Benign and Malignant cysts and tumors of the ovary Dr . Hayder Al Shamma’a

Treatment of ovarian cyst/tumor Determine whether functional or neoplastic , and if neoplastic whether benign or malignant Calculate the Risk of Malignancy Index ( RMI ) By measure CA 125 u/ml x US score x menopausal score US score = (0 ,1, 3 ) for each of the following feature , one point multilocular, bilateral, solid area, metastasis, ascitis (0 for no US score, 1 for one US finding , 3 for 2 or more points) Premenopause 1 , postmenopause 3

Example :- 25 years old , bilateral simple ovarian cyst, CA 125 = 20 u/ml RMI = 20 x 1 x 1 = 20 → low risk ( cutoff value 200 ) Example 55 years , solid bilateral tumor , CA 125 = 90 u/ml RMI = 90 x 3 x 3 = 810 high risk malignancy

Treatment of functional cyst Functional cyst in asymptomatic woman ,(unilateral, simple cyst, thin wall, no ascitis less than 7 cm ) follow up for 6 weeks Functional cyst will disappear

Treatment of ovarian neoplasm Mainly surgical Laparoscopy for benign ( low risk ) Laparotomy for malignant (high risk )

Treatment of benign ovarian cyst Below age of 45 years treated by cystectomy for small cyst oopherectomy for large cysts Above age 45 years TAH + BSO

Treatment of malignant ovarian tumor Staging +treatment Stage I and II TAH + BSO + omentectomy + para aortic lymphadenectomy + biopsy from diaphragm For stage III and IV surgical staging + cytoreduction + chemo/radio therapy

Terminal care Ascitis :- repeated aspiration, some times local chemotherapy Intestinal obstruction:- subacute obstruction treated conservatively , surgical treatment indicated if the disease limited to a small segment of the bowel Pain :- pain relief is an essential part of care and it is the least thing to do to the patient

Tumor like conditions Follicular cyst :- very common When small not regarded as abnormal Thin walled cyst lined by granulosa cells Contain clear fluid Rarely exceeds 5 cm Asymptomatic secret estrogen May cause endometrial hyperplasia Occur when Graafian folicle not ovulate

Corpus luteum cyst:- Bleeding inside corpus luteum Increase it’s life span Secret progesterone Delay menstruation Some time painful Misdiagnosed as ectopic

Theca lutein – graulosa lutein cysts Bilateral Occur when excessive stimulation of the ovaries by gonadotrophins From H- mole secret hCG From Clomiphene treatment or FSH Disappear when gonadotrophins stoped

Ovarian tumors in pregnancy Occur in 1/1000 pregnancy 5% malignant 10% functional 85% benign , dermoid and cystadenoma

Management Malignant → treat irrespective to pregnancy Benign → treat in 2nd trimester

Thank you