Benign Tumors of the Female Reproductive Tract

Benign Tumors of the Female Reproductive Tract
輔仁大學實習醫師核心課程新光吳火獅紀念醫院婦產科黃莉文

Benign tumors of the Female Reproductive Tract
Pelvic mass A pelvic mass may be gynecologic in origin or it may arise from the urinary tract or bowel. The gynecologic causes of a pelvic mass may be uterine, adnexal, or more specifically ovarian. 我們就這幾個年齡層分述如下：Prepubertal Age Group, Adolescent Age Group, Reproductive Age Group, Postmenopausal Age Group.

Prepubertal Age Group - Differential Diagnosis
< 5% of ovarian malignancies Germ cell tumors make up 1/2 to 2/3 35% of all ovarian neoplasms occurring during childhood and adolescence were malignant < 9y/o, 80% malignant < 5% of ovarian malignancies occur in children and adolescents. Ovarian tumors account for approximately 1% of all tumors in these age groups. Germ cell tumors make up 1/2 to 2/3 of ovarian neoplasms in < 20 y/o, compared with 20% of these tumors in adults. A review of studies conducted from 1940 until 1975 concluded that 35% of all ovarian neoplasms occurring during childhood and adolescence were malignant. In girls < 9 years of age, approximately 80% of the ovarian neoplasms were malignant.

Symptoms: abdominal or pelvic pain Pelvic mass very quickly becomes abdominal in location as it enlarges because of the small size of the pelvic cavity. Diagnosis is difficult because of the rarity of the condition (and therefore a low index of suspicion) Many symptoms are nonspecific Acute symptoms are more likely to be attributed to more common entities such as appendicitis. Abdominal or pelvic pain is the most frequent initial symptoms. In a prepubertal child, a pelvic mass very quickly becomes abdominal in location as it enlarges because of the small size of the pelvic cavity. The diagnosis of ovarian masses in the prepubertal age group is difficult because of the rarity of the condition (and therefore a low index of suspicion), because many symptoms are nonspecific, and acute symptoms are more likely to be attributed to more common entities such as appendicitis.

Abdominal palpation bimanual rectoabdominal examination Abdominal in location: can be confused with other abdominal masses Acute pain: torsion. The ovarian ligament becomes elongated as a result of the abdominal location, thus creating a predisposition to torsion. Abdominal palpation and bimanual rectoabdominal examination are important in any child who has nonspecific abdominal or pelvic complaints. An ovarian mass that is abdominal in location can be confused with other abdominal masses occurring in children, such as Wilms' tumor or neuroblastoma. Acute pain is often associated with torsion. The ovarian ligament becomes elongated as a result of the abdominal location of these tumors, thus creating a predisposition to torsion.

Prepubertal Age Group - Diagnosis and Management
Ultrasonography Unilocular cysts are virtually always benign and will regress in 3 to 6 months do not require surgical management with oophorectomy or oophorocystectomy. Diagnosis and Management In recent years, ultrasonography has become an excellent tool for predicting the presence of a simple ovarian cyst. Unilocular cysts are virtually always benign and will regress in 3 to 6 months; thus, they do not require surgical management with oophorectomy or oophorocystectomy.

Figure 13-11 Management of pelvic masses in premenarchal and adolescent girls

Close observation recommended (discuss risk of ovarian torsion with the child's parents.) Recurrence rates after cyst aspiration - 50%. Attention: long-term effects on endocrine functioning, future fertility, preservation of ovarian tissue Premature surgical therapy - ovarian and tubal adhesions that can affect future fertility. Close observation is recommended, although there is a risk of ovarian torsion that must be discussed with the child's parents. Recurrence rates after cyst aspiration (either ultrasonographically guided or with laparoscopy) may be as high as 50%. Attention must be paid to long-term effects on endocrine functioning as well as future fertility; preservation of ovarian tissue is a priority for patients with benign tumors. Premature surgical therapy for a functional ovarian mass can result in ovarian and tubal adhesions that can affect future fertility.

