slide benign diseases of the female reproductive tract

8/10/2019 Slide Benign Diseases of the Female Reproductive Tract

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BENIGN DISEASES OF THEBENIGN DISEASES OF THEBENIGN DISEASES OF THEBENIGN DISEASES OF THEBENIGN DISEASES OF THEBENIGN DISEASES OF THEBENIGN DISEASES OF THEBENIGN DISEASES OF THE

FEMALE REPRODUCTIVEFEMALE REPRODUCTIVEFEMALE REPRODUCTIVEFEMALE REPRODUCTIVEFEMALE REPRODUCTIVEFEMALE REPRODUCTIVEFEMALE REPRODUCTIVEFEMALE REPRODUCTIVE

TRACTTRACTTRACTTRACTTRACTTRACTTRACTTRACT

Department of Obstetric and GynecologyMedical School

University of Sumatera Utarra Medan

INTRODUCTIONINTRODUCTION

Benign tumors of the Female ReproductiveBenign tumors of the Female Reproductive

Tract are not infrequent.Tract are not infrequent.

They are grouped into: Vulva,Vagina,Uterus,FalThey are grouped into: Vulva,Vagina,Uterus,Fal

lopian Tube and Ovarian Benign Tumors.lopian Tube and Ovarian Benign Tumors.

The tumors may also be devided into: Solid andThe tumors may also be devided into: Solid andCystic, or into the cellular origin.Cystic, or into the cellular origin.


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Benign tumors of the Vulva.Benign tumors of the Vulva.

They may be Cystic or Solid.They may be Cystic or Solid.

The cystic tumors: Bartholin cystic/abscess andThe cystic tumors: Bartholin cystic/abscess and

Hydrocele.Hydrocele.

Common Solid tumor of the Vulva: Fibroma,Common Solid tumor of the Vulva: Fibroma,

Lipoma, or Hydradenoma.Lipoma, or Hydradenoma.

A.A. CysticCystic anandd BartholinBartholine Abscesse Abscess

ChChronironic Ic Inflamnflammationmationobstruobstructctiiononccyystisticc dilatadilatattiion.on.

AAbsbscceesssspainpain..

The iThe infenfection is usuallyction is usually polpolyymimiccrobarobass withwithgonogonoccoocalcal 20%20% -- 30%.30%.

IInncciissiion of theon of the absabscceessss withwith draindrain reducesreducespain and complaints.pain and complaints.

StonyStony absabscceessss && nonenone responsiresponsive to theve to thedraindrainmarsupialimarsupializzaattiion.on.

ChChronironicc BartholinBartholinitisitis dispareunidispareuni or dry vagina.or dry vagina.

Batholins aBatholins absbscceessss inin papattienient oft of ppoosst menopausalt menopausalwomanwoman malignancymalignancy.. HistopathologicHistopathologic

examinationexamination should be doneshould be done.. A completeA complete eexcxciissiion of theon of the controled Bartholinscontroled Bartholins

infectrion, should be widely done at theinfectrion, should be widely done at the vulvavulva toto

extirpate the whole part of the gland.extirpate the whole part of the gland.

VulvaVulva

Bartholins cystBartholins cyst


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VulvaVulva

Bartholins cystBartholins cystB.B. CyCyststicic / H/ Hyydrodroccelelee ofof NuckNuck

RRotundumotundum lligamentigamentss ,, leafes theleafes the pelvipelvic cavityc cavitythrough thethrough the ccanalanal ofof Nuck anNuck andd ttererminated in theminated in thetissue oftissue of labia mayora.labia mayora.

HHyydrodroccelelee,, cycyststss,, oror herniahernia may be formedmay be formed atat

thisthis tratracct ant andd appeared asappeared as vulvarvulvar cycystisticc tumortumor..

HHerniaernias surgical treatment of thes surgical treatment of the ccanalanal ofof NuckNuckiclude theiclude the disdissseectionction ofof herniahernial capsulel capsule highhighligaligattiionon anandd strengthening ofstrengthening of the externalthe external

inguinal ring.inguinal ring.

