[GYNE] BENIGN TUMORS OF THE OVARIES

FOR CLUSTER EXAM ON PL 12

Characteristics of a malignant mass

Septations, Loculations, Papillations, Solid or cystic lesions, Small cysts, Free fluid in the cul de sac, Fixed mass, Bilateral

If in the OR and you want to establish benign or malignant, what will you perform?

Frozen section

Physiologic cysts found in the first half of the cycle

Follicular cyst

Physiologic cysts found in the second half of the cycle

Corpus Luteum cyst

Pathologic size of an ovary

>6 cm

Sonographic features of physiologic versus pathologic ovarian cysts

Physiologic: unilocular, thin walled, hypoechoic, (-) color flow

Pathological: multiocular, thick walled, mixed echogenicity, (+) color flow

Granuloma, Thecoma, Fibroma, Sertoli cell, Sertoli leydig cell, Steroid

Sex cord stroma

Most frequent cystic structures in normal ovaries due to excess FSH

Follicular cyst

Minimum diameter to be considered as cyst

2.5 to 3 cm

Marker to evaluate follicular cyst in postmenopausal women

Normal beyond 12 weeks

CA-125

Causes of Ovarian cysts

a. Dominant follicle failing to rupture

b. Immature follicle failing to undergo atresia or failure to reabsorb follicular fluid

Imaging of choice for ovarian cyst to differentiate whether it is simple or complex

Endocervical UTZ

Most important marker to differentiate benign versus malignant ovarian cyst

LDH

Indications for removal of ovarian cyst

a. Not a simple cyst

b. CA 125 of >135

c. Cyst of >10 cm

Surgical management in ovarian cyst if they are NON MALIGNANT

Oophorocystectomy

Corpus luteum cyst is caused by

Progesterone

Corpus albicans cyst

Term used when rupture does not occur and blood in the cyst cavity is replaced by clear fluid

Convoluted lining, yellowish orange

Gross appearance of corpus luteum cyst

Halban’s classic triad

1.Normal period followed by spotting

2.Pelvic pain

3.Small, tender, adnexal mass

Also seen in ectopic pregnancy

Bleeding occurs in what days of the cycle?

Day 20-26

Prominent symptom of corpus luteum cyst

Sudden, severe, abdominal pain

Right ovary predominance

Imaging of choice to evaluate severity of hemorrhage in corpus luteum cyst

Culdocentesis

Treatment if cysts are persistant with intraperitoneal bleeding

Cystectomy

Theca lutein cysts arises from ?

1.Excessive stim of ovaries by gonadotropins

2.Increased ovarian sensitivity to gonadotropins

Enlargement secondary to development of multiple luteinized

Causes of Hcg rise aside from cysts

1.Molar pregnancy

2. Twin pregnancy

3.Trophoblastic diseases

Cyst which grossly appear as honeycomb

Theca lutein cysts

Cystic structures with elements of the three germ layers

Benign cystic teratoma

1.Dermoid cyst

2.Mature cyst

3.Teratoma

Irritating component of a dermoid cyst

Sebum

Usual location of a dermoid cyst

Cul de sac

Anterior to the broad ligament

Thyroid tissue found in benign teratoma

Struma ovarii

Medical conditions associated with dermoid cysts

1.Thyrotoxicosis

2.Autoimmune hemolytic anemia

3.Primary carcinoid t

Arises from GI or respiratory epithelium

Primary Carcinoid Tumor

Marker for the diagnosis of carcinoid tumor

Serum serotonin

5-Hydroxyindoleacetic acid

Most serious and frequent complication of cysts

Rupture or Torsion

Reason for torsion in dermoid cysts

Long pedicles

Diagnosis if with slow leaking sebaceous material

Ovarian carcinoma with metastasis

Most common causes of enlargement of the ovary

Endometriosis

Most common benign solid neoplasm of the ovary

Fibroma

Symptom of fibroma due to transudation of fluid from it

Ascites

This develops due to ascitic flow into the pleural cavity via lymphatics of the diaphragm

Hydrothorax

Management of Fibroma

Removal of fibroma

Suction ascites

Associated with serous or mucinous cystadenomas of the ipsilateral teratoma or ovary

Transitional cell tumors / Brenner Tumor

Pathophysiology of Transitional Cell Tumors

Metaplasia of coelomic epithelium

2 Principal components of Transitional cell tumor

1.Solid masses or nests of epithelium that resemble urinary bladder

2.Surrounding fibrous stroma

Management choice of transitional cell tumor

Simple Excision

Both benign firm tumors with epithelial and fibrous cells

Adenofibroma and Cystadenomafibroma

Histologic findings: Cystadenofibroma

Microscopic and occasional macroscopic cysts

Histologic findings: Adenofibroma

small fibrous tumors from the ovary

Histologic findings: Papillary adenofibroma

With excrescence of malignant tumors with

Management choice for adeno and csytadenofibromas for postemenopausal

TAHBSO or BIlateral salphingo-oophorectomy

Management choice for adeno and cystadenofibroma for younger women

Simple excision and inspection of the contralateral ovary

Most common cause of torsion

Ovarian enlargement (8-12 cm)

Why is the right ovary more involved than the left in torsion?

Right ovary has a longer R utero-ovarian ligament while the L is protected by the sigmoid colon

Clinical presentation of torsion

Acute, severe, unilateral lower abdominal and pelvic pain

Nausea and vomiting

Reason for Fever in torsion

Compromise in arterial blood supply → Hypoxia → Necrosis → Fever

Cyclic chronic pelvic pain due to small areas of functioning ovary after intended removal of both ovaries

Ovarian remnant

Major risk factor for ovarian remnant

Laparoscopic oophorectomy

Management choice for ovarian remnant

Laparascopy or laparotomy

Cysts near the fallopian tubes in the mesosalpinx

Paratubal Cyst

Cysts in the ovary in the mesovarium

Paraovarian Cyst

Most prevalent benign tumor of the oviduct

Adenomatoid tumor

Cysts that are pedunculated and near the fimbriated end

Hydatid cysts of Morgagni

Major predisposing factor in Torsion

Pregnancy

Intrinsic causes of Torsion

Congenital abnormalities that increase tortuosity / excessive length of tube

Hydrosalpinx, hematosalpinx, tubal neoplasms, prev operations

Extrinsic causes of Torsion

Ovarian and peritubal tumors

Pregnancy

Adhesions

Trauma

Epithelial tumors of the ovary: cuboid epithelium

Serous cyst adenoma

Epithelial tumors of the ovary: multilocular and content is thick, yellowish and viscous

Mucinous cyst adenoma

Epithelial tumors of the ovary: mimics endometrial lining wherein content is old blood, glands and stroma

Endometrioid cyst