OS 215: Repro-Endo Dra. E.

Manalo

Benign Gynecologic Lesions Exam 2

LECTURE OUTLINE o is not as circumscribed in gross configuration

Benign lesions of: o it may be ulcerated with necrosis or grossly
A. Vulva
B. Vagina edematous
C.
D.
Cervix
Uterus
*** were not discussed • majority are asymptomatic but some may have
E. Fallopian Tubes dysuria
F. Ovaries (Functional Cysts) • therapy
G. Ovaries (Benign Neoplasms) o hot sitz baths
o antibiotics
Benign Characteristics: o topical estrogen cream
• slow-growing
o excision of the redundant mucosa – rarely
• well-circumscribed
done but may be necessary
• not associated with hemorrhage, necrosis or evidence
of widespread dissemination (metastasis)
• no constitutional signs and symptoms of weight loss C. Vulvar Cysts
and anorexia • Bartholin’s duct cyst is the most common of the
*specific diagnosis is by tissue biopsy large vulvar cysts
• treatment is not necessary in women younger
VULVA than 40 unless the cyst becomes infected or
A. Urethral Caruncle enlarges enough to produce symptoms
• fleshy outgrowth of the distal edge of the urethra • the most common small vulvar cysts are:
• frequently in postmenopausal women o epidermal inclusion cysts
• must be differentiated from urethral carcinomas  develops when an infolding of
• generally small, single and sessile but may be squamous epithelium has occurred
pedunculated and grow to be 1 to 2 cm in beneath the epidermis in the site of an
diameter episiotomy or obstetric laceration
• tissue is soft, smooth, friable and bright red and  when found in the vagina – most likely
initially appears as an eversion of the urethra related to previous trauma
• believed to arise from an ectropion of the  alternative theories of histogenesis
posterior urethral wall associated with retraction – include embryonic remnants
and atrophy of the postmenopausal vagina – occlusion of pilosebaceous ducts of
• histologically composed of transitional and sweat glands
stratified squamous epithelium with loose  treatment
connective tissue – usually none
• growth is secondary to chronic irritation or – if infected – local heat as well as
infection incision and drainage
• symptoms are variable: – recurrent cysts require excision
o mostly asymptomatic o sebaceous cysts
o dysuria frequency, and urgency  located immediately beneath the
• differential diagnosis: epidermis
o primary carcinoma of the urethra  mostly discovered on the anterior half
of the labia majora
o prolapse of the urethral mucosa
 multiple, freely movable, round, slow
o not a precursor for urethral carcinoma
growing, and nontender with firm
• diagnosis is established by biopsy under local
consistency
anesthesia
 grossly appear white or yellow with
• treatment: caseous contents on cut section
o initially:  local scarring of the adjacent skin
 oral or topical estrogen sometimes occurs when rupture of the
 avoidance of irritation contents of the cyst produces
o cryosurgery, laser therapy, fulguration, or inflammatory reaction in the
operative excision subcutaneous tissue
o following operative destruction, a foley
catheter should be left in place for 48 to 72 D. Nevus
hours • commonly referred to as a mole
o follow-up is necessary to avoid urethral • a localized nest/ cluster of melanocytes
stenosis • arise from the embryonic neural crest and are
present from birth
B. Urethral Prolapse • one of the most common benign neoplasms in
• predominantly in premenarchal females females
• grossly: • generally asymptomatic
o does not have the bright-red color of a • histologic groups:
caruncle
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Benign Gynecologic Lesions
o junctional
o compound
o intradermal nevi
• 5% to 10% of all malignant melanomas in women
arise from the vulva
• 50% of malignant melanomas arise from a
preexisting nevus
• symptoms of an early malignancy include
(ABCD):
o asymmetry
o border irregularity
o color variegation
o diameter usually greater than 6 mm
• all flat vulvar nevi should be excised and
examined histologically
• flat junctional nevus and dysplastic nevus have
high malignant potential
• proper excisional biopsy should be three
dimensional and adequate in width and depth
o approximately 5 -10 mm of normal skin
surrounding the nevus should be included,
o the biopsy should include the underlying
dermis as well
E. Hemangioma
• are rare malformations of blood vessels rather
than true neoplasms.
• frequently discovered initially during childhood
• approximately 60% of vulvar hemangiomas
spontaneously regress in size by the time the
child goes to school
• appear histologically as predominantly thin-
walled capillaries arranged randomly and
separated by thin connective tissue septa.
• most are asymptomatic
• may occasionally become ulcerated and bleed
F. Fibroma
• most common benign solid tumor of the vulva
• commonly found in the labia majora
• occur in all age groups
• have smooth surface and distinct contour
• with low grade potential for becoming malignant
• smaller fibromas are asymptomatic
• large tumors may produce chronic pressure
symptoms or acute pain
• treatment: operative removal if the fibromas are
symptomatic and/or continue to grow
G. Lipoma
• benign, slow growing, circumscribed tumors of fat
cells arising from the subcutaneous tissue of the
vulva.
• second most frequent benign vulvar
mesenchymal tumor
• most lipomas are discovered in the labia majora
and are superficial in location
• malignant potential is extremely low
H. Hidradenoma
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Exam 2
• benign vulvar tumor that originates from apocrine
sweat glands of the inner surface of the labia
majora and nearby perineum.
• found in white women between 30 and 70 years
of age.
• asymptomatic but may cause pruritus or bleeding
if the tumor undergoes necrosis
• excisional biopsy is the treatment of choice
I. Syringoma***
J. Endometriosis
• rare in the vulva
• firm, small nodule or nodules
• varies from a few millimeters to several
centimeters in diameter
• found at the site of an old, healed obstetric
laceration, episiotomy site, an area of operative
removal of a Bartholin’s cyst, or along the canal
of Nuck
• pathophysiology:
o secondary to metaplasia
o retrograde lymphatic spread, or
o potential implantation of endometrial tissue
during operation
• commonly present with introital pain and
dyspareunia
• classic history - cyclic discomfort and
enlargement of the mass during menses
• treatment: wide excision or laser vaporization
depending on the size of the mass
• recurrence after treatment is common
K. Granular Cell Myoblastoma***
L. von Recklinghausen’s disease***
M. Hematomas
• usually secondary to blunt trauma (straddle
injury)
• spontaneous hematomas are rare and usually
occur from rupture of a varicose vein during
pregnancy or the postpartum period
• management:
o usually conservative unless the hematoma is
greater than 10 cm in diameter or is rapidly
expanding
o direct pressure may be applied to control the
bleeding
o compression and application of an ice pack
to the area
o identification and ligation of bleeders if the
hematoma continues to expand
N. Dermatologic Lesions
• skin of the vulva is susceptible to any generalized
skin disease or involvement by systemic disease.
• most common skin diseases include
o contact dermatitis
o neurodermatitis
o psoriasis
o seborrheic dermatitis
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Benign Gynecologic Lesions Exam 2