C. EndometriosisC. Endometriosis

EEndometrindometrial cellsal cells may implant anywheremay implant anywherethrough the canal of Nuckthrough the canal of Nuck, episiotom, episiotomy ory orat a previousat a previous surgical scarsurgical scar..

The lesion may beThe lesion may be cycystistic or solidc or solid..

ExcExciision + medicaments is the best choicesion + medicaments is the best choiceto manage this diseaseto manage this disease..

D. LD. Lyypomapomass

Originated from the fatty tissue ofOriginated from the fatty tissue of thethe lablabiiaamamajjoraora oror mons venerismons veneris that growed relativelythat growed relativelyslowslow..

Cause no symptomsCause no symptoms except when the diameterexcept when the diameter

is extremely bigis extremely big.. Some of the lypomas growed into a very bigSome of the lypomas growed into a very big

sizesize,, but more often the sizebut more often the size will not exceedwill not exceed 1010 --12 cm.12 cm.

The indication of lesion excision depends onThe indication of lesion excision depends onthe patients wish,or deleterious effect to thethe patients wish,or deleterious effect to thesurroundings.surroundings.


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E. FibromaE. Fibroma

A solid nodule of connective tissue in theA solid nodule of connective tissue in the lablabiiaamamajjoraora or vaginal portion of the cervix.or vaginal portion of the cervix.

UlUlcceraerationtion anandd neneccrorottiizingzing pprroocess may occur atcess may occur atthethe distaldistal part of the cervixpart of the cervix..

Hystopathologically they areHystopathologically they are dermatofibromadermatofibromass

demarcated sharply by ademarcated sharply by abundlebundle ofofccoolllagenlagentissuetissue anandd mixedmixed fibroblasfibroblastt..

For cosmetical reasons the lesion should beFor cosmetical reasons the lesion should be

excisedexcised thoroughlythoroughly..

F. HF. Hyydradenomadradenoma

An umbilicated benign chocolate colourAn umbilicated benign chocolate colourtumortumor,,withwith 11-- 2 cm2 cm diameter,appear from thediameter,appear from thesurface of the skinsurface of the skin..

The growing tumorThe growing tumor,, maymay turns into a cysticturns into a cysticformform..

HHistologiistologicallycally it is an capsulatedit is an capsulated apokrinapokrinvulvavulval gandl gand adenoma.adenoma.

ThisThis tumortumor mimics themimics the apokrinapokrin gland tumorgland tumorof the breastof the breast..

Excised the tumor for histologic evident.Excised the tumor for histologic evident.

G.G. CCondondyyloma Aloma Accuminatuminatumum

EtiologyEtiology virus HPV typevirus HPV type 6.6.

MacroscopicallyMacroscopically cowly flowercowly flower..

The location of growth : vulva, anus,The location of growth : vulva, anus,vagina and cervix.vagina and cervix.

CCondondyyloma Aloma Accuminatuminatumum


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BENIGN TUMOR OFBENIGN TUMOR OF VAGINAVAGINA

VaginaVagina is not common for benign tumor tois not common for benign tumor togrowgrow,, and isand is almostalmost asasyymptomatimptomaticc..

The tThe tumorumor solid or cysticsolid or cystic..

The small,The small, asasyymptomatimptomatic cytsc cyts need noneed nointerventionintervention..

To rule out malignacy, solid tTo rule out malignacy, solid tumorumor shouldshouldbe excised forbe excised for histologihistologicc diagnosis.diagnosis.

A. DuA. Ducctus Gartnertus Gartner CyCystst

Growed from the rudimentary ofGrowed from the rudimentary of mesonefrosmesonefrosduduccts.ts.

