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Gynecology 2.1b

Benign Neoplasms of Oviducts and Ovaries

Dr. Co-Hidalgo

Something AD

OUTLINE

Usually located on the SEROSAL SURFACE

I.

Oviducts

Usually unilateral and present as small nodules just under the tubal serosa

a.

Leiomyoma

Do not produce pelvic symptoms or signs, and also found below the

b.

Angiomyoma

c.

Paratubal Cyst

serosa of the fundus

d.

Adenofibroma

Do not become malignant

II.

Ovaries

a.

Follicular Cysts

 
   

C. PARATUBAL CYSTS

b.

Corpus Luteum Cysts

c.

Theca Lutein Cysts

Often multiple from 0.5 to more than 20 cm in diameter

d.

Benign Neoplasm of Ovaries

Usually an incidental finding during pelvic surgery, during routine

e.

Benign Cystic Teratoma

f.

Endometriosis

hysterectomy or explore laparotomy

g.

Ovarian Fibroma

Located within the broad ligament between the tube and the ovary

h.

Epithelial Cystic Tumors

Translucent containing clear or pale yellow fluid

i.

Brenner Tumor

j.

Ovarian Remnant Syndrome

Small, asymptomatic, slow growing and are discovered during the third and fourth decades of life

LEARNING OBJECTIVES

Thin-walled, soft and contain clear fluid. Often, there are multiple small

1.

To be able to finish this accursed trans in the middle of Christmas break.

cysts

 

If you identified the ovary and it is normal and there is a cyst beside it,

REFERENCES

 

can be a paratubal cyst

Unless otherwise stated, everything came from the ppt.

Trans Group/Editor’s Notes

  Unless otherwise stated, everything came from the ppt. Trans Group/Editor’s Notes

Recording information is italicized

Chapter 18, Comprehensive Gynecology (6 th Edition) *

FALLOPIAN TUBES (OVIDUCT)

 

*Dra. Focused her discussion on the more common conditions of the oviduct (bold)

Leiomyomas

Figure 2. 2cm Non-neoplastic cyst with broad ligaments abuts the normal ovary.

Adenomyotoid Tumor

Adenofibromas

 

CLINICAL MANIFESTATIONS

Paratubal Cysts

Usually asymptomatic

Cystic Mesthelioma

Dull pain is produced if symptomatic

Serous Cystadenoma

o There are no symptoms unless they are stretched or if there is torsion

 

Oviduct is often stretched over a large Paratubal cyst. The oviduct should

Tubal torsion is usually accompanied by torsion of the ovaries. Torsion is

A. LEIOMYOMAS

 

not be removed in these cases because it will return to normal size after

*Not discussed but part of PowerPoint.

excision of the cyst

Underreported

They can grow rapidly during pregnancy

Tubal leiomyomas may be single or multiple and usually are discovered

TORSION usually happens during pregnancy or during puerperium

in the interstitial portion of the tubes

Usually coexist with the more common uterine leiomyomas

May originate from muscle cells in the walls of the tube or blood vessels

secondary to an ovarian mass in 50-60% of patients and common among women of reproductive age

or from smooth muscle in the broad ligament May be subserosal, interstitial or submucosal Present as smooth, firm, mobile, usually non-tender masses that may be palpated during the bimanual examination

Acute lower abdominal and pelvic pain, sudden or gradual, 48 hours duration is an important symptom of torsion. Pain may be located in the iliac fossa, radiating to the thigh and flank.

Appear as a spherical mass that protrudes from beneath the peritoneal

 

TREATMENT

surface, varying from a few mm to 15 cm diameter

Simple excision

Majority are asymptomatic

Rarely, they may undergo acute degeneration or be associated with

 

D. HYDATID CYSTS OF MORGAGNI

unilateral tubal obstruction or torsion Treatment if symptomatic is excision

Paratubal cysts which are pedunculated and near the fimbrial end of the fallopian tube

B. ADENOMATOID TUMORS or ANGIOMYOMA

Gynecology 2.1b Benign Neoplasms of Oviducts and Ovaries Dr. Co-Hidalgo Something AD OUTLINE  Usually located

Figure 1. Adenomatoid Tumor.