o cutaneuos candidiasis
o lichen planus
• majority are scalelike rashes and usually C. Dysontogenetic Cysts***
presents with pruritus
• diagnosis and treatment are often obscured or
modified by the environment of the vulva D. Tampon Problems

O. Hidradenitis Suppurativa*** • risks with its usage:

P. Vulvar Edema o vaginal ulcers

• may be a symptom of either local or generalized
disease o toxic shock syndrome from toxins produced
by Staphylococcus aureus
• most common causes:
o associated with microscopic epithelial
o secondary reaction to inflammation changes

o lymphatic blockage • the classic “forgotten” tampon presents with a

foul vaginal discharge and occasional spotting

• treatment: antibiotic vaginal cream for the next 5

VAGINA to 7 days

A. Urethral Diverticulum

• a saclike projection arising from the posterior E. Local Trauma

urethra
• coitus is the most frequent etiology
• often present as a mass of the anterior vaginal
wall • most common injury is a transverse tear of the
posterior fornix
• symptoms are identical to lower genital tract
infection
• manifests with profuse or prolonged vaginal
bleeding
• diagnosis:

o voiding cystourethrograph
• management:

o cystourethroscopy. o prompt suturing under adequate anesthesia

o other diagnostic tests: urethral pressure

profile recordings, vaginal ultrasound,
CERVIX
positive-pressure urethrography and MRI
A. Endocervical and Cervical Polyps
• treatment:
• most common benign neoplastic growth of the
o excisional surgery in acute infection cervix

• seen in multiparous women in their 40s and 50s

B. Inclusion Cyst
• usually secondary to inflammation or due to
• most common cystic structures of the vagina abnormal focal responsiveness to hormonal
stimulation
• usually discovered in the posterior or lateral walls
of the lower third of the vagina • symptoms:

• common in parous women o classic symptom is intermenstrual bleeding

• often results from birth trauma or gynecologic o many are asymptomatic

surgery
o recognized for the first time during a routine
• majority are asymptomatic speculum examination

• if symptomatic, excisional biopsy is indicated • management:

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Benign Gynecologic Lesions Exam 2

o polypectomy may be an office procedure • may become pedunculated and protrude through
the external os of the cervix
o most can be managed by grasping the base
of the polyp with an appropriately sized • diagnosis is by inspection and palpation
clamp.
• management
o the polyp is avulsed with a twisting motion
and sent to the pathology for microscopic o similar to uterine myomas
evaluation.
o observation/ expectant management
o if bleeding ensues, the base may be treated
with chemical cautery, electrocautery, or o medical therapy with GnRH agonists
cryocautery
o myomectomy or hysterectomy

B. Nabothian Cysts
E. Cervical Stenosis
• so common that they are considered a normal
feature of the adult cervix • most often occurs in the region of the internal os

• retention cysts of endocervical columnar cells • may be divided into congenital or acquired
occurring where a tunnel or cleft has been
covered by squamous metaplasia. • causes of acquired cervical stenosis:

• produced by the spontaneous healing process of o operative (i.e. cone biopsy, cautery)
the cervix
o radiation
• asymptomatic
o infection
• treatment is not necessary
o neoplasia

o atrophic changes
C. Lacerations

• frequently occur with both normal and abnormal • symptoms

deliveries
o in premenopausal women: dysmenorhea,
• vary from minor superficial lacerations to pelvic pain, abnormal bleeding, amenorrhea
extensive full-thickness lacerations and infertility

o postmenopausal women are usually

• management
asymptomatic

o acutely bleeding cervical lacerations should o diagnosis is established by inability to

be sutured introduce a 1 to 2 mm dilator into the uterine
cavity
o should be palpated to determine the extent
of cephalad extension of the tear
• management

• complications o dilation of the cervix with dilators

o extensive cervical lacerations especially o if stenosis recurs, monthly laminaria tents

those involving the endocervical stroma may may be used
lead to incompetence of the cervix during a
subsequent pregnancy o after a cervical dilation - a stent is left in the
cervical canal for a few days to maintain
patency
D. Cervical Myomas
o treatment success depends on the proper
• smooth, firm masses similar to myomas of the use of the laser and the quality and quantity
fundus of residual columnar epithelium remaining in
the endocervix
• most are small and asymptomatic

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 OS 215: Repro-Endo Dra. E. Manalo

Benign Gynecologic Lesions Exam 2

UTERUS • highest prevalence occurring during the fifth

decade of a woman’s life
A. Endometrial Polyp
• majority are found in the corpus of the uterus
• localized overgrowths of endometrial glands and
stroma that project beyond the surface of the • classified into subgroups by their relative
endometrium anatomic relationship and position to the layers of
the uterus.
• most arise from the fundus of the uterus
• 3 most common types:
• may vary from a few millimeters to several
centimeters in diameter o intramural

• may have a broad base or be attached by a o subserous - gives the uterus its knobby
slender pedicle. contour during pelvic examination

• peak incidence between ages 40 and 49 o submucous - associated with abnormal

vaginal bleeding or distortion of the uterine
• etiology is unknown cavity that may produce infertility or abortion

• often associated with endometrial hyperplasia • other types:

o unopposed estrogen may be the cause
o may be associated with chronic
administration of tamoxifen
• majority are asymptomatic
o parasitic myoma - myoma that outgrows its
blood supply and obtains a secondary blood
supply from another organ
o broad ligament myoma – results from lateral
growth of myoma

• those that are symptomatic are associated with a • etiology:

wide range of abnormal bleeding patterns.
o each tumor results from an original single
• components: muscle cell (monoclonal theory)

o endometrial glands o somatic mutation of normal myometrium to

leiomyomas influenced by estrogen and
o endometrial stroma progesterone and local growth factors

o central vascular channels • rare before menarche

• malignant transformation has been estimated to • most diminish in size following menopause with
be as high as 0.5% the reduction of a significant amount of circulating
estrogen.
• diagnosis:
• often enlarge during pregnancy and occasionally
o hydrosonography enlarge secondary to oral contraceptive therapy

o hysteroscopy and/or hysterosalpingography • lower incidence among smokers

• management: removal by curettage or via the • however, the relationship between estrogen and
hysteroscope progesterone levels and myoma growth is
complex