Failure of degeneration process:Failure of degeneration process:Mesonefric and Mullerian ducts unificationMesonefric and Mullerian ducts unification

The cyThe cystst may grow deeply into themay grow deeply into the tissue andtissue and

traverses thetraverses the paravaginaparavaginall sheath, causingsheath, causingeexcxciissiion difficulton difficult anandd bbleedingleeding..

The differential dThe differential diagnoiagnosissis : epit: epithhelieliaall

inincclusilusion cyston cyst anandd suburetsuburethhrarall divertidiverticculum.ulum.

B. EpitB. Epithhelieliaal Inl Incclusilusionon CyCyststss

Originated from the vaginal epithelium.Originated from the vaginal epithelium.

The frequent cause :The frequent cause : OObstetribstetricclalacceraerattiions orons or episiotomepisiotomyy

Accumulated, caseouse like substanceAccumulated, caseouse like substanceof the desquamated cellsof the desquamated cells cyst.cyst.

HyHystologstologically:ically: stratifiedstratified ssqquamouamouussepitepithheleliumium.. Frequently, at the lowerFrequently, at the lowerthird part of the vaginal wall and at thethird part of the vaginal wall and at theposterior or posterolateral aspect.posterior or posterolateral aspect.


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C.C. Solid TumorsSolid Tumors

Clinically it appears like aClinically it appears like a polipoidalpolipoidaltumortumor or as painless mass.or as painless mass.

Hystologically reveals the presence ofHystologically reveals the presence ofunstriatedunstriated musclemuscle(leiom(leiomyyomaoma),connective tissue),connective tissue fibrefibre((fibroma),fibroma),or mixed form (fibromyoma)or mixed form (fibromyoma)..

Surgical incision:Surgical incision:treament as well astreament as well as

hystological meanshystological means..

D. EndometriosisD. Endometriosis

Endometriosis is not uncommon inEndometriosis is not uncommon invagina as an extraperitoneal lesion.vagina as an extraperitoneal lesion.

The patient complaints of cyclical painThe patient complaints of cyclical pain

anandd dispareundispareunia.ia.

The lesion is painfull on palptionThe lesion is painfull on palption..

The dThe diagnosisiagnosis is confirmedis confirmedhistologicallyhistologically anandd surgical excision orsurgical excision orhormonal is the treatment of choicehormonal is the treatment of choice..

E.E. CCondondyylomalomass

SqSquamouamouuss eepitpithheliumelium of theof the vagina can bevagina can beinfected byinfected by certain types of HPV(Humancertain types of HPV(HumanPapiloma Virus)Papiloma Virus)..

PodophylinPodophylin (cytotoxic agen)(cytotoxic agen) vulvavulvallccondondyylomalomas,s, but not vaginal for neurotoxicbut not vaginal for neurotoxicreasonreason

Chemical cChemical cauteriauterizzaattiionon usingusing bichloraceticbichloraceticanandd trichloroacetictrichloroacetic acidacid.. Other treatmentOther treatmentalternatives,alternatives, laserlaser ablaablattiionon,, ccrryyooccauterauteryy, an, anddinterferon.interferon.


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BENIGNBENIGN TUMORTUMORS OFS OF

THE UTERUSTHE UTERUS A.A. CERVIXCERVIX

A.1.A.1. CervicalCervical PoliPolieepp

ChChronironicc papilpapilllar endoservitisar endoservitiscervical poliep;cervical poliep;rounded, red soft massrounded, red soft mass,, easily bledeasily bled..

DifferentialDifferential DiagnosDiagnosisis ::

Fragmen polipoid endocervical carcinomaFragmen polipoid endocervical carcinoma

Retained product of conception.Retained product of conception.

Prolapsed submucous fibroid or anProlapsed submucous fibroid or anendometrial poliep.endometrial poliep.

The poliepThe poliep grasped and torted with agrasped and torted with atenaculumtenaculum then cautery for haemostasis.then cautery for haemostasis.

A.2.A.2. LeiomyomaLeiomyoma

Leiomyoma or fibroid is very common tumor inLeiomyoma or fibroid is very common tumor inthe uterus.the uterus.

