BENIGN CYSTS

AND TUMORS OF

OVARIES

OVARIAN CYSTS

Follicular

Corpus luteum

Dermoid

Endometriomas

Types of cysts

Follicular Cyst

Most common type of ovarian cyst

Formed during 1st half of menstural

cycle[dominant follicle fails to ovulate]

Can be upto 6cm or more

Can be very large with hyperstimulation of

exgenous gonadotrophins

In POCS,the follicles in which the eggs

normally mature fail to open and cysts

form.

Corpus Luteum Cyst

Formed by hematoma or excessive growth of

corpus luteum

Less common but more clinically significant

than follicular cysts

Formed in the later half of the menstural

cycle

Not larger than 6cm

Formed due excess physiologic blessding

during the vasculization stage of corpus

luteum formation.

Dermoid Cyst

This type of cyst contains tissue similar to

that in other parts of the body. That

includes skin, hair, and teeth.

Benign cystic teratoma

Most common germ cell neoplasma and

mostly seen in women under 20yrs of age

18-25% of all ovarian tumors

Endometriomas

In women with endometriosis,tissue from the

lining of the uterus grows in other areas of the

body. This includes the ovaries.

Endometriosis can be very painful and can

affect fertility

This chocolate cyst is caused by endometriosis,

and formed when a tiny patch of endometrial

tissue (the mucous membrane that makes up the

inner layer of the uterine wall) bleeds, sloughs

off, becomes transplanted, and grows and

enlarges inside the ovaries.

OVARIAN TUMORS

Ovarian Malignancies

Two Major Classifications

NON-EPITHELIAL

Germ cell tumors

Stromal tumors

EPITHELIAL

Epithelial cell tumor

Germ cell Tumors start in the cells that

produce the eggs.

They can either be benign

or cancerous.

Most are benign.

Derived from:

Ectoderm,Mesoderm and

endoderm or any

combination

Germ cell tumors can

be cancerous or non-

cancerous tumors

Classification Teratoma

Mature cystic teratoma- "

Rokitansky’s protuberance"

Immature teratoma

Monodermal teratoma

(e.g. struma ovarii)

Dysgerminoma

Yolk sac tumor (endodermal

sinus tumor)

Embryonal carcinoma

Choriocarcinoma

Mature cystic teratoma

most common ovarian teratoma and most

common ovarian germ cell tumor

cystic tumor with firm capsule, filled with

sebaceous material and hair (occasionally

teeth can be found)

thickened area from which hair and teeth

arise is called "Rokitansky's protuberance"

Monodermal teratoma

Monodermal teratoma is composed

predominantly of one tissue element

most common type is "struma ovarii",

which is mature thyroid tissue.

Immature teratoma

occurs in children and young adults

usually a unilateral, solid tumor

similar to mature teratoma but contains

immature or embryonal tissues

Malignant neoplasm

Dysgerminoma

most common malignant ovarian germ cell

tumor

typically occurs in 2nd and 3rd decades

typically a unilateral, solid, firm to fleshy

tumor composed of malignant germ cells,

similar to primordial germ cells

Yolk Sac Tumor

second most common malignant ovarian

germ cell tumor.

occurs in childhood, adolescence, and adult

life (most <30 years)can be pure or a

component of a mixed germ cell tumor

almost always a unilateral solid or solid and

cystic tumor

Embryonal Carcinoma

uncommon ovarian germ cell neoplasm

occurs in children and young adults

usually occurs in combination with yolk sac

tumor

typically a unilateral, solid tumor with

hemorrhage and necrosis composed of

undifferentiated, pleomorphic, large cells

Choriocarcinoma

very rare as a pure ovarian neoplasm or as a

component of a mixed germ cell tumor

occurs in children and young adults

associated with elevated serum hCG levels

typically a unilateral, solid, hemorrhagic

tumor composed of malignant

cytotrophoblast and syncytiotrophoblast

Stromal Cell Tumors

Also known as sex cord-stromal tumor is a

group of tumors of sex cord-derived tissues

of the ovary and testis.

originate in the cells that produce female

hormones.

This group of tumors is significantly less

common than testicular germ cell tumors in

men, and slightly less common than ovarian

germ cell tumours in women.

Classification

Granulosa cell tumor

Sertoli-Leydig cell tumor

Granulosa cell tumor

adult form typically occurs at any age after

puberty but is more common in postmenopausal

women

most common clinically estrogenic ovarian tumor

can present with abnormal vaginal bleeding

can be associated with endometrial hyperplasia

and carcinoma

typically a unilateral solid or solid and cystic

tumor, often with hemorrhagic areas

Sertoli-Leydig cell tumor

accounts for less than 0.5% of ovarian tumors

occurs in all age groups but encountered most

often in young women

present with virilization in ~1/3 of cases

(oligomenorrhea, amenorrhea, loss of female

secondary sex characteristics with hirsutism,

clitoromegaly, deepening of voice)

almost always a unilateral tumor that can be

solid, solid and cystic, or even papillary

Epithelial cell tumors start from the cells on the surface of the

ovaries,i.e. germinal epithelium or ovary.

This is the most common form of ovarian

cancer and occurs primarily in adults.

Accounts to 95% of ovarian tumors

Classification Serous

Mucinous

Endometroid

Serous tumour They are

common neoplasms with a

strong tendency to

bilaterality,

they account for 50% of

all ovarian tumours.

Sixty percent are benign,

10% are borderline and

30% are malignant.

Risk Factors

age -- specifically women who have gone through

menopause

smoking

obesity

not having children or not breastfeeding (however,

using birth control pills seems to lower the risk)

fertility drugs (such as Clomid)

hormone replacement therapy

family or personal history of ovarian, breast, or

colorectal cancer (having the BRCA gene can increase

the risk)

Symptoms

Pain or bloating in the abdomen

difficulty urinating, or frequent need to urinate

dull ache in the lower back

pain during sexual intercourse

painful menstruation and abnormal bleeding

weight gain

nausea or vomiting

loss of appetite, feeling full quickly

Complication of ovarian

tumors

Torsion

- common with dermoid/fibroma

- Severe abdominal pain/vomitting

Rupture

Haemorrhage

Impaction

infection

Staging

Stage 1 Growth limited to one or both

ovaries

Stage 2 Growth limited to one or both

ovaries with pelvic extension

Stage 3 Tumor involving one/both

ovaries with peritoneal implants

outside pelvis/positive

retroperitoneal or inguinal nodes

Stage 4 Growth involving one or both

ovaries with distant metastasis

Ovarian tumor and pregnancy

Found incidentally

Corpus luteal/dermoid

2% are malignant

If discover early and persist , surgery

around 16 weeks

If complicated …operate immediately

Physical signs

Benign:

- usually mobile.unless large or complicated

- Dermoid cyst anterior to bladder

• Malignant:

- Bilateral

- Ascites

- Hard deposit in pelvis

- Leg edema

- Signs of bowel obstruction ,of ureteric obstruction

Investigation

CT scan

Tumor markers(ca125,CEA,HCG,alpha FP)

Urea and electrolyte

Chest X ray

Ultrasound

PAP smear

Treatment The treatment of ovarian cancers based on the stage of

the disease which is a reflection of the extent or spread of the cancer to other parts of the body.

It also depends on histologic cell type, and the patient's age and overall condition.

There are basically three forms of treatment of ovarian cancer:– surgery

– Chemotherapy

– radiation treatment

Other Therapies

Vaccines

Gene therapy

Immunotherapy

Acupuncture

massage therapy

herbal supplements

vitamin supplements

special diets

meditation/relaxation therapy