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

Ovaries are normally not palpable in pre-menarche, and after the menopause 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 Early menopause 1 – 2 yrs 2 x 1.5x0.5cm Late menopause 2-5yrs 1.5x0.75x0.5cm

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: I. Functional Benign II Neoplastic borderline Malignant

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

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.

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

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

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

ENDOMETRIOMA (Chocolate cysts) 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. ENDOMETRIOMA (Chocolate cysts) - Associated with endometriosis

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

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

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

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

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

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

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