BENIGN TUMOURS,CYSTS&MALFORMATIONS OF THE GENITAL TRACT

WAQAR SAEED

09-122

MALFORMATIONS OF THE GENITAL TRACT

I. THE MALFORMATIONS

1.Faliure of Recanalization:

- Imperforate hymen or

transverse septum

- Cruciate Incision in the hymen

2.Failure of Ducts to form or fuse:

FAILURE OF DUCTS TO FUSE

BENIGN CYSTS OF VULVA

- Bartholin cysts

- Skene Gland cysts

- Mucus inclusion cysts

with or without vulval discomfort

BARTHOLIN CYSTS

MARSUPIALIZATION OF CYST

II. VULVAL CANCERS

•VULVAL TUMORS:

- Similar to those that arise in skin

- Vulval varicosities

VAGINAL CANCER

VAGINAL TUMORS: ( Rare)

- Cysts

- Gartner Duct Cyst

- Urethral Diverticulum

- Myoma

THE TUMORS…

CERVICAL TUMORS:

Cervical Polyp:

- Most common

- Columnar to squamous

metaplasia

- May ulcerate

- Intermittent/postcoital bleed

- Remove by twisting pedicle

THE TUMORS….Cervical Tumors:

Genital Papillomata

Fibroids

THE TUMORS…

UTERINE TUMORS:

1.)Endometrial Polyps

- Associated with endometrial

hyperplasia

- Abnormal uterine bleeding

- Detected by curettage or by

hysteroscopy.

THE TUMORS…

2.) Uterine Fibroids:

Gen. Considerations:

- Most common tumor of the GT

- Smooth muscle fibers interspersed

with connective tissue

- More common in nulliparous women

- Etiology unclear

- Post Menopausal Atrophy

- Types

Symptoms:

- Depend on size and position of fibroid

- Mostly asymptomatic

- Abnormal uterine bleeding

- Pelvic pressure and discomfort

Diagnosis:

- On PA

- Pelvic U/S

Management:

i) Observe

ii) Myomectomy

iii) Hysterectomy

iv) GnRH analogues

Effect of:

i) Pregnancy on Fibroid:

“ Red Degeneration”

ii) Fibroid on Pregnancy:

- Spontaneous Miscarriage

- Large tumor malpresentation of

fetus

- Can Obstruct Labour

- Bladder/Bowel Symptoms

- PPH

Manage Fibroid in Pregnancy:

- * AVOID Myomectomy

- If labour obstructed go for CS

BENIGN OVARIAN CYSTS &TUMORS

-Ovary consists of:

- Coelomic Epithelium

- Oocytes

- Mesenchymal elements that form

medulla

BENIGN OVARIAN CYSTS &TUMOURS

CLASSIFICATION:

TUMOR Cell Origin Type Incidence

Functional Cysts Normal Follicle Cystic 24

Serous Cystadenoma

Coelomic Epitelium

Cystic 20

Mucinous CYstadenoma

Coelomic Epithelium

Cystic 20

Teratoma (Dermoid Cyst)

Oogonia Cystic 15

Endometrioma Ectopic Endometrium

Cystic 10

Fibroma Mesenchyme Solid 5

BENIGN OVARIAN CYSTS &TUMOURS

1.) FUNCTIONAL CYST:

- Enlargement of unruptured Graffian

follicle

- Unilat. < 5cm

- May secrete estrogen resulting in

menorrhagia

- TVS for diagnosis

Rx:

- Observe ( 2-3 months)

- Aspirate under U/S & laproscopic guidance

- If Blood stained aspirate Laprotomy

- Multilocular cyst Surgical removal

BENIGN OVARIAN CYSTS &TUMOURS

2.) Mucinous Cystadenoma:

- B/w age 35-55

- Usually unilat.

- Lined by Columnar cells

- Psuedomyxoma peritonei

3.) Serous Cystadenoma:

- Age b/w 35-55

- Cuboidal Lining

- 1/3 may have malignant change

BENIGN OVARIAN CYSTS &TUMOURS

4.) Endometrioma:

- Chocolate Cyst

- Rx as Endometriosis

5.) Benign Teratoma:

( Dermoid Cyst)

- Age 20-40

- Epithelial,Endothelial, Mesothelial

elements

BENIGN OVARIAN CYSTS &TUMOURS

6.) Connective Tissue Neoplasm:

- Fibromas

- 10% Bilateral

- Meig’s Symdrome??

- Diagnosis by TVS

BENIGN OVARIAN CYSTS &TUMOURS

Management:

- Surgical

- Young Cystectomy

- BSO TAH