The cervix fibroids constituted of 8%.The cervix fibroids constituted of 8%.

The tumors have common histological typeThe tumors have common histological typeand formsand forms at the uterine corpus and fundus.at the uterine corpus and fundus.

A compressing force to its surroundings:A compressing force to its surroundings:(bladder) frequent voiding, dispareunia, or(bladder) frequent voiding, dispareunia, ordistocya at parturition. Surgical treatment :distocya at parturition. Surgical treatment :myomectomymyomectomy, or, or hysterectomyhysterectomy is the treatmentis the treatmentof choice.of choice.

A.3.A.3. EndometriosisEndometriosis

The vesicular lesion of red/reddish blue.The vesicular lesion of red/reddish blue.

The most common cause ofThe most common cause of

dysmenorrhea or dyspareunia,dysmenorrhea or dyspareunia,especially at the premenstrual period.especially at the premenstrual period.

InfertilityInfertility destruction of endocervicaldestruction of endocervical

glands andglands and mucous productsmucous products

Management : th/ hormone and cautery,Management : th/ hormone and cautery,excision or laser.excision or laser.


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B. UTERINE FIBROIDSB. UTERINE FIBROIDS Benign nBenign neoplaseoplastic diseasetic disease of nonof non--striatedstriated

muscle cells,muscle cells, connective,connective, anandd ccoolllagenlagen tissue.tissue.

Incidence : 20Incidence : 20--25 % of reproductive age.25 % of reproductive age.

Localization :Localization :

SSubmuubmuccoouuss fibroidsfibroids (6,1%)(6,1%)

IIntramuralntramural fibroidsfibroids (54%)(54%)

SSubseroubserouuss fibroidsfibroids (48,2%)(48,2%)

Uterine fibroids/Mioma UteriUterine fibroids/Mioma Uteri

OnlyOnly 2020 50%50% of the caseof the case,,showed clinical signshowed clinical signand symptomsand symptoms ::

AAbnormalbnormal bleedingbleeding (menor(menorrhrhagia/metroragia/metrorrhrhagia)agia)

Etiologic factors for bleeding :Etiologic factors for bleeding :

Ovarian hormone(estrogen) :Ovarian hormone(estrogen) : endometrial hyperplasia or..... ...endometrial hyperplasia or..... ...adenocarcinoma.adenocarcinoma.

Widening of the endometrial surface.Widening of the endometrial surface.

WeakenedWeakeneduteruterineine ccontraontracctilittilitiesies

IncreasedIncreased vasvasccularisaularisattiion of the uteruson of the uterus..

PainPain

Pain sensation:Pain sensation:dydysmenorsmenorrhrhea,ea, lowerlowerabdominal pain and backageabdominal pain and backage (in(in 65%65%of theof thepatients)patients)..

Sign and symptom of the tumorSign and symptom of the tumorcompressing force:compressing force: Depend on theDepend on the sizesize anandd place ofplace of the fibroidsthe fibroids..

Symptoms:Symptoms: urineurine retenretenttiion oron or constipation.constipation.

InfertilitInfertilityy LikeLike endometriosis,endometriosis, fibroids may alsofibroids may also causecause

infertilitinfertilityy in (in (2727 55%55%)) wwomenomen..


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ManagementManagement::

ObservaObservation.tion.

MedicamentsMedicaments

Applied before surgical treatment.Applied before surgical treatment.

GnRH analogue:GnRH analogue: reduce bleeding at thereduce bleeding at thetime of surgical treatment and to ease thetime of surgical treatment and to ease theseperation of tissue adhesions.seperation of tissue adhesions.

Surgical treatmentSurgical treatment ::

Laparotomy:.Laparotomy:.Myomectomy/Hysterectomy.Myomectomy/Hysterectomy.

Laparascopy:.Laparascopy:.Myomectomy/Hysterectomy.Myomectomy/Hysterectomy.