Additional imaging : CT, MRI, Doppler flow studies. Risk of a germ cell tumor is high, the finding of a solid component mandates surgical assessment. Additional imaging studies, such as CT scanning, MRI, or Doppler flow studies, may be helpful in establishing the diagnosis. Because the risk of a germ cell tumor is high, the finding of a solid component mandates surgical assessment.

Adolescent Age Group Differential Diagnosis Ovarian Masses
Uterine Masses Inflammatory Masses Pregnancy

Adolescent Age Group - Ovarian masses
The risk of malignant neoplasms lower. Germ cell tumors - most common tumors of the first decade of life but occur less frequently during adolescence. Epithelial neoplasms - increasing frequency with age. Mature cystic teratoma - most frequent neoplastic tumor of children and adolescents, accounting for > 1/2 of ovarian neoplasms in women < 20 y/o The risk of malignant neoplasms is lower among adolescents than among children. Epithelial neoplasms occur with increasing frequency with age. Germ cell tumors are the most common tumors of the first decade of life but occur less frequently during adolescence. Mature cystic teratoma is the most frequent neoplastic tumor of children and adolescents, accounting for > 1/2 of ovarian neoplasms in women < 20 y/o

Neoplasia can arise in dysgenetic gonads. 25% of dysgenetic gonads of patients with a Y - malignant. Gonadectomy - recommended for patients with XY gonadal dysgenesis or its mosaic variations. It is well established that neoplasia can arise in dysgenetic gonads. Malignant tumors have been found in about 25% of dysgenetic gonads of patients with a Y. Gonadectomy is recommended for patients with XY gonadal dysgenesis or its mosaic variations.

Functional ovarian cysts Incidental finding on examination Pain caused by torsion, leakage, or rupture. Endometriosis is less common during adolescence than in adulthood. In series of adolescents referred with chronic pain, 50% to 65% have been found to have endometriosis. Functional ovarian cysts occur frequently in adolescence. They may be an incidental finding on examination or may be associated with pain caused by torsion, leakage, or rupture. Endometriosis is less common during adolescence than in adulthood, although it can occur during adolescence. In series of adolescents referred with chronic pain, 50% to 65% have been found to have endometriosis.

Most adolescents with endometriosis do not have associated obstructive anomalies. In young women, endometriosis may have an atypical appearance, with nonpigmented or vesicular lesions, peritoneal windows, and puckering. Although endometriosis can occur in young women with obstructive genital anomalies (presumably as a result of retrograde menstruation), most adolescents with endometriosis do not have associated obstructive anomalies. In young women, endometriosis may have an atypical appearance, with nonpigmented or vesicular lesions, peritoneal windows, and puckering.

In young women, endometriosis may have an atypical appearance, with nonpigmented or vesicular lesions, peritoneal windows, and puckering.

Adolescent Age Group - Uterine Masses
Uterine leiomyomas - not common Obstructive uterovaginal anomalies occur during adolescence, at the time of menarche, or shortly thereafter. The diagnosis is frequently neither suspected nor delayed, particularly when the patient is seen by a general surgeon. Uterine leiomyomas are not commonly seen in this age group. Obstructive uterovaginal anomalies occur during adolescence, at the time of menarche, or shortly thereafter. The diagnosis is frequently neither suspected nor delayed, particularly when the patient is seen by a general surgeon.

Adolescent Age Group - Uterine Masses
Uterine anomalies - imperforate hymen, transverse vaginal septa, vaginal agenesis with a normal uterus and functional endometrium, vaginal duplications with obstructing longitudinal septa, and obstructed uterine horns. Cyclic pain, amenorrhea, vaginal discharge, or an abdominal, pelvic, or vaginal mass. Hematocolpos, hematometra A wide range of anomalies can be seen, from imperforate hymen to transverse vaginal septa, to vaginal agenesis with a normal uterus and functional endometrium, vaginal duplications with obstructing longitudinal septa, and obstructed uterine horns. Patients may seek treatment for cyclic pain, amenorrhea, vaginal discharge, or an abdominal, pelvic, or vaginal mass. A hematocolpos, hematometra, or both frequently will be present, and the resulting mass can be quite large.