Gynecology 2.1b Benign Neoplasms of Oviducts and Ovaries Dr. Co-Hidalgo Something AD OUTLINE  Usually located

Figure 3. Hydatid Cyst of Morgagni. Broad Ligament Cyst. This parovarian, paratubal cyst, is thin walled and contains clear watery fluid.

E. ADENOFIBROMA
E. ADENOFIBROMA

MOST COMMON BENIGN TUMOR OF THE FALLOPIAN TUBE

Occasionally reported but more a recent study revealed that

MESOTHELIAL in origin though some authors say that it is an endothelial

adenofibromas are common in the tubes

origin in rare tumors

Almost exclusively located in the distal (fimbrial) portion

Small, well-circumscribed nodule, whitish (gray-white, 1-2 cm)

More solid

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GYNECOLOGY 2.1b

OVARIES
OVARIES

Functional Cysts, hence no treatment is needed, will resolve in 3-6 months

GYNECOLOGY 2.1b OVARIES  Functional Cysts , hence no treatment is needed, will resolve in 3-6
  • If cystic central cavity persists, blood is replaced by clear fluid, and the result is a hormonally inactive corpus albicans cyst

If you see the patient today and after 3 months, a follicular or physiologic

 

CLINICAL MANIFESTATIONS

cyst should already disappear during this time frame. You let the patient come back day 5 to day 7 of menses, and this should disappear.

 

Asymptomatic to severe abdominal pain because of intraperitoneal bleeding associated with rupture Most ruptures occur on cyclesday 20-26

Can produce hemorrhage and some are explored due to pain

A. FOLLICULAR CYSTS

Produce dull, unilateral, lower abdominal and pelvic pain

MOST FREQUENT CYST IN NORMAL HEALTHY OVARIES

Enlarged ovary is moderately tender on pelvic examination

Arise from temporary pathologic variation of a normal physiologic

Depending on the amount of progesterone secretion associated with

process Result from either failure of a dominant follicle to rupture (persistent

cysts, the menstrual bleeding may be normal or delayed several days to weeks with subsequent menorrhagia.

follicle) or failure of an immature follicle to undergo the normal process

Classic triad of delay in a normal period followed by spotting; unilateral

of atresia (failure to resorb follicular fluid) Lined with inner layer of granulosa cells and an outer layer of the theca interna cells

pelvic pain; and a small, tender, adnexal mass (similar to ectopic pregnancy)

Occurs during all stages of life: fetal to postmenopausal period

 

DIAGNOSIS

Translucent, thin walled, unilocular filled with a watery, clear to straw colored fluid

Vaginal ultrasound is useful for diagnosis. Shows an anechoic mass.

Mostly asymptomatic, do not do anything unless it is very big but usually

   

DIFFERENTIAL DIAGNOSES

Ectopic Pregnancy - differentiate with serum or urinary HCG

it will resolve spontaneously. Mostly diagnosed in routine gynecological exam

Ruptured Endometrioma

No solid component, just clear liquid inside Situated in the ovarian cortex, and sometimes appear as translucent

Adnexal Torsion

domes on the surface of the ovary

   

TREATMENT

Observation for mild pain or minimal peritoneal fluid will resolve

Observation for mild pain or minimal peritoneal fluid – will resolve

May be found as early as 20 weeks gestation in female fetuses and throughout a woman’s reproductive life. Found most commonly in young, menstruating women. Multiple, varies from few mm to 15 cm diameter.

Cystectomy is the operative treatment of choice since it is conservative

Not neoplastic and are believed to be dependent on gonadotropins for growth. They arise from a temporary variation of a normal physiologic process

May present with signs and symptoms of ovarian enlargement, rule out an ovarian neoplasm

May rupture during examination, because of their thin walls. May

present with tenesmus, transient pelvic tenderness, deep dyspareunia, or no pain whatsoever

Figure 4. Corpus Luteum Cyst on Ultrasound (left). Hemorrhagic corpus luteum with an outer yellow rim and central hemorrhage (right).

