAVINESS IN THE LOWER ABDOMEN
 GRADUALLY INCREASING MASS IN LOWER
ABDOMEN
 DULL ACHING PAIN IN LOWER ABDOMEN
 IF NEGLECTED, THE TUMOUR GROWS TO
FILL THE WHOLE ABDOMEN  PRODUCES
CARDIORESPIRATORY EMBARRASMENT
OR GIT SYMTOMS LIKE NAUSEA OR
INDIGESTION

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 MENSTRUAL PATTERN UNAFFECTED
UNLESS ASSO WITH HORMONE
PRODUCING TUMOURS – MENORRHAGIA
OR POSTMENOPAUSAL BLEEDING OR
PRECOCIOUS PUBERTY IN FEMINISING
TUMOUR LIKE GRANULOSA CELL TUMOUR
OR AMENORRHOEA IN MASCULINISING
TUMOUR LIKE ANDROBLASTOMA

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 SIGNS-
 CACHETIC DUE TO PROTEIN LOSS IN
MUCINOUS CYST ADENOMA
 PITTING OEDEMA OF LEGS MAY BE PRESENT
WHEN A HUGE TUMOUR PRESSES ON THE
GREAT VEINS.

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 ABDOMINAL EXAMINATION:
 INSPECTION:
 BULGING OF LOWER ABDOMEN
 MASS MAY BE PLACED CENTRALLY OR IN ONE
SIDE
 MASS FILLS THE ENTIRE ABDOMINAL CAVITY
EVERTING THE UMBILICUS WITH VISIBLE VEINS
UNDER THE SKIN.

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 PALPATION:
 FEEL IS CYSTIC
 FREELY MOVABLE FROM SIDE TO SIDE BUT
RESTRICTED FROM ABOVE DOWN UNLESS
THE PEDICLE IS LONG.
 UPPER AND LATERAL BORDERS ARE WELL
DEFINED BUT LOWER POLE IS DIFFICULT TO
REACH (SUGGESTS PELVIC ORIGIN)…
 SURFACE OVER THE TUMOUR IS SMOOTH
BUT OFTEN GROOVED IN LOBULATED

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 PERCUSSION:
 DULL NOTE IN THE CENTRE AND RESONANT
IN THE FLANKS
 FLUID THRILL MAY BE ELICITED WHEN THE
WALLS ARE THIN AND THE CONTENT IS
WATERY…
 IF ASCITES WITH BENIGN SOLID TUMOUR 
MEIG’S SYNDROME

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 AUSCULTATION:
 FRICTION RUB MAY BE PRESENT OVER THE
TUMOUR
 VASCULAR FIBROID  HISSING SOUND
 ASCITES  GARGLING SOUND
 PREGNANT UTERUS  FHS…

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 PELVIC EXAMINATION:
 UTERUS SEPERATED FROM THE MASS
 GROOVE BETWEEN THE MASS AND THE UTERUS
 MOVEMENT OF THE MASS FAILS TO MOVE THE
CERVIX
 ON ELEVATION OF THE MASS PER ABDOMEN,
THE CERVIX REMAINS IN STATIONARY POSITION.
 LOWER POLE OF THE CYST CAN BE FELT
THROUGH THE FORNIX
 ABSENCE OF THE PULSATION OF THE UTERINE
VESSELS THROUGH THE FORNICES..

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 SPECIAL INVESTGATIONS:
 SONOGRAPHY FOR IDENTIFYING UTERUS AND
TUMOUR
 STRAIGHT X-RAY OF THE ABDOMEN OVER THE
TUMOUR : SHADOW OF TEETH OR BONES
 LAPARASCOPY: TO DIFFERENTIATE A PAINFUL
CYSTIC MASS WITH DISTURBED ECTOPIC
PREGNANCY
 CYTOLOGY: IF ASCITES/ PLEURAL EFFUSION 
CYTOLOGICAL EXAMINATION OF ASPIRATED
FLUID IS DONE FOR MALIGNANT CELLS…

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 DIFFERENTIAL DIAGNOSIS:
 FULL BLADDER
 FIBROID
 PREGNANCY
 PREGNANCY WITH FIBROID
 ASCITES
 BROAD LIGAMENT CYST

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 COMPLICATIONS:
 TORSION OF THE PEDICLE
 INTRACYSTIC HAEMORRHAGE
 INFECTION
 RUPTURE
 MALIGNANCY

49. TORSION OF THE PEDICLE
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 AXIAL ROTATION
 FOUND IN ABOUT 10-15% CASES AT
OPERATION
 TUMOUR HAVING
 MODERATE SIZE, MODERATE WEIGHT AS
DERMOID CYST, FREE MOBILITY, LONG
PEDICLE….

