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

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Presentation on theme: "BENIGN OVARIAN TUMORS Dr. Mashael Al-Shebaili Asst. Prof. & Consultant Ob/Gyn Dept."— Presentation transcript:

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

2 Ovaries are normally not palpable in pre-menarche, and after the menopause Ovaries are normally not palpable in pre-menarche, and after the menopause In the reproductive age group ovaries are palpable in the lean pts. 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 Premenopause 3.5 x 2 x 1.5 cm Early menopause 1 – 2 yrs Early menopause 1 – 2 yrs 2 x 1.5x0.5cm Late menopause 2-5yrs 1.5x0.75x0.5cm Late menopause 2-5yrs 1.5x0.75x0.5cm

3  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 OVARIAN CYSTS CAN BE CLASSIFIED AS FOLLOWS: OVARIAN CYSTS CAN BE CLASSIFIED AS FOLLOWS: I.FunctionalBenign I.FunctionalBenign IINeoplasticborderline IINeoplasticborderlineMalignant

4 FUNCTIONAL OVARIAN CYSTS INCLUDES: a.Follicular cysts b. Corpus luteum cysts c. Theca luten cysts BENIGN OVARIAN NEOPLASM 1.Serous cystadenoma 2. Mucinous cystadenoma 3. Endometrioma 4. Dermoid cysts 5. Fibroma

5 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.

6  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

7  Benign ovarian neoplasia - 80% of ovarian neoplasm - 80% of ovarian neoplasm are benign are benign - Benign ovarian neoplasm can be solid or cystic

8 I. Serous Cystadenoma (Commonest) - Usually do not reach very large sizes - unilocular or multilocular - smooth surface - fluid filled

9 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

10 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 to chemical peritonitis

11 V. FIBROMA - Firm in consistency * Meigs syndrome Ovarian fibroma + ascites, hydrothorax following removal of fibroma, there is spontaneous resolution of ascites and hydrothorax

12 Clinical signs and symptoms of ovarian masses: Clinical signs and symptoms of ovarian masses: 1.  abdominal girth 2. Abdominal discomfort 3. Pressure symptomsbladder bowel 4. Acute abdomen due to -Hge -Rupture -Torsion 5. Asymptomatic coincidentally diagnosed

13 RADIOLOGICAL FEATURES OF BENIGN OVARIAN MASSES: RADIOLOGICAL FEATURES OF BENIGN OVARIAN MASSES: 1.Unilocular 2.Smooth surface 3.No solid elements 4.No external or internal outgrowth 5.No ascites 6.Unilateral 7. Normal doppler flow

14 CLINICAL FEATURES OF BENIGN OVARIAN TUMORS CLINICAL FEATURES OF BENIGN OVARIAN TUMORS Unilateral Unilateral Cystic Cystic Mobile Mobile No ascites No ascites No cul de-sac nodules No cul de-sac nodules Slow or no growth Slow or no growth

15 EVALUATION OF THE PATIENT WITH OVA ADNEXAL MASS. Complete Hx and physical exam Complete Hx and physical exam U/S U/S CT scan with contract or IVP CT scan with contract or IVP Ba enema or colonoscopy Ba enema or colonoscopy Laparoscopy or laparotomy accordingly Laparoscopy or laparotomy accordingly

16 INDICATIOONS FOR SURGERY INDICATIOONS FOR SURGERY Ovarian cyst >5 cm followed for 6- 8wks. Ovarian cyst >5 cm followed for 6- 8wks. Solid lesions Solid lesions Papillary vegitation Papillary vegitation Mass >10 cm at the time of presentations Mass >10 cm at the time of presentations Ascites Ascites Palpable mass in premenarchal or post menopausal Palpable mass in premenarchal or post menopausal Suspicion of torsion or rupture Suspicion of torsion or rupture


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