MANAGEMENT

   

C. THECA LUTEIN CYSTS

 

Almost always bilateral secondary to hundreds of thin-walled lobules

Conservative observation is the initial management. The majority of

follicular cysts disappear spontaneously by either reabsorption of the cyst fluid or silent rupture within 4 to 8 weeks of initial diagnosis.

or cysts, producing a honeycombed appearance Produce moderate to massive enlargement of the ovaries

Ultrasound reveals anechoic or black structure (purely fluid)

 Vary in size from 1 cm to 10cm or more in diameter

 

Observe for 3-6 months, then let the patient come back for ultrasound on day 5-7 of menses and check if it is still there

 

Arise from other prolonged or excessive stimulation of the ovaries by endogenous or exogenous gonadotropins or increased ovarian

Oral contraceptives may be prescribed for 4 to 6 weeks

sensitivity to gonadotropins LEAST COMMON OF THE PHYSIOLOGIC OVARIAN CYSTS

 

B. CORPUS LUTEUM CYSTS

 

Produces an enlarged ovary, larger than corpus, usually seen in

Less common than follicular cysts, but clinically more important

All corpora lutea are cystic with gradual reabsorption of a limited amount

Minimum of 3 cm diameter

secretion of progesterone

hydatiform mole

Mainly result from intracycstic hemorrhage

 
  • 50% molar pregnancies and 10% choriocarcinomas have associated

  • External surface of the ovary appears lobulated

bilateral theca lutein cysts. HCG from trophoblast produces luteinization

of hemorrhage, which may form a cavity.

of the cells in immature, mature, and atretic follicles

They may be associated with normal endocrine function or prolonged

 

Small cysts contain a clear to straw-colored or hemorrhagic fluid

   
 

   
 

Menstrual pattern may be normal, delayed menstruation or amenorrhea

Majority of women with smaller cysts are asymptomatic

 

2-4 days post-ovulation, during the stage of vascularization, thin-walled capillaries invade the granulosa cells from the theca interna. Spontaneous but limited bleeding fills the central cavity of the maturing corpus luteum with blood.

Generally only the larger cysts produce vague symptoms, such as a sense of pressure in the pelvis Ascites and increasing abdominal girth have been reported with hyperstimulation from exogenous gonadotropins.

If the hemorrhage into the central cavity is brisk, intracystic pressure increases and rupture is possible.

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GYNECOLOGY 2.1b

GYNECOLOGY 2.1b DIAGNOSIS  Palpation followed by transvaginal ultrasound for confirmation  Presence of theca lutein
DIAGNOSIS  Palpation followed by transvaginal ultrasound for confirmation  Presence of theca lutein cysts is
DIAGNOSIS
Palpation followed by transvaginal ultrasound for confirmation
Presence of theca lutein cysts is established by palpation and confirmed
by ultrasound
Dermoid is a term that emphasizes the preponderance of ectodermal
tissue with some mesodermal and rare endodermal derivatives
Believed to arise from a single germ cell after the 1 st meiotic division.
They develop from totipotential stem cells and are neoplastic sequelae
from a transformed germ cell.
TREATMENT
 Conservative because they usually regress spontaneously
Bleeding is difficult to control in these cases because of the thin walls
that constitute the cysts. No
puncture them.
attempts should be made to drain or
Account for more than 90% of germ cell tumors of the ovary
Certain elements from all three germ cell layers
May contain a malignant component usually in >40 years old: found in
1% of cases and usually a squamous carcinoma
 Occurs from infancy to postmenopausal years
MOST COMMON OVARIAN NEOPLASMS
MOST
COMMON
OVARIAN
NEOPLASM IN PREPUBERTAL AND
TEENAGERS
Bilaterality is 10 to 15%
 Grow from few mm to 25cm in diameter
Doughy consistency upon palpation and usually unilocular
50-60% are asymptomatic, but others may present with pain and
sensation of pelvic pressure

Figure 5. Bilateral Theca Lutein Cysts. Note its lobulated appearance

RELATED CONDITIONS TO THECA LUTEIN CYSTS

1. HYPERREACTIO LUTEINALIS

Ovarian enlargement secondary to the development of multiple luteinized follicular cyst

2. LUTEOMA OF PREGNANCY

Rare, specific, benign hyperplastic reaction of ovarian theca lutein cells Asymptomatic