Obstructive Genital Anomalies

Hematocolpos

Bulging vaginal mass

Cruciate/Circular Incision

Uterine anomalies

Adolescent Age Group - Inflammatory Masses
Adolescents have the highest rates of PID An adolescent who has pelvic pain may be found to have an inflammatory mass. The diagnosis is primarily clinical, based on the presence of lower abdominal, pelvic, and adnexal tenderness; cervical motion tenderness; a mucopurulent discharge; elevated temperature, white blood cell count, or sedimentation rate

Associated with the risks STD Inflammatory masses may consist of Tuboovarian complex Tuboovarian abscess Pyosalpinx Hydrosalpinx PID is clearly associated with the risks of acquiring STD methods of contraception may either decrease the risk (oral contraceptives, male latex condoms) or increase it (the intrauterine device in the interval immediately after insertion). Inflammatory masses may consist of a tuboovarian complex (a mass consisting of matted bowel, tube, and ovary), tuboovarian abscess (a mass consisting primarily of an abscess cavity within an anatomically defined structure such as the ovary), pyosalpinx or, chronically, hydrosalpinx.

Adolescent Age Group - Pregnancy
Pregnancy should always be considered Adolescents more likely to deny the possibility of pregnancy. Ectopic pregnancies may cause pelvic pain and an adnexal mass. Quantitative measurements of b-hCG, ectopic pregnancies are being discovered before rupture, allowing conservative management with laparoscopic surgery or medical therapy with methotrexate. In adolescents, pregnancy should always be considered as a cause of a pelvic mass. Adolescents may be more likely than adults to deny the possibility of pregnancy because of wishful thinking, anxiety about discovery by parents or peers, or unfamiliarity with menstrual cycles and information about fertility Ectopic pregnancies may cause pelvic pain and an adnexal mass. With the availability of quantitative measurements of b-human chorionic gonadotropin (hCG), more ectopic pregnancies are being discovered before rupture, allowing conservative management with laparoscopic surgery or medical therapy with methotrexate.

Adolescent Age Group - Diagnosis
A history and pelvic examination Anxiety associated with a first pelvic examination Issues of confidentiality related to questions of sexual activity. Always include a pregnancy test (regardless of stated sexual activity) CBC/DC. Tumor markers (AFP, hCG…) A history and pelvic examination are critical in the diagnosis of a pelvic mass. Considerations in adolescents include the anxiety associated with a first pelvic examination, as well as issues of confidentiality related to questions of sexual activity. Laboratory studies should always include a pregnancy test (regardless of stated sexual activity), and a complete blood count may be helpful in diagnosing inflammatory masses. Tumor markers, including a-fetoprotein and hCG, may be elaborated by germ cell tumors and can be useful in preoperative diagnosis as well as follow-up

Adolescent Age Group - Diagnosis
Ultrasonography. TVS provide more detail than Abd sonography TVS may not be well tolerated by adolescents CT or MRI As in all age groups, the primary diagnostic technique for evaluating pelvic masses in adolescents is ultrasonography. Although transvaginal ultrasonographic examinations may provide more detail than transabdominal ultrasonography, particularly for inflammatory masses, a transvaginal examination may not be well tolerated by adolescents. For cases in which the ultrasonographic examination is inconclusive, CT or MRI may be helpful. An accurate preoperative assessment of anatomy is critical, particularly in cases of uterovaginal malformations. MRI can be useful for evaluating this group of rare anomalies. An unexpected finding of a complex uterine or vaginal anomaly requires careful surgical planning and decision making

