BENIGN OVARIAN TUMORS Dr Mashael AlShebaili Asst Prof

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

n n ë 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. 5 x 0. 5 cm Late menopause 2 -5 yrs 1. 5 x 0. 75 x 0. 5 cm

ë 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 n OVARIAN CYSTS CAN BE CLASSIFIED AS FOLLOWS: n I. Functional Benign n II Neoplastic borderline Malignant

FUNCTIONAL OVARIAN CYSTS INCLUDES: a. b. c. Follicular cysts Corpus luteum cysts 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.

ë ë ë 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

ë 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 68 wks. 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