Discovered during caesarian section or postpartum ligation

NOT A TRUE NEOPLASM Regress spontaneously following completion of pregnancy Nodules do NOT arise from the corpus luteum of pregnancy 50% are multiple, and 30% have bilateral nodules Incidental findings during surgery of solid, fleshy often hemorrhagic nodules Masculinization of the mother in 30% and sometimes the female fetus

GYNECOLOGY 2.1b DIAGNOSIS  Palpation followed by transvaginal ultrasound for confirmation  Presence of theca lutein

Figure 6. Luteoma of pregnancy with numerous solid brown nodules.

GYNECOLOGY 2.1b DIAGNOSIS  Palpation followed by transvaginal ultrasound for confirmation  Presence of theca lutein

Figure 7. 3cm Luteoma with multiple reddish nodules.

D. BENIGN CYSTIC TERATOMA

Dermoid Cyst, Mature teratoma

Teratoma literally means “monstrous growth.” Teratomas of the ovary may be benign or malignant. Although dermoid is a misnomer, it is the most common term used to describe the benign cystic tumor, composed of mature cells, whereas the malignant variety is composed of immature cells (immature teratoma).

Torsion most frequent complication of a dermoid. Associated medical conditions are thyrotoxicosis, carcinoid syndrome, autoimmune hemolytic anemia

DIAGNOSIS
DIAGNOSIS

Diagnosis is often established when a semisolid mass is palpated anterior to the broad ligament 50% have pelvic calcifications on radiographic exam Ultrasound - These characteristics include a dense echogenic area within a larger cystic area, a cyst filled with bands of mixed echoes, and an echoic dense cyst

TREATMENT
TREATMENT

Cystectomy for young patients, pre-menopausal, especially the

nulligravid (remove the cyst and retain ovarian tissue) Salphingo-oophorectomy for older patient with a complete family (remove the fallopian tubes and ovaries)

 

NOTABLE SH*T

 

1.

TUBERCLE OF ROKITANSKY

Protrusion or Mamilla in the cyst wall containing mostly solid elements.

  • Most solid elements arise and are contained in a protrusion or nipple (mamilla)

in

the

cyst

wall,

termed

the

prominence or tubercle of

Rokitansky. May be visualized by ultrasound as an echodense region. If malignancy occurs, it is most always found in this nest of cells. The wall of the cyst will often contain granulation tissue, giant cells, and

pseudoxanthoma cells

  • 2. STRUMA OVARII ()

A teratoma in which the thyroid tissue has overgrown other elements and is the predominant tissue. Usually unilateral and measure less than 10 cm in diameter. Less than 5% develop thyrotoxicosis, which may be secondary to the production of increased thyroid hormone by either the ovarian or the thyroid gland.

GYNECOLOGY 2.1b DIAGNOSIS  Palpation followed by transvaginal ultrasound for confirmation  Presence of theca lutein

Figure 8. Mature cystic teratoma (dermoid cyst) filled with hair and keratinous debris with one solid nodular area (Rokitansky protuberance).