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 CAUSES OF TORSION:
 TRAUMA
 VIOLENT PHYSICAL MOVEMENTS
 CONTRACTIONS OF PREGNANT UTERUS
 INTESTINAL PERISTALSIS

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 SYMPTOMS:
 SUDDEN ACUTE PAIN LOWER ABDOMEN
ALONG WITH LUMP
 PATIENT IN AGONY WITH PAIN
 ABDOMINAL EXAMINATON: TENDER, TENSE
CYSTIC MASS, WITH RESTRICTED MOBILITY ,
SITUATED IN THE HYPOGASTRIUM AND
ARISING FROM THE PELVIS.
 PELVIC EXAMINATION REVEALS MASS FELT
PER ABDOMEN IS SEPERATED FROM THE

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 ONCE DIAGNOSED, PATIENT SHOULD BE
ADMITTED FOR OPERATION…. TO
PREVENT COMPLICATIONS…
 DIFFERENTIATION BETWEEN BENIGN AND
MALIGNANT OVARIAN TUMOUR SHOULD
BE MADE BY CLINICAL EXAMINATION,
ULTRASONOGRAPHY, LAPARATOMY AND
FINALLY BY BIOPSY…

56. Guidelines for surgery
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 Incision should be sufficiently big enough to
deliver the cyst intact
 To inspect the nature of the peritoneal fluid
 To deliver the tumour intact and to note it
carefully about its nature
 To inspect the other ovary, pelvic organs,
omentum, liver , under surface of the
diaphragm.

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 To proceed for the definitive surgery.
 To cut the tumour and inspect the inner side
for any evidence of malignancy
 It is not suggestive to bisect the contralateral
ovary, if it looks absolutely normal…

58. DEFINITIVE SURGERY…
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 IN YOUNG PATIENTS:
 OVARIAN CYSTECTOMY LEAVING BEHIND
THE HEALTHY OVARIAN TISSUE IS THE
OPERATION OF CHOICE…
 IF BILATERAL OVARIAN INVOLVEMENT
CYSTECTOMY SHOULD BE DONE ATLEAST IN
ONE OVARY…
 OVARIOTOMY IS RESERVED FOR A BIG
TUMOUR DESTROYING ALMOST ALL THE
OVARIAN TISSUES IN AXIAL ROTATION OF
THE PEDICLE…

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 IN PAROUS WOMEN AROUND 40 YEARS…
 TOTAL HYSTERCTOMY WITH BILATERAL
SALPINGO-OOPHORECTOMY IS TO BE DONE

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 IN BETWEEN THESE TWO EXTREMES OF
AGE
 DUE CONSIDERATION IS TO BE GIVEN ABOUT
THE REPRODUCTIVE AND MENSTRUAL
FUNCTION…
 IN ALL CASES, THE ENTIRE TUMOUR IS TO
BE SENT FOR HISTOLOGICAL
EXAMINATION…
 IF A PART IS TO BE SENT, A SMALL PIECE
FROM THE COMPARATIVELY SOLID OR THICK
CAPSULE IS TO BE SELECTED

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62. BARYTA MUR
6/14/2017 OVARIAN TUMOUR 62
 OVARIAN TUMOUR….
 INDURATION OF THE OVARIES
 SQUEEZING PAIN IN THE PELVIS
 ESPECIALLY OF SCROPHULOUS
CONSTITUTIONS…

63. COLOCYNTHIS…
6/14/2017 OVARIAN TUMOUR 63
 OVARIAN TUMOURS, OCCASIONALLY
SHARP PAIN LIKE A STAB IN RIGHT PELVIC
REGION
 WALKS BENT AND PRESSES HER HANDS
UPON OVARY..
 CRAMP LIKE PAIN IN THE LEFT OVARIAN
REGION.
 GREAT RESTLESSNESS..
 BILIOUS VOMITING DURING PAROXYSMS
 EXTREME WEAKNESS AND LASSITUDE
WITH TREMBLING OF THE LEGS..

64. CONIUM MACULATUM
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 INDURATION OR ENLARGEMENT OF THE
OVARIES OR WOMB, OF SCROPHULOUS
NATURE..
 LANCINATING PAINS EXTENDING
THROUGH THE WHOLE LOWER PART OF
ABDOMEN..
 OVARIAN AFFECTIONS WITH
AMENORRHOEA AND ILL-EFFECTS OF
SUPPRESSED SEXUAL INSTINCT…

65. FLUORIC ACIDUM
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 OVARIAN TUMOUR, RIGHT SIDE WITH
CONTINOUS GRINDING, WORRYING PAIN
AND SENSE OF WEIGHT
 INCREASED NECESSITY TO WALK ABOUT,
TO EXERCISE THE MUSCLES WITHOUT
FATIGUE, REGARDLESS OF HEAT IN
SUMMER OR COLD IN WINTER…
 TOO FREQUENT AMENORRHOEA

66. GRAPHITES
6/14/2017 OVARIAN TUMOUR 66
 LEFT INDURATED OVARY SWELLS UP AND
BECOMES VERY HARD
 VIOLENT PAINS TO TOUCH, ON INSPIRATION,
OR HAWKING…
 PROFUSE GENERAL SWEAT AND CONTINUED
LOSS OF SLEEP
 TUMOUR IN THE RIGHT AND LEFT ILIAC
FOSSA
 HARD, ROUND, SLIGHTLY MOVABLE…
 GRINDING, TWISTING PAINS IN THE RIGHT
OVARY AS IF IT WOULD BURST..

67. PODOPHYLLUM
6/14/2017 OVARIAN TUMOUR 67
 OVARIAN TUMOUR…
 PAIN IN OVARIAN REGION, ESP.. RIGHT
SIDE, WITH HEAT, DOWN THIGHS, BETTER
FROM PRESSURE
 CANNOT KEEP THE FEET STILL, PAINS
EXTENDING UPWARD TO THE
SHOULDER…
 TIRED FEELING IN BOTH OVARIES, WITH
EXTERNAL SWELLING IN BOTH LIMBS…

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