Adolescent Age Group - Management
Laparoscopy Acute PID to confirm the diagnosis Persisted symptoms in patient with the clinical diagnosis of PID or TOA The surgical management of inflammatory masses is rarely necessary in adolescents, except ruptured TOA or failure of medical management with broad-spectrum antibiotics Some surgeons advocate the use of laparoscopy in the management of suspected acute PID to confirm the diagnosis, and to perform irrigation, lysis of adhesions, drainage and irrigation of unilateral or bilateral pyosalpinx or tuboovarian abscess, or extirpation of significant disease. While symptoms persist in a patient with the clinical diagnosis of PID or tuboovarian abscess, laparoscopy should be considered to confirm the diagnosis. A clinical diagnosis may be incorrect in up to 1/3 of patients. The surgical management of inflammatory masses is rarely necessary in adolescents, except to treat rupture of tuboovarian abscess or failure of medical management with broad-spectrum antibiotics

Reproductive Age Group
Differential Diagnosis Uterine Masses Ovarian Masses Nonneoplastic Ovarian Masses Other Benign Masses Neoplastic Masses Other Adnexal Masses

Reproductive Age Group - Uterine Masses
Uterine leiomyomas - most common benign uterine tumors. Usually diagnosed on physical examination. Incidence: 20% (reproductive age) 40% to 50% of women older than 35 years of age. Uterine leiomyomas, also known as myomas or fibroids, are by far the most common benign uterine tumors. Other benign uterine growths, such as uterine vascular tumors, are rare. Uterine leiomyomas are usually diagnosed on physical examination. They are estimated to be present in at least 20% of all women of reproductive age and may be discovered incidentally during routine annual examination.

Types of fibroids They may be Subserosal Intramural
submucosal in location within the uterus or located in the cervix, in the broad ligament, or on a pedicle.

Malignant degeneration < 0.5% Leiomyosarcoma -rare malignant neoplasm composed of cells that have smooth muscle differentiation. Most diagnoses are determined (postoperatively) after microscopic examination. Studies suggest that malignant degeneration of a preexisting leiomyoma is extremely uncommon, occurring in less than 0.5% Leiomyosarcoma is a rare malignant neoplasm composed of cells that have smooth muscle differentiation. The typical patient with leiomyosarcoma is in her mid-50s and seeks treatment for abnormal bleeding. In most cases, diagnoses are determined (postoperatively) after microscopic examination of a uterus removed because of suspected leiomyomas. Sarcomas that have a malignant behavior have 103 mitoses/hpf.

Symptoms Menorrhagia Chronic pelvic pain Acute pain Urinary symptoms: Frequency, Partial ureteral obstruction, complete urethral obstruction Infertility The most common initial symptom associated with fibroids, and the one that most frequently leads to surgical intervention, is menorrhagia. Chronic pelvic pain may also be present. Pain may be characterized as dysmenorrhea, dyspareunia, or pelvic pressure. Acute pain may result from torsion of a pedunculated leiomyoma or infarction and degeneration The following urinary symptoms may be present: 1.Frequency, which may result from extrinsic pressure on the bladder. 2.Partial ureteral obstruction may be caused by pressure from large tumors at the pelvic brim. Reports suggest some degree of ureteral obstruction in 30% to 70% of tumors above the pelvic brim. Ureteral compression is 3 to 4 times more common on the right, because the left ureter is protected by the sigmoid colon. 3.Rarely, complete urethral obstruction, resulting from elevation of the base of the bladder by the cervical or lower uterine leiomyoma with impingement on the region of the internal sphincter, may occur. 4. Leiomyomas are an infrequent primary cause of infertility and have been reported as a sole cause in only a small percentage of infertile patients. 5. One review of myomectomies performed for all indications noted a history of infertility in 27% of women. 6. Pregnancy loss or complications can occur in women with leiomyomas, although most patients have uncomplicated pregnancies and deliveries. 7. One study calculated a 10% rate of pregnancy complications in women with fibroids. 8. Although growth of leiomyomas may occur with pregnancy, no demonstrable change in size (based on serial ultrasonographic examination) has been noted in 70% to 80% of patients. The risk of pregnancy complications is influenced by both myoma location and size。

