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Management:
• Think:
o OVARIAN NEW GROWTH is present
o Any complication is an emergency.
Pain is considered as an emergency in this
case.
o Emergency laparotomy the presentation would
dictate the urgency of intervention.
• Work-up before surgery:
o CBC
o Bleeding parameters
o Blood Typing and cross matching especially with
cystic hemorrhage
o Ultrasound determine the component but more
on counseling
o X-ray of the chest
o Urinalysis
• Surgical Management:
o Cystectomy
o Oophorectomy if the whole ova is already
pathologic.
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Case 14 – Benign Lesions for Ovaries Endometrial cyst that is movable via de novo
Discussion with Dr. Gonzalez pathogenesis
o Brenner Tumor benign transitional
A 17 year old high school student was brought to the epithelium of the urinary tract
emergency room because of sudden, moderate to severe right • Benign suffix: cyst adenoma or cyst
iliac pain since 3 hours ago. She also noted a progressively • Malignant adenocarcinoma
enlarging mass on the right side of the lower abdomen since 1
year ago. On PE, she was conscious, cooperative, though in Few associations:
obvious pain. BP – 100/70, PR – 98, RR – 22, T – 36.8 C. • Serous
Abdomen- presence of a tender, cystic, movable, right iliac o Watery
mass, about 12 cm in diameter. External genitalia – intact o Generally, unilocular
hymen. Rectal examination: cervix – long, firm, movable; • Mucinous
uterus – normal in size, slightly deviated to the left and o Mucoid, viscid fluid, slimy contents
posteriorly; (+) tender, slightly movable, 12 cm. Diameter o In general, multiloculated, septations
cystic mass with solid components located to the right of the o Tends to grow larger
uterus. • Endometroid
o Thick chocolate
Review • Brenner Tumor
• Physiologic Mass (Generalities) o Solid, benign fibroma, thecoma and Brenner
o Size: Relatively small – 8 cm or less The exceptions to the rules.
o Consistency: Cystic without any solid areas
Regress by themselves, no intervention Classifications
necessary. • Benign
o OCPs may alter them but the further studies are • Low Malignant Potential / Atypical Proliferative
necessary. Tumors (Borderline)
o There is pseudostratification already
Physiologic Masses o No stromal invasion
• Follicular cyst o 3 layers thick stratification
o Arises from the follicle which is a normal o Not used anymore
component. However, in this case, it’s an • Malignant
exaggeration.
o Normal: After follicular development and the Generalities for Germ Cell
arising of a mature follicle, some of the follicles • Usually happens in the younger age group
may persist or progress in maturation due to • Benign versus malignant
GnRH. • Dermoid Cyst – Mature Cystic Teratoma
However, these generally regress within 3 o Most common benign Mature Cyst
cycles. Teeth, hair, bone, cartilage, GI epithelium,
o Manifestation: Cystic growth in adnexal area thyroid epithelium
(purely cystic), freely movable, 6-8 cm in size. Sebum
o Ultrasound: denotes purely cystic structure o Most common malignant Dysgerminoma
o If asymptomatic, just observe then after 3 Other malignant
months, follow it up • Endodermal Sinus Tumor
• Corpus Luteum Cyst • Immature Teratoma immature if there
o Corpus luteum should only last for at about 2 is presence of neural structures.
weeks and regresses if pregnancy does not
occur. Generalities of Stromal Tumors:
o Hemorrhagic phase – part of the regression • Benign
May get exaggerated and the corpus luteum o Thecoma
may be filled up with blood. o Fibroma
o Corpus luteum may persist to function and may Made up of fibroblasts that are present all
cause: over the body.
PE: Missed period + tender unilateral mass Meig’s Syndrome
• Ddx – Ectopic Pregnancy • Associated ascites and pleural effusion
o Serial pelvic examinations should be done with a solid tumor mimics advanced
o UTZ: lace-like pattern with streaks of blood. ovarian malignancy
• Theca Lutein Cyst • Malignant
o Stromal cells that produces estrogen o Granulosa Cell Tumor low grade malignancy
o Associated with pregnancy and hydatidiform mole • Thecoma and GCT produces the ovarian hormones.
o HCG stimulates ovaries to produce the cyst, they They are the factories of estrogen. When they grow,
are generally bilateral stimulates both ovaries they are highly likely functional and are hormone
unlike the follicular cyst which may be unilateral. producing
o Regresses once the HCG levels go down • Generally causes 10-12 cm endometrium medium
o Generally not removed unless they become sized
symptomatic • PE finding:
Review: o Thickened endometrium abnormal bleeding
• Ovary (unopposed estrogen)
o Follicles – germ cell
o Theca and Granuloma Cells – stroma Case Discussion
o Capsule – Epithelium Low cuboidal • Ask for the rate of growth:
80% of the tumors generalities o Rapid growth leans towards a malignancy.
• Neoplastic • How relevant is the information about the intact
o Beyond 8 cm hymen?
o Persist for more than 3-4 months o Rule out possible pregnancy or it lowers the
possibility of it.
Epithelial tumors • Cystic mass with solid components would mean?
• Replicates or mimics the lining epithelium of Mullerian o Cystic would mean benign
tissues/derivatives o Solid components may point to malignant mass
• If the tumor that arose from the ovary histologically • Movability
looks like the: o Movable - benign
o Mucosa of the fallopian tube (low cuboidal o Fixed – malignant
ciliated) Serous cyst adenoma Except endometrioma
o Endocervix Mucinous • Pain
o Endometrial Tissue Endometrioid o Caused by compression presenting as a pressure
symptom
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