Embolisation of the uterine arteryEmbolisation of the uterine artery

C. AdenomiosisC. Adenomiosis A binign tumor of the uterusA binign tumor of the uterus wherewhere

endometrial glands and stromal cellsendometrial glands and stromal cells

found growingfound growing in thein the mmyyometriometrial tissue.al tissue. This invation induced hypertrophy &This invation induced hypertrophy &

hyperplasiahyperplasia uterine enlargement.uterine enlargement.

The incidence : 20%, (uterine dissectionThe incidence : 20%, (uterine dissectionrevealed 65% incidence rate).revealed 65% incidence rate).

Meyer:Meyer: weakened myometrialweakened myometrial --endometrial barrier.endometrial barrier.


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SymptomsSymptoms ::

60%60% women complaints ofwomen complaints of abnormal uterabnormal uterineinebleedingbleeding, 50% h, 50% hyypermenopermenorrrrhheeaa, an, andd 25%25%metrorrhagia.metrorrhagia.

DDyysmenorsmenorrhrheea:a: 25%25% of the caseof the case..

GnRH agonistGnRH agonist symptoms, butsymptoms, butrecurrency was found only within 6 month.recurrency was found only within 6 month.

The definitive treatmentThe definitive treatment totatotal hysterecl hysterec--

tomtomyy

D. ENDOMETRID. ENDOMETRIALAL POLIPOLIEEPP

The hyperplastic growing of endometrialThe hyperplastic growing of endometrial

glands & stromal tissue forming a nodule.glands & stromal tissue forming a nodule.

The most common symptom:The most common symptom:premenpremensstrualtrual spotting orspotting or metrorrhagiametrorrhagia..

HHistoloistologicallygically proliferatiproliferativeve endometriumendometrium..

Diagnosis:Diagnosis: histologic test after D&C.histologic test after D&C.

The common and frequent treatment, D&CThe common and frequent treatment, D&C..but ifbut if adenoadenoccararccinomainoma was proven,was proven, TAH.TAH.

The cThe combinombineded estrogenestrogen--progestinprogestin oraloralpillspills is recommendedis recommended for young agefor young age

womenwomen..


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BENIGNBENIGN TUMORTUMOR OF THEOF THE

FALLOPIAN TUBE &FALLOPIAN TUBE & OVARIUMOVARIUM

The incidence of benign fallopian tumorThe incidence of benign fallopian tumor low.low.

A pedunculated small tumor located at theA pedunculated small tumor located at the

lumen of the tube.lumen of the tube.

AdematoidAdematoid most common tumor.most common tumor.

The diameter 3 cm,no malignant potentiality.The diameter 3 cm,no malignant potentiality.

THE CLASSIFICATION OF OVARIAN BENIGNTHE CLASSIFICATION OF OVARIAN BENIGNTUMORTUMOR

NonNon--neoplasticneoplastic

TumorTumor by infectionby infection

Other tOther tumorumor::

FFoollliliclclee cystcyst

CCorpus luteumorpus luteum cycystst

LLuteinutein cycystst

GGerminal inerminal incclusilusion Cyon Cystst

EndometriosisEndometriosis CyCystst SteinStein LeventhalLeventhal CyCystst

NNeoplasticeoplastic

CyCystisticc

CyCystoma ovarii simplestoma ovarii simplexx

CyCystadenoma ovarii mustadenoma ovarii muccinosuminosum CyCystadenoma ovarii serosumstadenoma ovarii serosum

EEndometroidndometroid CyCystst

DDermoidermoid CyCystst

SolidSolid Fibroma, leiomioma, fibroadenoma, papiloma,Fibroma, leiomioma, fibroadenoma, papiloma,

angioma, limfangiomaangioma, limfangioma

BrennerBrenner ttumorumor AAdrenaldrenal rudimentary tumorrudimentary tumor (mas(mascculinoulino

blastoma)blastoma)


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TTUMORS BY INFECTIONUMORS BY INFECTION

TuboTubo--OvarianOvarian AbsAbscceessss

UntreatedUntreated aaccutute infection ofe infection of thethetubes:tubes:suppurative and abscess formation.suppurative and abscess formation.