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GYNECOLOGY 2.1b

GYNECOLOGY 2.1b   E. ENDOMETRIOSIS Patches of “normal” endometrium located outside of the uterus MOST
  E. ENDOMETRIOSIS Patches of “normal” endometrium located outside of the uterus MOST COMMON LOCATIONS
E. ENDOMETRIOSIS
Patches of “normal” endometrium located outside of the uterus
MOST COMMON LOCATIONS for these implants are on the
o Ovary
On pelvic exam, ovaries are often tender and immobile, secondary to
associated inflammation and adhesions
o
DIAGNOSTIC FINDINGS
There are no laboratory tests that are specific for endometriosis. -
o
o
Anterior and posterior cul-de-sac
Posterior broad ligament
Uterosacral ligament
o Uterus
o
o
o
Fallopian tube
ultrasound must be done
Medium level echoes are noted on ultrasound
Always document if viable or normal tissue was noted on ultrasound
to guide surgeons in performing invasive procedures
o
Sigmoid Colon
o Appendix
o
Round ligament
o
Size varies from small superficial, blue-black implants that are 1 to 5 mm
diameter to large, monoculated hemorrhagic cysts 5 to 10 cm
Endometriomas are areas of ovarian endometriosis that become cystic
Ovarian surface is often pucked, irregular and scarred
CAUSE
The specific cause of endometriosis is not known
Some women with endometriosis have a persistent complex or solid
adnexal mass on ultrasound, CT or MRI.
These endometriomas can assume a passable resemblance to
almost any adnexal neoplasm.
o This means that the differential diagnosis for virtually any adnexal
mass would include endometriosis.
Most women with endometriosis will have an elevated serum CA-125,
however this is not specific.
o This chemical is released any time when there is peritoneal irritation
from any source
Several theories can, in part, explain the existence of endometriosis
1.
IMPLANTATION THEORY
o
During menses, some reflux of menstrual products back through the
DIAGNOSIS
Clinical diagnosis is through HISTORY of the classical description
o
fallopian tubes occurs.
Viable endometrium can land on a favorable site and, if tolerated by
Surgical diagnosis is made by visualizing typical endometriosis implants in
the typical places endometriosis tends to flow in.
the patient’s immune system, can establish enough of a blood supply
to live and respond to the cyclic ovarian hormones
LAPAROSCOPY – method of choice for direct visualization
Histologic diagnosis
o
2.
COELOMIC METAPLASIA THEORY
o The peritoneal cavity contains some cells that have retained their
undifferentiated nature and, given the proper stimulus, may grow
and differentiate into endometrial cells.
NATURAL HISTORY
Untreated
Endometriosis can worsen
Regress or stay the same
INCIDENCE
More often is progressive
Exact incidence of endometriosis in the general population is not known.
Pregnancy and breast-feeding SUPPRESS endometriosis.
Endometriosis is found in
o 6% to 43% of women undergoing sterilization
12% to 32% of women undergoing laparoscopy for pelvic pain
21% to 48% of women undergoing laparoscopy for infertility
50% of teenagers undergoing laparoscopy for chronic pelvic pain and
dysmenorrheal
Usually associated with endometriosis in other areas of the pelvic cavity
Birth
control
pills,
even
if
taken
cyclically,
usually
SUPPRESS
endometriosis, particularly
if the endometriosis
is minimal
(mild or
o
o
moderate).
At menopause, endometriosis usually REGRESSES.
o
ENDOMETRIOSIS AND INFERTILITY
Probably between 25% and 50% of infertile women will have at least
some degree of endometriosis present
CLINICAL PRESENTATION
Most are asymptomatic, but most common symptoms are pelvic pain,
dyspareunia and infertility
About half of the women who are demonstrated to have endometriosis
have no symptoms at all
 Classically, women with symptomatic endometriosis present with a
chronic steadily worsening pelvic pain. It is worse with menses and
sometimes worse with ovulation. It may be focal or diffuse but its
location is usually constant.
A second classical symptom is painful intercourse on deep penetration.
Less common is painful bowel movements. If Implants are located on
the rectosigmoid or close to it (uterosacral ligaments), then she may
experience pain while actually passing her stool.
PRINCIPLES OF MANAGEMENT
There is no single best management for all women with endometriosis
Treatment must be individualized.
There are PRIMARY FACTORS to be considered namely:
o
The need for preserving childbearing capacity
o The severity of her symptoms
o Presence or absence of infertility as a clinical concern for her.
o Age
For example:
A 35 year old woman with severe symptoms and no desire for any further
childbearing might be best managed by a hysterectomy.
The same woman at age 50 might prefer to go with medical therapy until
menopause, when the symptoms will go away.
CLASSICAL PHYSICAL FINDINGS
Unusual tenderness and thickness (a dough-like consistency) in the
adnexal areas.
Tender nodules along the uterosacral ligament, usually appreciated best
on combined recto-vaginal bimanual exam.
Tender nodules at the junction of the bladder and the uterus.
Tender nodules over the uterine corpus.
Many women (particularly those with asymptomatic endometriosis) have
no positive physical findings.
The same woman at age 40, but with mild symptoms might do well on birth
control pills.
ALWAYS INFORM PATIENTS OF RISKS AND BENEFITS OF PROCEDURES.
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GYNECOLOGY 2.1b