• pathology:
B. Hematometra***
o grossly, has a lighter color than the normal
myometrium

C. Leiomyoma o on cut surface it has a glistening, pearl-white

appearance, with the smooth muscle
• benign tumors of muscle cell origin arranged in a trabeculated or whorled
configuration
• often referred to as fibroids or myomas
o histologically there is a proliferation of
• most frequent tumors of the pelvis mature smooth muscle cells; the nonstriated

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Benign Gynecologic Lesions Exam 2

muscle fibers are arranged interlacing o medical treatment involves reduction in the
bundles. size of the myoma by reducing the level of
estrogen and progesterone (e.g.GnRh
• types of degeneration: agonists)

o hyaline o advantages:

o myxomatous  facilitate easier surgery

o calcific  induction of amenorrhea

o cystic o disadvantages:

o fatty  delay in final tissue diagnosis

o red degeneration  degeneration of some leiomyomas,

necessitating piece-meal enucleation at
o occurs in pregnancy in 5% to 10% of gravid myomectomy
women with myomas
 hypoestrogenic side effects (e.g.
o medically treated during pregnancy, trabecular bone loss, vasomotor
otherwise, myomectomy is done flushes)

o necrosis  cost

o malignant - 0.3% and 0.7%  self-administration needed or repetitive

injections in many cases
• symptoms:
• surgical management:
o most common are pressure from an
enlarging pelvic mass, pain and abnormal o indications for surgery:
uterine bleeding
 rapidly expanding pelvic mass
o severity of symptoms is usually related to the
number, location, and size of the myomas  persistent abnormal bleeding

o majority are asymptomatic  pain or pressure

o rapid growth after menopause is a disturbing  enlargement of an asymptomatic

symptom myoma to more than 8 cm in a woman
who has not yet completed child bearing
• diagnosis:
o contraindications to surgery:
o pelvic examination
 pregnancy
o ultrasound
 advanced adnexal disease
• management:
 malignancy

o if small & symptomatic - observation

• transcatheter uterine artery embolization
o at first discovery, pelvic exams every 6
o newest modality in managing uterine
months to determine the rate of growth
myomas
o women with abnormal bleeding and
o multiple embolic materials have been used
leiomyomas should be investigated
including gelatin sponge, silicon spheres,
thoroughly for concurrent problems such as
metal coils, and polyvinyl alcohol particles of
endomterial hyperplasia
various diameters
o surgery when persistently symptomatic
o postprocedural abdominal and pelvic pain is
common for the first 24 hours
• medical management:

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Benign Gynecologic Lesions Exam 2

o success rates in regard to decreasing • most prevalent benign tumor of the oviduct
menorrhagia and reduction in uterine size
are promising • small,gray-white, circumbscribed nodules, 1 to 2
cm in diameter

• usually unilateral
D. Adenomyosis
• asymptomatic
• growth of glands and stroma into the uterine
myometrium to a depth of at least 2.5 mm from • do not become malignant but may be mistaken
the basalis layer for low-grade neoplasm

• sometimes known as internal endometriosis

• pathogenesis remains unknown C. Paratubal Cysts

• pathology: • diagnosis is incidental

o diffuse involvement of the anterior and the
posterior walls of the uterus, with the
posterior being more often involved
o there is a focal area of the lesion -
adenomyoma.
o results in a asymmetric uterus where there is
usually a pseudocapsule.
• often multiple and may vary from 0.5 cm to more
than 20 cm in diameter
• when pedunculated and near the fimbrial end of
the oviduct - hydatid cysts of Morgagni
• treatment is simple excision
• complications: torsion

• criteria for diagnosis:

o a finding of inactive or proliferative glands, D. Torsion

more than one low power field (2.5 mm) from
the basalis layer of the endometrium • rare event however has been reported with both
normal and pathologic fallopian tubes
• diagnosis:
• pregnancy predisposes to this problem
o majority of women are asymptomatic
• usually accompanies torsion of the ovary in 50-
o may present with secondary dysmennorhea 60% of cases
and menorrhagia. severity of symptoms
• right tube more frequently involved than the left
increases proportionally with depth of
invasion and penetration.
• presents with acute lower abdominal and pelvic
o usually presents with uterine enlargement pain
palpated through pelvic examination
• management:
o ultrasound and MRI are helpful in diagnosis
o exploratory operation

