Benign Ovarian Mass

8/11/2019 Benign Ovarian Mass

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BENIGN OVARIAN MASS

Dr. VIDHI CHAUDHARY

ASSISTANT PROFESSOROBS& GYNAE, LHMC, DELHI.


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Ovarian masses are a common finding.

It is often difficult to clinicallydifferentiate between benign and

malignant conditions

Neoplasms constitute a significant

number, and most are benign.


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CLASSIFICATION


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FUNCTIONAL OVARIAN CYSTS INCLUDES:

a. Follicular cysts

b. Corpus luteum cysts

c. Theca luten cysts

BENIGN OVARIAN NEOPLASM1. Serous cystadenoma

2. Mucinous cystadenoma

3. Endometrioma4. Dermoid cysts

5. Fibroma


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FUNCTIONAL CYSTS

- disruption of normal ovulation & altered

Angiogenesis

- derive mass from accumulation of

intrafollicular fluids rather than cellular

proliferation

- most common detected cysts in the

reproductive age group

- Usually asymptomatic

- Resolve spontaneously.

- surgical evaluation -required for persistent

cysts.


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FOLLICULAR CYSTS

Follicular cysts -Hormonal dysfunction

prior to ovulation results in expansion ofthe follicular antrum with serous fluid andformation of a follicular cyst.


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CORPUS LUTEUM CYST

Results from Hemorrhage inside a corpus luteum.

"great imitators"

Immediately following hemorrhage into its cavity,the cyst appears echogenic and mimics a solidmass.

reticular pattern develop

retracting clot -intramural nodule.

transvaginal color Doppler -brightly colored ringbecause of increased surrounding vascularity k/ar ing of f i re.


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Theca luteal cysts

Result from over stimulation of theovary by HCG.

Common in molar pregnancy,choriocarcinoma, IVF pregnancy


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Risk Factors

Smoking- changes in gonadotropin

secretion and ovarian function .

progestin-only contraceptives

Tamoxifen- 15 to 30 percent


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Symptoms

Asymptomatic.

Symptoms -pain and vague pressuresensations are common.

acute severe pain ruptured corpus

luteum with hemorrhage.


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Diagnoses

Pelvic examination-

mobile, cystic, nontender, and foundlateral to the uterus

Transvaginal Scan-rounded anechoiclesions with thin, regular walls

TUMOR MARKERS- Detection of serumbeta hCG to differentiate ectopicpregnancy or a corpus luteum ofpregnancy


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Follicular cyst

smooth walls and lack of internal echoes.


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Diffuse low level echoes


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Reticular interfaces :resolving

hemorrhagic cyst


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Theca lutein cysts


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Management

Observation -spontaneously regress within6 months of identification.

Post menopausal-sonographic evidence of

1. thin-walled, unilocular cyst

2. (2) cyst diameter less than 5 cm

3. (3) no cyst enlargement duringsurveillance

4. (4) normal serum CA125 levels


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Management

OCP- unclear role.

Surgical Excision - persistent cysts & >3 cm &> 5cm

diameter(premenopausal&

postmenopausal respectively)

Laparoscopic cystectomy.


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Benign Neoplastic Ovarian

CystsMost common :

serous and mucinous cystadenomas(surface epithelial neoplasia group)

mature cystic teratomas (germ cell)


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Serous cystadenoma-

5% to 10% -borderline malignant potential

20% to 25% are malignant.

multilocular, with papillary components. The surface epithelial cells secrete serous

fluid, resulting in a watery cyst content.Psammoma bodies, (areas of fine calcific

granulation), if present can be seen onradiograph.


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Mucinous ovarian tumors-

grow to largesize.

bilateral in 10% . 5-10% are malignant.

They have lobulated, smooth surface,

multilocular, . Mucoid material ispresent within the cystic loculations . It

is difficult to distinguish histologically

from metastatic gastrointestinal

malignancies.


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22/396,810 grams, 20 cm X 40

Benign serous

cystadenoma


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Teratoma

Teratomas arise from a single germ cell.

can contain any of the three germlayersectoderm, mesoderm, or

endoderm.

Types

a. mature b.immature


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Mature teratoma

benign tumor

mature forms of the three germ celllayers

(1) Mature cystic teratomas /benign

cys t ic teratoma /dermo id cyst

(2) Mature solid teratomas-elements

formed into a solid mass


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Mature teratoma

(3) Fetiform teratomas orhomunculus.

(4) Monodermal teratoma-composed

one highly specialized tissue type.

Eg.thyroid tissue are termed st ruma

ovar i i.


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b. immature -This neoplasm is

malignant. Immature tissues from one,

two, or all three germ cell layers are

found and frequently coexist with

mature element.


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Mature cystic teratomas

peak incidence -20 to 40 years ,pregnancy.

bilateral -10 percent .

10 to 25 percent of all ovarian neoplasms

60 percent of all benign ovarian

neoplasms

Malignant transformation -1 to 3 percent-

most common squamous cell carcinoma

80%, sarcoma


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PathologySmooth walled,unilocular

with an area of localized growth that

protrudes into the cystic cavity.

Inner surface has a localized nodule, k/a

Rokitansky protuberance, composed of

adipose tissue (embryonal node)

Hair and fatty secretions +

Tumor Origin-genetic material

contained within a single oocyte


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Diagnosis

Tip of the iceberg"echogenic interfaces offat, hair, and tissues in focus that shadowand thus obscure structures behind it.

Fat-fluid or hair-fluid levelslineardemarcation where serous fluid interfaceswith sebum or hair.

Hairlines and dots. Rokitansky protuberancehyperechoic, and

creates an acute angle with the cyst wall.


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Complications

-15 percent torsion.

-cyst rupture (rare)- acute granulomatusperitonitis


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Other benign tumors

Fibromas(a focus of stromal cells)-

associated with Meigs syndrome (pleural

effusion with benign pelvic tumors)

Pseudo-Meigssyndrome consists of

pleural effusion ,ascites, and benign

tumors of the ovary other than fibromas.tumors of the fallopian tube or uterus

,mature teratomas and struma ovarii.


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Treatment

SURGICAL EXCISION

-definitive diagnosis, affords relief of

symptoms, and prevents complications oftorsion, rupture, and malignantdegeneration.

ROUTE-laparoscopic or laparotomy/ minilap

LAPROSCOPY -increased rates of cystrupture with the risk for tumor spill andmalignant seeding .


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Treatment

Surgery influenced by lesion size, age,

and intraoperative findings

-cystectomy preservation of

reproductive function

-oophorectomy- postmenopausal women

-Staging -Clinical findings of malignancy


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RADIOLOGICAL FEATURES OF BENIGN

OVARIAN MASSES:

1. Unilocular

2. Smooth surface

3. No solid elements4. No external or internal outgrowth

5. No ascites

6. Unilateral

7. Normal doppler flow


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CA-125 in:

Leiomyoma

Endometriosis/adenomyosis

PID

Pregnancy

Malignancies-lung, breast, colon

Pancreatitis

Cirrhosis


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i


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E ith li l i t

ovarian

capsule

Benign Ovarian Mass

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