Common amongCommon among sesexxual aual acctitive women, ofve women, ofrelatively young agesrelatively young ages ((2020--4040)) yearsyears..

RiRisksk ffaktoraktorss : p: promiscuityromiscuity, Clamiydia infe, Clamiydia infettiionon, G, GOOanandd IUCD usersIUCD users..

PatPathhogenesogenesis :is : babaccteriterialal invasiinvasionon to theto theepitepithhelelialial layer of the fallopianlayer of the fallopian tubatuba tissuetissue

damagedamage andand neneccrorottiiccs,s, good medium forgood medium foranaerobanaerobic bacteria to growic bacteria to grow..

Sign and symptoms:Sign and symptoms:

MaMajjoror ccriteriariteria Lower abdominal tenderness, palpatedLower abdominal tenderness, palpated

uunilateral/bilateralnilateral/bilateral adnexaadnexal mass of a slurl mass of a slurboundery.boundery.

Stiff movement of the cStiff movement of the cerviervix.x.

MinorMinor ccriteriariteria Body TempefratureBody Tempefrature 3838CC

Abnormal serviAbnormal servixx oror vaginal dischargevaginal discharge EErryytthhrorocycyttee sedimensedimentt anandd CC-- reaktif proteinreaktif protein LLababoratory test:.oratory test:. NN.. Gonorrhea anGonorrhea andd CC..

Trachomatis.Trachomatis.

Diff.Diff.Diagnosis :Diagnosis : ruptured ectopicruptured ectopicpregnancypregnancy, periap, periapppendiendixx absabscceesss,s,pypyosalposalpyynnxx, ap, apppendiendixx perforaperforattiionon,,

endomeendomettrioma, anrioma, andd dermoiddermoid cycystst ManagementManagement ::

UnrupturedUnruptured TuboTubo--ovarian Absovarian Abscceesss.s.

AsAsyymptomatimptomatic :c :Proper ABProper AB (very(veryclose observation)close observation)..

SSyymptomatimptomatic :c :

HospitalizationHospitalization broad spektrum AB.broad spektrum AB.If the initial treatment isIf the initial treatment is

successfullysuccessfullycontinuecontinue ABAB 1010--1414daysdays..

IfIf absabscceessss formation cant beformation cant beprevented,prevented, eveneven rupturruptureded,, surgicalsurgicalintervention must be done.intervention must be done.


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RupturedRuptured TuboTubo--ovarian Absesovarian Abses::

AnAn aaccutute event:e event: surgicalsurgicalintervention.intervention.

Unruptured aUnruptured absbscceessss:: goodgood prognosprognosisis,,and for the rupturedand for the ruptured absabscceessss if properif proper

and adequately treatedand adequately treated thethe mortalitmortality rate:y rate:


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GGerminal inerminal incclusilusion cyon cystst The iThe invaginainvaginaionon anandd isolaisolattiion ofon of a smalla small

piece ofpiece of germinativum epitgerminativum epithheleliumium at theat theovariumovarium surfacesurface..

The tThe tumorumor is frequently foundis frequently found at old ageat old age,,and theand the diameterdiameter never exceednever exceed 1 cm.1 cm.

The cyThe cystst is found under theis found under the ovariovarianansurfacesurface;; with a layer of cubal epithelianwith a layer of cubal epithelianwallwall or lowor low tthhoraoraciccic cellscells, an, andd the contentthe contentisis a cleara clear seroserous fluidus fluid..

EndometriosiEndometriosis cys cystst EndometriosisEndometriosis The functional andThe functional and

growing endometrial tissue out sidegrowing endometrial tissue out sideuterine cavity.uterine cavity.