• treatment: o with a minor degree of torsion, it is possible

to restore normal circulation to the tube and
o no satisfactory proven medical treatment for salvage it
adenomyosis.

o hysterectomy is the definitive treatment

OVARIES (Functional Cysts)

A. Follicular Cysts
FALLOPIAN TUBES
• most frequent cystic structure in normal ovaries
A. Leiomyomas***
• arises from temporary variation of a normal
physiologic process

B. Adenomatoid Tumors • may result from either

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Benign Gynecologic Lesions
o the dominant mature follicle’s failing to
rupture (persistent follicle) or
o an immature follicle’s failing to undergo the
normal process of atresia.
• most commonly found in young, menstruating
women
• majority are asymptomatic
• may be discovered during ultrasound imaging of
the pelvis or a routine pelvic examination
• may also present with signs and symptoms of
ovarian enlargement and therefore must be
differentiated from a true ovarian neoplasm
• management
o conservative observation
o majority disappear spontaneously by either
reabsorption of the cyst fluid or silent rupture
within 4 to 8 weeks on initial diagnosis
o persistent ovarian mass necessitates
operative intervention to differentiate it from
a true neoplasm of the ovary
o cystectomy and oophorectomy
B. Corpus Luteum Cysts
• less common than follicular cysts, but clinically
more important
• minimum of 3 cm in diameter
• may be associated with either normal endocrine
function or prolonged secretion of progesterone.
• associated menstrual pattern may be normal,
delayed menstruation or amenorrhea
• vary from being asymptomatic to those causing
catastrophic and massive intraperitoneal bleeding
with rupture
• differential diagnosis:
o ectopic pregnancy
o ruptured endometrioma
o adnexal torsion
• management:
o conservative if unruptured
o with persistent bleeding - treatment is
cystectomy
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Exam 2
C. Theca Lutein Cysts
• least common of the three types of physiologic
ovarian cysts
• almost always bilateral and produce moderate to
massive enlargement of the ovaries
• arise from either prolonged or excessive
stimulation of the ovaries by endogenous or
exogenous gonadotrophins
• Seen in 50% of molar pregnancies and 10% of
choriocarcinoma
• also discovered in the latter months of
pregnancies often with conditions that produce a
large placenta, such as twins, diabetes and Rh
sensitization
• hyperreactio luteinalis - is the condition of ovarian
enlargement secondary to the development of
multiple luteinized follicular cysts.
• luteoma of pregnancy - not a true neoplasm but
rather a specific, benign, hyperplastic reaction of
ovarian theca lutein cells
• produce vague symptoms, such as pressure in
the pelvis
• presence is established by palpation and often
confirmed by ultrasound examination
• treatment is conservative
OVARIES (Benign Neoplasms)
A. Dermoid Cyst
• a benign cystic teratoma
• most common ovarian neoplasm in prepubertal
females and in teenagers
• vary from a few millimeters to 25 cm in diameter,
may be single or multiple
• usually discovered either in the cul-de-sac or
anterior to the broad ligament
• composed of mature cells, usually, from all three
germ layers
• most solid elements arise are contained in a
protrusion or nipple (mamila) in the cyst wall
termed the prominence or tubercle of Rokitansky
• adult thyroid tissue is discovered microscopically
in approximately 12% of benign teratomas
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Benign Gynecologic Lesions
• struma ovarii - teratoma in which the thyroid
tissue has overgrown other elements and is the
predominant tissue
• presenting symptoms include pain, sensation of
pelvic pressure
• 50% to 60% are asymptomatic
• some are discovered during a routine pelvic
examination, coincidentally visualized by an
abdominal x-ray or ultrasound examination
• management: cystectomy with preservation of as
much normal ovarian tissue as possible
• complications:
o torsion
o rupture
o infection
o hemorrhage
o malignant degeneration
B. Endometrioma
• areas of ovarian endometriosis that become
cystic
• usually associated with endometriosis in other
areas of the pelvic cavity
• large chocolate cysts of the ovary may reach 15
to 20 cm
• the most common symptoms associated:
o pelvic pain
o dyspareunia
o infertility
• tender and immobile ovaries on pelvic
examination - dense adhesions on surrounding
structures is a common finding
• management:
o the choice of management depends on:
 patient’s age
 future reproductive plans