Symptoms Rectosigmoid compression, with constipation or intestinal obstruction Prolapse of a pedunculated submucous tumor Venous stasis of the lower extremities and possible thrombophlebitis secondary to pelvic compression Polycythemia Ascites

Management of Leiomyomas Nonsurgical Management Intervention is reserved for specific indications and symptoms. Periodic examinations GnRH agonists Nonsurgical Management Judicious patient observation and follow-up are indicated primarily for uterine leiomyomas; intervention is reserved for specific indications and symptoms. Periodic examinations are indicated to ensure that the tumors are not growing rapidly. Uterine size should be recorded on the patient's chart, and the location of palpable and ultrasonographically localized leiomyomas should be described and diagrammed.

GnRH agonists 40% to 60% decrease in uterine volume Hypoestrogenism: reversible bone loss and symptoms: hot flashes. limited to short-term use Regrowth of leiomyomas within a few months after stopping therapy in about 1/2 women treated The use of GnRH agonists results in a 40% to 60% decrease in uterine volume and can be of value in some clinical situations. Treatment results in hypoestrogenism, which has been associated with reversible bone loss and symptoms such as hot flashes. Thus, treatment has been limited to short-term use, although low-dose hormonal replacement may be effective in minimizing the hypoestrogenic effects. Regrowth of leiomyomas is experienced within a few months after stopping therapy in about one-half of women treated. Some indications for the use of GnRH agonists in women with leiomyomas are as follows: 1.Preservation of fertility in women with large leiomyomas before attempting conception, or preoperative treatment before myomectomy 2.Treatment of anemia to allow recovery of normal hemoglobin levels before surgical management, minimizing the need for transfusion or allowing autologous blood donation 3.Treatment of women approaching menopause in an effort to avoid surgery 4.Preoperative treatment of large leiomyomas to make vaginal hysterectomy, hysteroscopic resection or ablation, or laparoscopic destruction more feasible 5.Treatment of women with medical contraindications to surgery 6.Treatment of women with personal or medical indications for delaying surgery.

Indications for GnRH agonist: 1.Preservation of fertility in women with large leiomyomas before attempting conception, or preoperative treatment before myomectomy 2.Treatment of anemia to allow recovery of normal hemoglobin levels before surgical management, minimizing the need for transfusion or allowing autologous blood donation 3.Treatment of women approaching menopause in an effort to avoid surgery 4.Preoperative treatment of large leiomyomas to make vaginal hysterectomy, hysteroscopic resection or ablation, or laparoscopic destruction more feasible 5.Treatment of women with medical contraindications to surgery 6.Treatment of women with personal or medical indications for delaying surgery. Indications 1.Preservation of fertility in women with large leiomyomas before attempting conception, or preoperative treatment before myomectomy 2.Treatment of anemia to allow recovery of normal hemoglobin levels before surgical management, minimizing the need for transfusion or allowing autologous blood donation 3.Treatment of women approaching menopause in an effort to avoid surgery 4.Preoperative treatment of large leiomyomas to make vaginal hysterectomy, hysteroscopic resection or ablation, or laparoscopic destruction more feasible 5.Treatment of women with medical contraindications to surgery 6.Treatment of women with personal or medical indications for delaying surgery.

Indications for surgery : Abnormal uterine bleeding - anemia, unresponsive to hormonal management Chronic pain with severe dysmenorrhea, dyspareunia, or lower abdominal pressure or pain Acute pain, as in torsion of a pedunculated leiomyoma, or prolapsing submucosal fibroid Urinary symptoms or signs such as hydronephrosis after complete evaluation Infertility, with leiomyomas as the only abnormal finding Markedly enlarged uterine size with compression symptoms or discomfort.

Indications for surgery because of the inability to exclude uterine sarcoma: Rapid enlargement of the uterus during premenopausal years or any increase in uterine size in a postmenopausal woman

Hysterectomy has long been viewed as the definitive management of symptomatic uterine leiomyomas. Myomectomy is an alternative to hysterectomy for patients who desire childbearing, who are young, or who prefer that the uterus be retained. Recent studies suggest that the morbidity of abdominal myomectomy and hysterectomy are similar Laparoscopic myomectomy minimizes the size of the abdominal incision, although several small incisions are required.