The inner capsule of the tumor consist ofThe inner capsule of the tumor consist ofendometriendometrial cells;al cells; the cyst filled withthe cyst filled withcchhoococolatlate colour fluide colour fluid consisting ofconsisting ofendometriosis, erendometriosis, eryytthhrorocycyttee, hemosiderin, hemosiderinee,,

andand makromakrophphagage cells.e cells.

The exact etiology was not known.The exact etiology was not known.

Some theories of endometriosis:Some theories of endometriosis:

Regurgitation and implantation.Regurgitation and implantation.

MMetaplasiaetaplasia ofof coelomcoelomic cellsic cells

Hematogenic and lymphaticHematogenic and lymphatic

disemination.disemination. Immunologic.Immunologic.

Genetic.Genetic.

Endvironment factors.Endvironment factors.

General symptom of endometriosis:General symptom of endometriosis:

Chronic pelvic painChronic pelvic pain

Abnormal uterine bleedingAbnormal uterine bleeding

DyspareuniaDyspareunia

InfertilityInfertility


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The diagnosis is made :The diagnosis is made : anamnesis,anamnesis,phisical examination and laparoscopicphisical examination and laparoscopicconfirmation.:confirmation.: AnamnesisAnamnesis

Gynecologic examination.Gynecologic examination.

UltrasonographyUltrasonography

LaparoscopyLaparoscopy

Laboratory examination.Laboratory examination.

GnRHGnRH--a functional test.a functional test.

Some of the objektives and subjektivesSome of the objektives and subjektivesfactors should be considered such as :factors should be considered such as : AgeAge

Wish to have a childWish to have a child

Duration of the infertilityDuration of the infertility

The location and the wide spreading ofThe location and the wide spreading ofthe endometriosis.the endometriosis.

The severity of symptoms.The severity of symptoms.

The adnexa pelvic lesions.The adnexa pelvic lesions.

The chosen treatment :The chosen treatment :

Hormonal;Hormonal;

Steroids : estrogen, progestin, OC PillsSteroids : estrogen, progestin, OC Pills

Danazol, GnRH analog (inducedDanazol, GnRH analog (inducedpregnancy)pregnancy)

Surgical treatment.Surgical treatment.

Conservative,Conservative,

Maintained the reproductive funcionMaintained the reproductive funcion

and ovarian hormonal function.and ovarian hormonal function. Radical,Radical,

Total abdominal hysterectomy +Total abdominal hysterectomy +bilateral salpingobilateral salpingo--oovorectomy andoovorectomy andendometrioma resection.endometrioma resection.


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SteinSteinLeventhalLeventhal cycystst

AnAn infertilinfertile fatty young womane fatty young woman,,withwithsecondarysecondary amenoramenorrhrheaea//oligomenooligomenorrrrhheaea..

Very often withVery often with hirsutismhirsutism withoutwithoutmasmascculinisaulinisattiionon, an, andd both of theboth of the ovariumovariumwere enlarged (2were enlarged (2--3) times, looks pale,3) times, looks pale,polipolicycystisticc,, smooth surface andsmooth surface and thickenedthickened

capsule.capsule.

Clinically the dClinically the diagnosisiagnosis was made onwas made on

symptomssymptoms laparoskoplaparoskopyy help to confirmhelp to confirmthethe diagnosis.diagnosis.

There is no sign ofThere is no sign of defeminisadefeminisattiion in theon in thecase ofcase of SteinStein LeventhalLeventhal syndromesyndrome, an, anddthethe funfunctctiion ofon of suprarenal glandsuprarenal glands remains remainnormal.normal.

THETHE OVARIOVARIANAN NEOPLASTINEOPLASTIC BENIGNC BENIGN

TUMORTUMOR

CYCYSTISTIC TUMORC TUMOR

CyCystoma ovarii simplestoma ovarii simplexx

Smooth surfaceSmooth surface,,usually pedunculatedusually pedunculated,,veryvery

oftenoften bilateral, anbilateral, and may grow bigger.The cysticd may grow bigger.The cysticwallwall is thinis thin anandd the fluid content wasthe fluid content was serousserousanand yellow in colourd yellow in colour..

