Diseases of the ovary Prof. Dr. Noorhan Shakir

Benign disease of ovary Are common, frequently asymptomatic, resolve spontaneously. 90% of all ovarian tumors are benign, although this varies with age, at 20th only 5% while at postmenopausal age 45% are malignant.

The main objectives of management of benign ovarian diseases To exclude malignancy & to avoid cyst accident without causing undue morbidity & impairing future fertility in young women.

Causes according to the age

Causes of benign disease of ovary Functional Follicular cyst Corpus luteal cyst Theca luteal cyst Inflammatory Tubo-ovarian abscess Endometrioma Germ cell Bengin teratoma Epithelial Serous cystadenoma Mucinous cystadenoma Brenner tumour Sex cord stromal Fibroma Thecoma

Presentations *Asymptomatic; incidental by USS, ANC *Pain: 1-acute; Torsion, rupture, Hg, infection, malignant change. 2-Chronic; Lower abdominal pain as a result of pressure, endometriosis, infection. *Abdominal swelling ; Benign mucinous tumour may fill the entire abdominal cavity. *Pressure effect; GIT, urinary symptoms , oedema, varicosity, hemorrhoid, uterine prolaps. *Menstrual effects; Oestrogen effects as precocious puberty , the endometrial hyperplasia in premenopausal women will cause menorrhagia, in older age, breast enlargement, PMB. *Hormonal effect: Thyrotoxicosis. *Abnormal Pap smear; ovarian T. could be benign. Benign & malignant diseases usually diagnosed by the presence of pelvi- abdominal mass .

Common investigations USS (TVS,TAS), CT scan or MRI Pregnancy test should be performed to exclude pregnancy. Inflammatory markers ; such as CRP and WBC, are D.D as appendicitis, tubo-ovarian abscess.

Tumour makers used in ovarian carcinoma

Functional cysts *The risk of functional cyst is reduced by use of contraceptive pill (OCCP) .

Functional cysts The follicular cyst diagnosed by USS when size 3cm, rarely reaches 10 cm in diameter. It resolved spontaneously depends on symptoms. Treatment; if asymptomatic follow up by USS. If symptomatic: Laparoscopic cystectomy

Functional cysts Corpus luteal cyst Theca luteal cyst When ovulation occurs bleeding continued so, the presentation; pain typically on late menstrual cycle, due to rapture or hemorrhage. it needs analgesia. Rarely needs laparoscopic pelvic washout or cystectomy. DD; ectopic pregnancy. During pregnancy usually resolve spontaneously.

Inflammatory ovarian cyst Most common in young age group is pelvic inflammatory diseases (PID). Diagnosed clinically and by laboratory; ↑WBC & C reactive protein become positive. Antibiotics, drainage, and excision ,while definitive surgery deferred after resolving acute state, because increased risk of systemic infection and difficulty of inflamed tissue.

Endometrioma Chocolate cyst; characteristic ground glass appearance by USS. Some time reaches up to 10cm in diameter.

Germ cell Tumour Mature cystic teratoma ( dermoid cyst); 1-The ectodermal structures are predominates: its lined by epithelium like dermis (skin & its appendages, teeth, sebaceous material, hair). 2-Endodermal (thyroid, intestine) 3- Mesoderm (bone, cartilage, SMF). Mesodermal tumour; means single tissue is present as carcinoid (serotonin) & Stroma ovarii (thyroid tissue hyperthyroidism) which contains hormonally active thyroid tissue. Treatment ; Surgical excision of cyst if torsion is complete---oophorectomy If viable ovary …cysectomy by laparotomy & laparoscopic often Mature cystic teratoma ( dermoid cyst); It is arise from differentiations in to embryonic tissue & account 50% of all ovarian tumour, age around 30 ys & usually bilateral.

Cystic teratomas (dermoid): second most common =

Epithelial cell tumours 1-Serous cystadenoma : These are the most common type, are cystic lined by cuboidal cell unilateral, at age before 40 years old. 70-75% of ovarian neoplasms are from surface. Serous tumours are more likely to be bilateral (20%) than mucinous(5%)

2-Mucinous cystadenoma It is 2nd common epithelial t, Typically are large unilateral multilocular with smooth inner surface,(14 kg) Lined with mucus- secreting columnar cell & thick ,gelatinous fluid in cyst.

This is a mucinous cystadenoma of the ovary. Impressive

3-Brenner They are small t. accidently found inside the ovary , Secrets estrogen.

sex cord stromal tumours All types are solid, hard, unilateral, mobile 1-Fibroma: The most common T. arise from stroma cells. Presented with torsion because heavy weight. It might cause Meigs syndrome (ascites, pleural effusion). 2-Theca cell T ( Thecoma ): Occur at postmenopausal age . Almost all are benign produce estrogens which may cause endometrial cancer, DUB, precocious puberty.

sex cord stromal tumours