12.benign tumors
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Benign Tumors of the
Ovaries and Fallopian
Tubes
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Differential Diagnosis of Ovarian Tumors
Pathogenesis Specific Type
Functional Follicular Cysts
Lutein Cysts
Theca-lutein cysts
Inflammatory Oophoritis
Salpingo-oophoritis
Metaplastic Endometriosis
Neoplastic Epithelial
Sex Cord-Stromal
Germ-Cell
Introduction
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high gonadotropin Theca-lutein cysts (ovulation induction) (hydatidiform mole) (invasive mole) (choriocarcinoma)
PathogenesisFunctional Ovarian Tumors
ovarian follicle follicular cyst
corpus luteum lutein cyst
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lutein cyst:
Clinical Features
Functional Ovarian Tumors
asymptomatic,unilocular, < 6 cm in diameter,regress
ovarian follicle cyst:
more firm / solid , delay period
undergo torsion: pain, tenderness and rebound ten-derness, moderate leukocytosis.
rupture: pain, tenderness, hemoperitoneum.
Theca-lutein cyst: high gonadotropin level, bilateral (10-15 cm) , regress
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Diagnosis
Functional Ovarian Tumors
Presumptive Diagnosis: 4 to 8 cm cystic adnexal mass is noted on bimanual examination mobile, unilateral, no ascites, < 8 cmConfirmed Diagnosis: regresses
ovarian follicle cyst: in the middle of the menstruationlutein cyst: before the upcoming period
Ultrasound Study: confirm the cystic nature of the mass, cannot excludes neoplastic tumor
delayed menses / abnormal uterine bleeding / abdominal pain differentiate with ectopic pregnancy, salpingo-oophoritis, or torsion of a neoplastic cyst.
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painful, multilocular / Surgical Explorationpartially solid
Management
Functional Ovarian Tumors
child-bearing, <6 cm Reexamination (oral contraceptive)
6 cm to 8 cm / fixed / Ultrasound study feels solid
> 40 years Observation not recommanded
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Management
Functional Ovarian Tumors
Surgical Exploration:
Laparoscopy Laparotomy
ovarian cystectomy
Laparoscopic inspection may not be helpful in differentiating between a functional and a neoplastic ovarian cyst.
An aspiration of a unilocular cyst and cytologic examination of the fluid may be misleading, and slow leakage of the fluid will disseminate cancer quite rapidly if the cyst is malignant.
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Epithelial Ovarian Neoplasms
mesothelial cells
cervical epithelium
endometrium ciliated endosalpinx
serousmucinous endometrioid
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•Serous : 10% bilateral, 70% benign, 5-10% borderline, 20-25% malignant
Epithelial Ovarian Neoplasms
Histologic Features:
•Mucinous: huge size, multilocular, 85% benign
•Brenner: solid benign
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fibromas
granulosa-theca cell tumors
Sertoli-Leydig cell tumors
gynandroblastomas
Sex Cord-Stromal Ovarian Neoplasms
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Sex Cord-Stromal Ovarian Neoplasms
Granulosatheca Cell Neoplasms : any age group feminizing effects
Sertoli-Leydig cell tumors : virilizing effects
Ovarian Fibroma: Meigs’ syndrome
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Germ-Cell TumorsBenign Cystic Teratoma 15-20% bilateral all adult tissues
primarily of skin and the dermal appendagessweat and sebaceous glands
hair follicles
Other tissue components: mature brain,
bronchus, thyroid,
cartilage, bone.
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Clinical Features: nonspecific
Diagnosis of Benign Ovarian TumorsSymptoms
most benign ovarian neoplasms are asymptomatic
Torsion: pain, nausea, vomiting Rupture:
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Bimanual pelvic examination: adnexal mass
Signs and Investigations
Diagnosis of Benign Ovarian Tumors
Abdominal examination: lower abdominal mass peritoneal irritation
Pelvic Ultra-Sonography:
exclude malignancy Serum CA 125:
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Confirmed Diagnosis of an Ovarian Neoplasm
Management of Ovarian Neoplasms
Definitive Treatment:
by surgical exploration and microscopic examination
the type of neoplasm
the patient's age
her desire for future child bearing
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Epithelial ovarian neoplasms:
Management of Ovarian Neoplasms Epithelial ovarian neoplasms
young and nulliparous, unilocular, no excrescences
unilateral salpingo-oophorectomy
carefully inspect the contralateral
ovarian cystectomy
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child-bearing women: salpingo-oophorectomy
Management of Ovarian Neoplasms Stromal-Cell Neoplasms
postmenopausal women:
hysterectomy & bilateral salpingo-oophorectomy
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Management of Ovarian Neoplasms Germ-Cell Tumors
ovarian cystectomyunilateral salpingo-oophorectomy
carefully inspect the contralateral
Cystic teratomas
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Benign Tumors of the Fallopian Tubes: inflammatory (hydrosalpinx or pyosalpinx) benign neoplasms of the oviducts
Benign Tumors of the Fallopian Tubes
difficult to differentiate on examination
definitive treatment: salpingectomy represents
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Parovarian neoplasms
generally small
located within the broad ligament
derived from paramesonephric structures
resect the cystic mass
Parovarian Neoplasms
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