TTrreeatment : surgical resection andatment : surgical resection and histologikhistologikevaluation of the speciment to rule outevaluation of the speciment to rule outmalignancymalignancy..


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CyCystadenoma ovarii mustadenoma ovarii muccinosuminosum

Usually at the age ofUsually at the age of 2020 5050 yearsyears..

Most often,Most often,unilateralunilateral but occationallybut occationallybilateral.bilateral. tumortumor rupturedruptured pseudomipseudomixxomaomaperitoperitoniinii..

It isIt is rereccomommmendended to doed to do CACA--11225 test.5 test.

TThe treatment of choice ishe treatment of choice is salpingosalpingo--oooovvoreorecctomtomy (do not rupture the tumor)y (do not rupture the tumor)

CyCystadenoma ovarii serosumstadenoma ovarii serosum

The tumor origin isThe tumor origin is ovariovarian surfacean surface epitepithhelelium.ium.

The characteristic of the tumor:The characteristic of the tumor: potenpotencciialalofofpapilpapilaarry growth into the inner wally growth into the inner wall 50%, an50%, andd to theto the

surfacesurface 5%.5%. The content of the tumor,The content of the tumor,serousserous,,yellow fluidyellow fluid, an, and occationallyd occationally cchhoococolatlatee forfor

blood stingedblood stinged..

It is expected to performIt is expected to perform frozen sectionfrozen sectionat theat the

operating theatreoperating theatre,, to decide the correct surgicalto decide the correct surgical

interventionintervention..


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EEndometrioidndometrioid cycystst

A smooth surface of unilateral tumorA smooth surface of unilateral tumor..

May be misdiagnosis with pelvic painMay be misdiagnosis with pelvic pain ananddddyyspareunispareuniaa for adhesionfor adhesion..

TTransvaginal USGransvaginal USG reveals a specifecreveals a specifecpicture. The lesion has nothing to do withpicture. The lesion has nothing to do with

endometriosis ovariiendometriosis ovarii..

DDermoidermoid cycystst

The tumor containedThe tumor contained elemeelements ofnts ofeecctodermal, mesodermal antodermal, mesodermal anddentodermalentodermal..

Tortion of the pedicle may causeTortion of the pedicle may cause acuteacuteabdomenabdomen..

Malignant degeneration :1,5%Malignant degeneration :1,5%

Surgical treatment :remove the wholeSurgical treatment :remove the wholetissue of the tumor withtissue of the tumor with ovarium.ovarium.

BENIGN SOLID OVARIUM TUMORBENIGN SOLID OVARIUM TUMOR

Fibroma ovariiFibroma ovarii May rich theMay rich the diameterdiameter ofof 22--30 cm, an30 cm, andd thethe

weight isweight is aboutabout 20 k20 kg.g. 90%90% of the case isof the case is

unilateral.unilateral. The surface is not even and theThe surface is not even and thecconsistenonsistency is stony hartcy is stony hart,, the colour is pinkthe colour is pink..

MeigsMeigs ssyyndromndrome is frequently founde is frequently found (asites +)(asites +)suspecting malignancy which is not true.Thesuspecting malignancy which is not true.Themalignant potentiality is extremely lowmalignant potentiality is extremely low,,


19/19

MaskulinovoblastomaMaskulinovoblastoma (adrenal cell rest)(adrenal cell rest)

Very rareVery rare

UsuallyUsually unilateral anunilateral andd withwith varivariououss sizesize fromfrom0,50,5 16 cm diameter.16 cm diameter.

Some of the tumor will causeSome of the tumor will cause masmascculiniulinizzaationtion,,such assuch as hirsutism,hirsutism, cclitorlitoromegalyomegaly,, breastbreast atrofatrofyyand low pitch voiceand low pitch voice..

Th/Th/ Operative.Operative.

slide benign diseases of the female reproductive tract

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