Benign conditions of the ovaries/fallopian tubes

types of functional cysts

-follicular

-corpus luteal

-theca-luteal

-polycystic ovaries

types of inflammatory cysts

-salpingo-oophoritis

-pyogenic oophoritis(puerperal, abortal, or IUD related)

-granulomatous oophoritis

types of metaplastic cysts

endometriomas

types of neoplastic cysts

-premenarchal(10% malignant)

-menstruating years(15% malignant)

-postmenopausal (50% malignant)

follicular cysts

-most common, arise after failure of a follicle to rupture during the follicular maturation phase of the menstrual cycle

-3-8cm, usually asymptomatic and unilateral

-large cysts can cause tender palpable ovarian mass and lead to torsion when >4 cm, resolve spontaneously 60-90 d

follicular cyst on US

-anechoic

-thin walled

-posterior acoustic enlargement

-resolved on f/u 2m later

corpus luteum cysts

-common, occur during luteal phase of menstrual cycle

-most formed when corpus luteum fails to regress after 14d, becomes enlarged(>3cm) or hemorrhagic(corpus hemorrhagicum)

-can delay menstruations and dull lower quadrant pain

-rupture causes acute pain

theca lutein cysts

-large, B/L cysts filled w/ clear, straw colored fluid (can be >30 cm)

-results from abnormally high B-HCG(from molar pregnancy, choriocarcinoma, or ovulation induced therapy)

endometriomas

-from growth of ectopic endometrial tissue within the ovary(also called chocolate cysts-thick brown blood inside)

-symptoms of endometriosis-pelvic pain, dysmenorrhea, dyspareunia, infertility

types of surface epithelial tumors

-serous

-mucinous

-endometrioid

-clear cell

-brenner

types of sex cord tumors

-fibroma/thecoma

-granulosa cell tumor

-sertoli- Leydig cell tumor

types of germ cell tumors

-dysgerminoma

-teratoma(mature or immature)

-embryonal carcinoma

-yolk sac tumor

-choriocarcinoma

benign ovarian tumors

-80% are benign

-90% epithelial in origin

-serous is most common epithelial

epithelial ovarian tumors

-includes mucinous and serous

-cystadenoma

-includes Brenner tumor(similar to transitional epithelial cells)

-most common type of ovarian tumor

-derived from mesothelial cell lining ovarian surface and peritoneal cavity

-mostly benign, can become malignant

stromal(sex cord) ovarian tumors

-includes thecomas, granulosa-theca cell, sertoli leydig cell, fibromas

-granulosa/theca-functioning, produce estradiol and inhibin A/B

-Sertoli-leydig- cause virilization

-derived from sex chords and stroma of ovary

-most have low malignant potential

-end organ responses influenced by estrogen production

germ cell ovarian tumors

-primary cause of ovarian tumors in women <30

-arise from totipotential germ cells

-most benign

-may have abd pain, rapidly enlarging mass, vaginal bleeding

clinical features of benign ovarian tumors

-non specific, asymptomatic unless >6-8 cm

-slowly enlarge, if large enough, palpable on bimanual exam

-pain mild and intermittent, unless there's torsion on pedicle-may rupture and cause acute pain and peritoneal irritation

dx benign ovarian tumors

-pelvic US(transvaginal) best initial

-CT abd/pelvis, MRI, PET to follow up

-CA 125 may be elevated if malignant

risk of malignancy index criteria

-menopausal status

-US features( multiloculated, solid areas, bilaterality, ascites)

-serum CA 125 titer(normal <35)

what tumor marker does dysgerminoma give off

LDH

what tumor marker does embryonal tumor give off

AFP/hCG

what tumor marker does teratoma give off

AFP

what tumor marker does endodermal sinus tumor and choriocarcinoma give off

hCG

management of benign ovarian tumors

-assess malignancy risk using RMI

-follow up US 6w after initial

-low RMI-observe and follow

-symptoms or enlarging-laparoscopic removal

-suspicious for malignancy-laparotomy

-intraoperative frozen section to assess for malignancy

congenital anomalies of ovaries

-uncommon, may see rare congenital duplication or absence of ovarian tissue

-rare ectopic ovarian tissue or extra ovaries

-turner syndrome-lack of gonadal development, rudimentary streaked ovaries

-complete androgen insensitivity-lack of androgen receptors produces female phenotype despite y chromosome

-gonads in women w/ high malignancy potential should be removed after puberty

benign conditions of fallopian tubes

-most are inflammatory/infectious

-TOA

-fallopian tube primary tumors rare(epithelial adenoma, myoma, inclusion cyst, angioma)

-paraovarian tumor within broad ligament

-adnexal torsion-complication of benign ovarian tumor, paraovarian cyst and tubal ligation remnants