 severity of symptoms
o medical therapy is rarely successful in
treating ovarian endometriosis
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Exam 2
o surgical therapy is complicated by formation
of de novo and recurrent adhesions
C. Fibroma
• the most common benign, solid neoplasm of the
ovary
• comprise approximately 5% of benign ovarian
neoplasms and approximately 20% of all solid
tumors of the ovary
• arises from undifferentiated fibrous stroma of the
ovary
• commonly presents in postmenopausal women
• malignant potential is low, less than 1%
• manifest with pressure symptoms and abdominal
enlargement
• Meigs’ syndrome
o the association of an ovarian fibroma,
ascites and hydrothorax
o both resolve after the removal of an ovarian
tumor
• management:
o exploratory operation
o in postmenopausal women, often a bilateral
salpingo-oophorectomy and total abdominal
hysterectomy are performed
D. Transitional Cell Tumors***
E. Cystadenoma
• the epithelial element is most commonly serous,
but histologically may be mucinous and
endometrioid or clear cell
• are usually small tumors that arise from the
surface of the ovary
• bilateral in 20% to 25% of women
• usually occur in postmenopausal women
• smaller tumors are asymptomatic or pelvic
operations.
• large tumors may cause pressure symptoms,
rarely adnexal torsion
• management:
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Benign Gynecologic Lesions
o postmenopausal women: bilateral salpingo-
oophorectomy and total abdominal
hysterectomy
o in younger women: simple excision of the
tumor and inspection of the contralateral
ovary is appropriate
F. Torsion
• a complication of benign ovarian tumors in the
postmenopausal woman
• important cause of acute lower abdominal and
pelvic pain
• commonly affects both fallopian tube and ovaries
• pregnancy appears to predispose women to
adnexal torsion
• symptoms:
o acute abdominal and pelvic pain
o nausea and vomiting
o fever
• management:
o conservative operation for young women -
laparoscope or via laparotomy
o with severe vascular compromise - unilateral
salpingo-oophorectomy
ENDOMETRIUM
Endometriosis
• a benign disease but a progressive one
• the presence or growth of the glands and stroma
of the lining of the uterus in an aberrant or
heterotopic location
o aberrant endometrial tissue grows under the
cyclic influence of ovarian hormones
• mid 30s, nulliparous and involuntarily infertile with
symptoms of secondary dysmenorrhea and
pelvic pain
• etiology
o retrograde menstruation - pelvic
endometriosis is secondary to implantation
of endometrial cells shed during
menstruation
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Exam 2
o metaplasia - arises from the metaplasia of
coelomic epithelium or proliferation of
embryonic rests.
o lymphatic and vascular metastasis -
endometrial tissue is transplanted via
lymphatic pathways and the vascular
system.
o iatrogenic dissemination
o Immunologic changes - the altered function
of the immune-related cells are directly
involved on the pathogenesis of
endometriosis
o genetic predisposition
• pathology
o ovaries are the most common site
o grossly exhibit wide variation in color, shape,
size and associated inflammatory and fibrotic
changes.
o cardinal histological features:
 ectopic endometrial glands
 ectopic endometrial stroma
 hemorrhage into the adjacent tissue
• signs and symptoms:
o classic symptoms include cyclic pelvic pain
and infertility.
o pelvic pain is often inversely proportional to
the amount of endometriosis.
o cyclic pelvic pain is related to the sequential
swelling and the extravasations of blood and
menstrual debris in to the surrounding tissue
and mediated by prostaglandins and
cytokines
o dyspareunia
o GI and urinary symptoms
o catamenial hemothorax and massive ascites
- rare
o classic pelvic findings of a retroverted uterus
with scarring and tenderness posterior to the
uterus
• medications:
o Danazol
o GnRH agonists
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Benign Gynecologic Lesions Exam 2

o oral contraceptives

o Medroxyprogesterone acetate (DMPA)

• surgical therapy

o often occurs concurrently during laparoscopy

to establish diagnosis

o only option after failed medical treatment

o for women who have moderate to severe

endometriosis

o conservative surgery has as its goal the

removal of macroscopic visible areas of
endometriosis with preservation of fertility

o types:

 laparoscopy

 laser

 total hysterectomy with ovarian

preservation

 total abdominal hysterectomy with

bilateral salpingo-oophorectomy

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