MEDICAL MANAGEMENT

  • 1. BIRTH CONTROL PILLS For mild or moderate endometriosis. Reduce the heaviness of the menstrual flow and its duration Provide a powerful decidualizing effect on the implants by virtue of their strong progestin. This discourages further growth of pre-existing implants. When taken continuously, stops the episodic hormonal withdrawal bleed that occurs both with normal endometrium and with endometrial implants. It usually takes 3-6 months of continuous OCPs or oral contraceptive pills, and up to 12 months to achieve maximum benefit. OCPs are relatively inexpensive, making this treatment choice very affordable for most patients.

GYNECOLOGY 2.1b MEDICAL MANAGEMENT 1. BIRTH CONTROL PILLS  For mild or moderate endometriosis.  Reduce

Fibromas are connective-tissue tumors that arise from the ovarian cortical stroma (undifferentiated ovarian stroma)

If the stroma is estrogenic or leutenized, the tumors are actually THECOMAS. Incidence of ascites is directly proportional to the size of the tumor Pelvic pressure and abdominal enlargement may develop Smaller tumors are asymptomatic since they do not elaborate hormones

MEIG’S

SYNDROME-

hydrothorax

Association

of

ovarian

fibroma,

ascites

and

MANAGEMENT
MANAGEMENT

Surgery: the approach and extent depend on the age of the patient Simple Excision brings about resolution of symptoms

Bilateral salpingo-oophorectomy and total abdominal hysterectomy done since the condition is common among post-menopausal women

  • 2. GnRH AGONISTS

 

a.

Luprolide

*The following topics were only graced with a cursory discussion by the lecturer

b.

Goserelin

 

G. EPITHELIAL CYSTIC TUMORS

 

Numerous drawbacks include temporary menopausal side effects

Epithelial cystic tumors account for about

60%

of

all true

ovarian

Moderately expensive; may be as expensive as surgery

neoplasms.

Consider the patient’s age. If she is an elderly female who is a good surgical candidate, opt for surgery over medical management

Serous Cystadenoma and Mucinous Cystadenoma

 

Given for about 6 months

 

1. SEROUS CYSTADENOMA

 
  • 3. DANAZOL

Typically unilocular but sometimes multilocular with papillary components (*that is, it’s walls are not smooth)

This is a cousin of testosterone and has both direct and indirect effects on endometriosis

 

2. MUCINOUS CYSTADENOMA

 

Account for approximately 10-15% of all epithelial ovarian neoplasms.

Directly inhibits endometriotic implant growth through its powerful decidualization properties

70% are benign and found in women 30-50 years old

Suppresses

the

secretion

of

pituitary

gonadotropins,

resulting in

Smooth walled compared to serous variety, they rarely are associated

 

inhibition of ovarian function and lower estrogen levels.

 

with true papillae.

Blocks steroidogenic enzymes.

 

Often multilocular

DRAWBACKS:

o High cost o Significant side-effects (weight gain, masculinizing side-effects and depression) o It is normally taken for about a year before stopping it.

  • 4. PROGESTINs Progestins seem to be about as effective in treating endometriosis as OCPs Somewhat less well tolerated Weight gain and breakthrough bleeding are the biggest problems It is not particularly expensive, and is a reasonable choice for someone wishing to avoid surgery and OCPs, but intolerant of Danazol or Luprolide

Mucinous tumors consist of epithelial cells filled with mucin. These cells resemble cells of the endocervix or may mimic intestinal cells, which can pose a problem in the differential diagnosis of tumors that appear to originate from the ovary or intestine

GYNECOLOGY 2.1b MEDICAL MANAGEMENT 1. BIRTH CONTROL PILLS  For mild or moderate endometriosis.  Reduce

Figure 9. Multi-loculated mucinous cystadenoma

     

Conservative surgical management:

   
 

o

Removal of endometriosis and retain normal tissue as much as possible to preserve child bearing capacity

Rare, small, smooth, solid, fibroepithelial ovarian tumors that are generally asymptomatic.