Vaginal myomectomy is indicated in the case of a prolapsed pedunculated submucous fibroid. Hysteroscopic resection of small submucous leiomyomas The recurrence risk for leiomyomas has been reported to be as high as 50% after myomectomy, with up to 1/3 requiring repeat surgery. Endometrial ablation can decrease bleeding for women with primary intramural fibroid

hysteroscopy

Nonextirpative approaches: Myolysis - use of lasers to coagulate or needle electrodes to deliver an electrical current to individual leiomyomas Uterine artery embolization - have serious consequences, including infection, massive bleeding, and necrosis requiring emergency surgery. Still consider investigational. Long-term safety and efficacy have not yet been demonstrated.

Reproductive Age Group - Ovarian Masses
During the reproductive years, the most common ovarian masses are benign. About 2/3 ovarian tumors are encountered during the reproductive years. Most ovarian tumors (80% to 85%) are benign, and 2/3 of these occur in women between 20 and 44 y/o. The chance that a primary ovarian tumor is malignant in a patient < 45 y/o is less than 1 in 15.

Pelvic findings in patients with benign and malignant tumors differ. Benign - unilateral, cystic, mobile, and smooth Malignant -bilateral, solid, fixed, irregular, and associated with ascites, cul-de-sac nodules, and a rapid rate of growth

Figure 13-14 Preoperative evaluation of the patient with an adnexal mass
In terms of assessing ovarian masses, the distribution of primary ovarian neoplasms by decade of life can be helpful Ovarian masses in women of reproductive age are most likely to be benign, but the possibility of malignancy must be considered

Reproductive Age Group - Nonneoplastic Ovarian Masses
Functional ovarian cysts include follicular cysts corpus luteum cysts theca lutein cysts All are benign and usually do not cause symptoms or require surgical management.

Follicular cyst the most common functional cyst cystic follicle can be defined as follicular cyst when diameter > 3 cm. found incidental to pelvic examination usually resolve in 4 to 8 weeks, seldom rupture causing pain and peritoneal signs

Corpus luteum cysts less common than follicular cysts. may rupture, leading to a hemoperitoneum and requiring surgical management. High risk - anticoagulant therapy. Rupture - more often on the right side and during intercourse. Most ruptures on cycle days 20 to 26.

Combination monophasic oral contraceptive therapy has been reported to markedly reduce the risk of functional ovarian cysts. It appears that, in comparison with previously available higher-dose pills, the effect of cyst suppression with current low-dose oral contraceptives is attenuated. Most studies have suggested that the use of triphasic oral contraceptives is not associated with an appreciable increased risk of functional ovarian cysts.

Other Benign Masses Women with endometriosis may develop ovarian endometriomas (“chocolate” cysts), which can enlarge to 6 to 8 cm in size. A mass that does not resolve with observation may be an endometrioma.

ovarian endometriomas (“chocolate” cysts)

Endometrioma

Endometrioma – “chocolate” content

In one study, 257 volunteers were examined with ultrasonography; 22% were found to have polycystic ovaries. The finding of bilateral generously sized ovaries on examination or polycystic ovaries on ultrasonographic examination should prompt evaluation for the full-blown syndrome which includes hyperandrogenism and chronic anovulation as well as polycystic ovaries. Therapy for PCOS is medical and generally not surgical.

Polycystic Ovaries

Reproductive Age Group - Neoplastic Ovarian Masses
More than 80% of benign cystic teratomas (dermoid cysts) occur during the reproductive years, although dermoid cysts have a wider age distribution than other ovarian germ cell tumors.

