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BENIGN OVARIAN TUMORS

BENIGN OVARIAN TUMORS. King Khalid University Hospital Department of Obstetrics & Gynecology Course 482. 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

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BENIGN OVARIAN TUMORS

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  1. BENIGN OVARIAN TUMORS King Khalid University Hospital Department of Obstetrics & Gynecology Course 482

  2. 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

  3. 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 Benign • II Neoplastic borderline Malignant

  4. FUNCTIONAL OVARIAN CYSTS INCLUDES: a. Follicular cysts b. Corpus luteum cysts c. Theca luten cysts BENIGN OVARIAN NEOPLASM 1. Serous cystadenoma 2. Mucinous cystadenoma 3. Endometrioma 4. Dermoid cysts 5. Fibroma

  5. 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 reach up to 10 cm in diameter • Resolve spontaneously.

  6. 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. common in molar pregnancy, choriocarcinoma and reproductive technology

  7. Benign ovarian neoplasia - 80% of ovarian neoplasm are benign - Benign ovarian neoplasm can be solid or cystic

  8. Serous Cystadenoma (Commonest) - Usually are not very large - unilocular or multilocular - smooth surface - fluid filled

  9. 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. • ENDOMETRIOMA (Chocolate cysts) - Associated with endometriosis

  10. 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

  11. FIBROMA - Firm in consistency * Meigs syndrome Ovarian fibroma + ascites, hydrothorax following removal of fibroma, there is spontaneous resolution of ascites and hydrothorax

  12. Clinical signs and symptoms of ovarian masses: 1.  abdominal girth 2. Abdominal discomfort 3. Pressure symptoms bladder bowel 4. Acute abdomen due to - Haemorrhage - Rupture - Torsion 5. Asymptomatic coincidental finding

  13. RADIOLOGICAL FEATURES OF BENIGN OVARIAN MASSES: 1. Unilocular 2. Smooth surface 3. No solid elements 4. No external or internal outgrowth 5. No ascites 6. Unilateral 7. Normal doppler flow

  14. CLINICAL FEATURES OF BENIGN OVARIAN TUMORS Unilateral  Cystic  Mobile  No ascites  No cul de-sac nodules  Slow or no growth

  15. EVALUATION OF THE PATIENT WITH ADNEXAL MASS.  Complete Hx and physical exam + Tumour markers  U/S  CT scan or MRI  Laparoscopy or laparotomy accordingly

  16. INDICATIOONS FOR SURGERY  Persistant Ovarian cyst >5 cm  Sypmtomatic ( pain or pressure or infertility )  Suspicion of malignancy Surgery either laparoscopy or laparotomy Either cystectomy or Oophrectomy according to age, fertility desire and malignancy index

  17. thx ??

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