 

Definitive Surgical management

 

Relatively rare and most common in the fourth to sixth decades of life

o Hysterectomy with or without removal of the tubes, ovaries and other sites of endometriosis.

Small, firm, and gray white solid, slow growing, with occasional yellow tinge with small cystic spaces

 

o

Hysterectomy with bilateral salpingo-oophorectomy.

1 to 2% chance of malignant transformation

o Hard to perform surgery due to possible puncturing of chocolate

 

Found incidentally at pathologic evaluation, often in conjunction with a

cysts or adherence to rectum

serous or mucinous cystadeoma or dermoid cyst

Two Principal components are solid masses or nests of epithelial cells

   

F. OVARIAN FIBROMA

and a surrounding fibrous stroma

MOST COMMON BENIGN SOLID OVARIAN NEOPLASMS

30% discovered as small, solid tumors in association with a concurrent

Occurs most commonly in postmenopausal women.

Unilateral and often at least 3cm in size Low malignant potential and extremely slow growing tumors

serous cystic neoplasia, such as serous or mucinous cystadenomas of the ipsilateral ovary.

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GYNECOLOGY 2.1b

Presently, most authorities accept the theory that most of these tumors result from metaplasia of coelomic epithelium into uroepithelium.

(*hence, the name transitional cell tumor)

Postmenopausal bleeding is sometimes seen, as endometrial hyperplasia is a coexisting abnormality in 10-16% cases

MANAGEMENT
MANAGEMENT

CT scan demonstrates a finding of extensive amorphous calcification within the solid components of the ovarian mass Surgery simple excision or ablation; depends on patient’s age

GYNECOLOGY 2.1b  Presently, most authorities accept the theory that most of these tumors result from

Figure 10. Brenner Tumor

GYNECOLOGY 2.1b  Presently, most authorities accept the theory that most of these tumors result from

Figure 11. Benign Brenner tumor. A cyst in the Brenner tumor is lined by an inner layer of endocervical-type mucinous cells and an outer layer of stratified transitional cells, a few of which have grooved nuclei.

INCIDENCES OF OVARIAN NEOPLASMS

Table 1. Incidences of Ovarian Neoplasms

 

Cystic Teratoma

58%

 
 

Serous Cystadenoma

25%

 

Mucinous Cystadenoma

12%

 

Benign Stroma

4%

 

Brenner tumor

1%

 
 

The diagnosis of PCOS has been simplified from the previously tedious

method. Currently, 2 of 3 criteria are required for diagnosis

  • 1. Polycystic ovaries (multiple small cysts, often around the periphery of the ovary, the classic “string of pearls” appearance)

  • 2. Signs of androgen excess (acne, hirsutism, temporal balding, male pattern hair loss, clitoromegaly, etc)

  • 3. Menstrual irregularities (oligomenorrhea or polymenorrhea).

    • Note that a diagnosis of PCOS does not require multiple ovarian cysts or polycystic ovaries.

GYNECOLOGY 2.1b  Presently, most authorities accept the theory that most of these tumors result from

Figure 12. PCOS on UTZ. Note the multiple unechoic areas indicating the presence of cysts

GYNECOLOGY 2.1b  Presently, most authorities accept the theory that most of these tumors result from

J. OVARIAN REMNANT SYNDROME

Chronic pelvic pain secondary to small area of functioning ovarian tissue after intended removal of both ovaries Most women who develop this had endometriosis or chronic pelvic inflammatory disease and extensive pelvic adhesions discovered during previous surgical procedures Another risk factors is laparoscopic oophorectomy 50% present with chronic pelvic pain is cyclic, exacerbated following coitus 50% present with pelvic masses that are small, 3 cm, most commonly located in the retroperitoneal space immediately adjacent to either ureter

MANAGEMENT
MANAGEMENT

Diagnosed through palpation during pelvic exam, vaginal ultrasound or MRI Surgical removal of remaining ovarian tissue via laparoscopy or laparotomy with wide excision of the mass using meticulous techniques to protect integrity of ureter

Edited by: bkcm

I tend to have too much vodka sometimes, and I eat too much processed food but I think the most unhealthful habit I have is comparing myself to others.

-notRenan

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