benign ovarian tumors.pptbenign ovarian tumors.

benign ovarian tumors.
benign ovarian tumors.
benign ovarian tumors.

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

2. 
Ovaries are normally not palpable in Ovaries are normally not palpable in
pre-menarche, and after the pre-menarche, and after the
menopausemenopause

In the reproductive age group ovaries In the reproductive age group ovaries
are palpable in the lean pts.are palpable in the lean pts.

Ovarian size of different age groupsOvarian size of different age groups
Premenopause 3.5 x 2 x 1.5 cmPremenopause 3.5 x 2 x 1.5 cm
Early menopause 1 – 2 yrs Early menopause 1 – 2 yrs
2 x 1.5x0.5cm2 x 1.5x0.5cm
Late menopause 2-5yrs Late menopause 2-5yrs
1.5x0.75x0.5cm1.5x0.75x0.5cm

3. 
If the ovaries are palpable in any of the If the ovaries are palpable in any of the
age groups when it is not supposed to be age groups when it is not supposed to be
through investigations and work up should through investigations and work up should
be carried outbe carried out

OVARIAN CYSTS CAN BE CLASSIFIED AS OVARIAN CYSTS CAN BE CLASSIFIED AS
FOLLOWS:FOLLOWS:

I.I.FunctionalFunctional BenignBenign

IIIINeoplasticNeoplastic borderlineborderline
MalignantMalignant

4. FUNCTIONAL OVARIAN CYSTS FUNCTIONAL OVARIAN CYSTS
INCLUDES:INCLUDES:
a.a.Follicular cystsFollicular cysts
b. Corpus luteum cystsb. Corpus luteum cysts
c. Theca luten cystsc. Theca luten cysts
BENIGN OVARIAN NEOPLASMBENIGN OVARIAN NEOPLASM
1.1.Serous cystadenomaSerous cystadenoma
2. Mucinous cystadenoma2. Mucinous cystadenoma
3. Endometrioma3. Endometrioma
4. Dermoid cysts4. Dermoid cysts
5. Fibroma5. Fibroma

5. FUNCTIONAL CYSTSFUNCTIONAL CYSTS
-These are cysts related to ovarian These are cysts related to ovarian
function i.e. the process of ovulationfunction i.e. the process of ovulation
-They are the most common detected They are the most common detected
cysts in the reproductive age groupcysts in the reproductive age group
-Can be reach up to 10 cm in diameterCan be reach up to 10 cm in diameter
-Resolve spontaneously.Resolve spontaneously.

6. Follicular cysts results from the Follicular cysts results from the
growth of a follicle that does not growth of a follicle that does not
rupturerupture
Corpus luteum cyst results from Hge Corpus luteum cyst results from Hge
inside a corpus luteuminside a corpus luteum
Theca luteum cysts result from over Theca luteum cysts result from over
stimulation of the ovary by HCG. Not stimulation of the ovary by HCG. Not
common in normal pregnancy but common in normal pregnancy but
common in molar pregnancy, common in molar pregnancy,
choriocarcinoma and reproductive choriocarcinoma and reproductive
technologytechnology

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

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

9. II.II.MUCINOUS CYSTADENOMAMUCINOUS CYSTADENOMA
- May reach very large size- May reach very large size
- Filled with thick mucinous material- Filled with thick mucinous material
- Perforation may lead to a serious - Perforation may lead to a serious
condition called pseudomyxoma condition called pseudomyxoma
peritonei for which chemotherapy peritonei for which chemotherapy
may be needed.may be needed.
III.III.ENDOMETRIOMA (Chocolate cysts)ENDOMETRIOMA (Chocolate cysts)
-- Associated with endometriosisAssociated with endometriosis

10. IV.IV.DERMOID CYSTS OR BENIGN CYSTIC DERMOID CYSTS OR BENIGN CYSTIC
TERATOMATERATOMA
- Usually small and may be bilateral- Usually small and may be bilateral
- Contain sebum, hair, teeth etc.- Contain sebum, hair, teeth etc.
- Contains elements from endoderm- Contains elements from endoderm
mesoderm and ectodermmesoderm and ectoderm
- Can change into malignant teratoma- Can change into malignant teratoma
- Avoid spilling of contents which leads- Avoid spilling of contents which leads
to chemical peritonitisto chemical peritonitis

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

12. •Clinical signs and symptoms of ovarian Clinical signs and symptoms of ovarian
masses:masses:
1.1. abdominal girth abdominal girth
2. Abdominal discomfort2. Abdominal discomfort
3. Pressure symptoms3. Pressure symptoms bladderbladder
bowelbowel
4. Acute abdomen due to4. Acute abdomen due to
-- HgeHge
-- RuptureRupture
-- TorsionTorsion
5. Asymptomatic coincidentally diagnosed5. Asymptomatic coincidentally diagnosed

13. •RADIOLOGICAL FEATURES OF BENIGN RADIOLOGICAL FEATURES OF BENIGN
OVARIAN MASSES:OVARIAN MASSES:
1.1.UnilocularUnilocular
2.2.Smooth surfaceSmooth surface
3.3.No solid elementsNo solid elements
4.4.No external or internal outgrowthNo external or internal outgrowth
5.5.No ascitesNo ascites
6.6.UnilateralUnilateral
7. Normal doppler flow7. Normal doppler flow

14. •CLINICAL FEATURES OF BENIGN CLINICAL FEATURES OF BENIGN
OVARIAN TUMORSOVARIAN TUMORS
UnilateralUnilateral
 CysticCystic
 MobileMobile
 No ascitesNo ascites
 No cul de-sac nodulesNo cul de-sac nodules
 Slow or no growthSlow or no growth

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

16. •INDICATIOONS FOR SURGERYINDICATIOONS FOR SURGERY
Ovarian cyst >5 cm followed for Ovarian cyst >5 cm followed for
6-6- 8wks.8wks.
Solid lesionsSolid lesions
Papillary vegitationPapillary vegitation
Mass >10 cm at the time of Mass >10 cm at the time of
presentationspresentations
AscitesAscites
Palpable mass in premenarchal Palpable mass in premenarchal
or or post menopausalpost menopausal
Suspicion of torsion or ruptureSuspicion of torsion or rupture