Benign cystic teratomas have an admixture of elements. comprising more than a single cell type derived from more than one germ layer, usually all 3. Cells differentiate along various germ lines, essentially recapitulating any tissue of the body. Examples include hair, teeth, fat, skin, muscle, and endocrine tissue

Malignant transformation: < 2% Bilateral: 10% Torsion: 15%, it occurs more frequently than with ovarian tumors because the high-fat content allowing them to float within the abdominal and pelvic cavity. As a result, frequently is anterior in location.

Cystectomy is almost always possible, even if it appears that only a small amount of ovarian tissue remains. Preserving a small amount of ovarian cortex in a young patient with a benign lesion is preferable Laparoscopic cystectomy is often possible, Intraoperative spill of tumor contents is rarely a cause of complications.

KUB Teeth In An Ovarian Cystic Teratoma

Sonography

Mature Teratoma / Dermoid Cyst

Torsion

Laparoscopic Surgery

Spill of contents

serous cystadenomas The risk of epithelial tumors increases with age 5% to 10% have borderline malignant potential 20% to 25% are malignant often multilocular, sometimes with papillary components. . Although serous cystadenomas are often considered the more common benign neoplasm, in one study, benign cystic teratomas represented 66% of benign tumors in women younger than 50 years of age; serous tumors accounted for only 20%.

Surface epithelial cells secrete serous fluid, resulting in a watery cyst content. Psammoma bodies are areas of fine calcific granulation, may be scattered within the tumor and are visible on radiograph. Frozen section is necessary to distinguish between benign, borderline, and malignant serous tumors, because gross examination alone cannot make this distinction.

Serous Cystadenoma

Serous Cystadenoma Psammoma bodies Psammoma bodies

Mucinous ovarian tumors may grow to large dimensions lobulated, smooth surface, multilocular Bilateral in up to 10% of cases Five to ten percent of mucinous ovarian tumors are malignant.

Mucoid material is present within the cystic loculations may be difficult to distinguish histologically from metastatic gastrointestinal malignancies

Other benign ovarian tumors include fibromas (a focus of stromal cells), Brenner tumors (which appear grossly similar to fibromas and which are frequently found incidentally), and mixed forms of tumors such as the cystadenofibroma.

Fibroma Meig’s Syndrome defined as the triad of benign ovarian tumor with ascites and pleural effusion that resolves after resection of the tumor. 40% of ovarian fibromas are associated with ascites and pleural effusion

Brenner Tumor Very uncommon 1-2% of all ovarian neoplasms
Usually discovered incidentally at surgery Vast majority are benign Solid and firm Dense fibrous stroma Difficult to distinguish from other solid neoplasms such as fibromas, thecomas, and pedunculated leiomyomas of uterus

Postmenopausal Age Group
Differential Diagnosis of Ovarian Masses During the postmenopausal years, the ovaries become smaller. Before menopause, the dimensions are approximately 3.5 × 2 × 1.5 cm. In early menopause, the ovaries are approximately 2 × 1.5 × 0.5 cm. In late menopause, they are even smaller: 1.5 × 0.75 × 0.5 cm.

Postmenopausal Age Group
Barber has described the postmenopausal palpable ovary (PMPO) syndrome, suggesting that any ovary that is palpable on examination beyond the menopause is abnormal and deserves evaluation Ovarian cancer is predominantly a disease of postmenopausal women; the incidence increases with age, and the average patient age is about 56 to 60 years

Figure 13-14 Preoperative evaluation of the patient with an adnexal mass

References Novak's Gynecology: Jonathan S. Berek, 2002 by Lippincott Williams & Wilkins. 13/e Atlas of Human Anatomy, Student Edition, 3rd Edition By Frank H. Netter, MD

Benign Tumors of the Female Reproductive Tract

Similar presentations

Presentation on theme: "Benign Tumors of the Female Reproductive Tract"— Presentation transcript:

Similar presentations

About project

Feedback

Log in

Auth with social network:

Benign Tumors of the Female Reproductive Tract

Similar presentations

Presentation on theme: "Benign Tumors of the Female Reproductive Tract"— Presentation transcript:

Similar presentations

About project

Feedback