BENIGN OVARIAN TUMORS

Dr. Mashael Al-Shebaili Asst. Prof. & Consultant Ob/Gyn Dept.

Ovaries are normally not palpable in pre-menarche, and after the menopause In the reproductive age group ovaries are palpable in the lean pts.
Ovarian size of different age groups Premenopause 3.5 x 2 x 1.5 cm Early menopause 1 2 yrs 2 x 1.5x0.5cm Late menopause 2-5yrs 1.5x0.75x0.5cm

If the ovaries are palpable in any of the age groups when it is not supposed to be through investigations and work up should be carried out OVARIAN CYSTS CAN BE CLASSIFIED AS FOLLOWS:

I. Functional
II Neoplastic

Benign
borderline Malignant

FUNCTIONAL OVARIAN CYSTS INCLUDES:

a. Follicular cysts b. Corpus luteum cysts c. Theca luten cysts

BENIGN OVARIAN NEOPLASM

1. 2. 3. 4. 5. Serous cystadenoma Mucinous cystadenoma Endometrioma Dermoid cysts Fibroma

FUNCTIONAL CYSTS - These are cysts related to ovarian function i.e. the process of ovulation
-

They are the most common detected cysts in the reproductive age group Can be reach up to 10 cm in diameter

Resolve spontaneously.

Follicular cysts results from the growth of a follicle that does not rupture
Corpus luteum cyst results from Hge inside a corpus luteum Theca luteum cysts result from over stimulation of the ovary by HCG. Not common in normal pregnancy but common in molar pregnancy, choriocarcinoma and reproductive technology

 Benign

ovarian neoplasia

- 80% of ovarian neoplasm are benign

- Benign ovarian neoplasm can be solid or cystic

I.

Serous Cystadenoma (Commonest) - Usually do not reach very large sizes

- unilocular or multilocular - smooth surface - fluid filled

II.

MUCINOUS CYSTADENOMA
- May reach very large size

- Filled with thick mucinous material

- Perforation may lead to a serious condition called pseudomyxoma peritonei for which chemotherapy may be needed.
III.

ENDOMETRIOMA (Chocolate cysts)

Associated with endometriosis

IV.

DERMOID CYSTS OR BENIGN CYSTIC TERATOMA

- Usually small and may be bilateral - Contain sebum, hair, teeth etc. - Contains elements from endoderm mesoderm and ectoderm - Can change into malignant teratoma - Avoid spilling of contents which leads to chemical peritonitis

V.

FIBROMA
- Firm in consistency

* Meigs syndrome
Ovarian fibroma + ascites, hydrothorax following removal of fibroma, there is spontaneous resolution of ascites and hydrothorax

Clinical signs and symptoms of ovarian masses: 1. abdominal girth 2. Abdominal discomfort 3. Pressure symptoms bladder bowel 4. Acute abdomen due to Hge Rupture Torsion 5. Asymptomatic coincidentally diagnosed

RADIOLOGICAL FEATURES OF BENIGN OVARIAN MASSES:

1. 2. 3. 4. 5. 6. 7. Unilocular Smooth surface No solid elements No external or internal outgrowth No ascites Unilateral Normal doppler flow

CLINICAL FEATURES OF BENIGN OVARIAN TUMORS

Unilateral Cystic Mobile No ascites No cul de-sac nodules Slow or no growth

EVALUATION OF THE PATIENT WITH OVA ADNEXAL MASS.

Complete Hx and physical exam U/S CT scan with contract or IVP Ba enema or colonoscopy Laparoscopy or laparotomy accordingly

INDICATIOONS FOR SURGERY

Ovarian cyst >5 cm followed for 68wks. Solid lesions Papillary vegitation Mass >10 cm at the time of presentations Ascites Palpable mass in premenarchal or post menopausal Suspicion of torsion or rupture