Pelvic mass of ovarian/adenexal origin
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Transcript of Pelvic mass of ovarian/adenexal origin
PELVIC MASSOF OVARIAN/ADNEXALORIGIN
By Ezmeer Emiral
Differentials Diagnosis
Ovarian
Adnexal
Uterine
Gastrointestinal
Bladder,Kidney,Peritoneal
OVARIAN
Benign Ovarian Neoplasm
Malignant Ovarian Neoplasm
Physiological Cysts
Physiological cyst
This groups includes follicular,corpus lteal and theca luteal cystUsu <5cm, have thin wall and well encapsulatedUsu unilocular & contain clear fluid
Follicular cystResults from unruptured Graafian follicle/failure of atresia in non-dominant follicleSeldom >5cm (May achieve up to 10cm)Thin wall + well encapsulatedMay resolve spontaneouslyf/up every month for 3 months; US guided asp/ laparoscopy
Corpus luteum cyst – progesterone prod Occurs when corpus luteum cyst become ruptured or bleeding
occurs into it and subsequently fails to regress Size similar to follicular cyst and usually regresses with time Patient can present with acute abdomen if bleeding occurs and
the cyst rupture. Treatment:Analgelsia /surgery
Theca luteal cyst-associated with multiple pregnancy.Most resolved
spontaneously.
OVARIAN TUMOURS
Benign epithelial tumours
Serous & mucinous cystadenoma
Brenner tumour
Endometriod cystadenoma
Benign germ cell T
Mature teratoma
Dermoid cyst
B. Sex cord stromal T.
Theca cell
Sertoli- leydig tumour
Granulosa cell
Malignant
PRIMARY: Epithelial cell Germ cell Sex Cord StromaSECONDARY: Metastatic eg: Krukenberg
tumour
40+ years
Epithelial Tumours
Arise from the simple cuboidal surface epithelium of the ovary
Account for 80-85% of all ovarian tumours
Classified according to the following histological subtypeo serous o mucinous o endometrioido clear cello Brennero undifferentiated.
Each subtype can be classified as benign, borderline (low malignant potential, LMP), or malignant (invasive).
Usu found in postmenopausal women (mean presentation age is 56 years )
Benign (60%)
- unilocular single layer of flattened or
cuboidal epithelium and the absence of mitoses.
Cyst fluid is clear, thin and colourless.
Papillae formation Malignant (25%)
multiloculated partially cystic, partially solid
tumours with friable papillae. Capsule smooth or irregular or
show papillary projections.
Benign (25%) Single layer of tall, columnar
cells Unilateral, multilocular The cyst fluid is thick,
yellow ,glutinous + mucin-producing cells
Malignant Solid CA in the wall Columnar cell, mitoses
serous tumours mucinous tumours
Papillary serous cystadenocarcinoma Composed of solid tissue and has invaded outside of the ovary, with papillations seen over the surface.
Papillary serous cystadenocarcinoma. Note the many papillations on the inner surface.
Germ Cell Tumours
Derived from primitive germ cells of the embryonic gonad, and may undergo germinomatous or embryonic differentiation.
Affecting young women (peak incidence is early 20s accounting for more than 50 % ovarian tumour of this age group)
TERATOMA (dermoid cysts)• Unilocular cyst (<15cm)• Contain sebaceous glands, teeth, hair, nervous tissue, cartilage, bone, resp & intestinal & thyroid tissue• Long pedicle, heavy & easily undergo torsion• Histologically, a variety of mature tissue elements may be found. • Most common presentaion is acute onset of pain &sudden onset nausea
Opened mature cystic of ovary. A ball of hair & mixture of tissue
Bilateral mature cystic teratoma
Sex Cord Stromal Tumours
Develop from the gonadal stroma Account for 5-10 % of all ovarian neoplasms Subdivided into the following clinicopathological entities:
Granulosa cell tumour Theca cell tumour Sertoli-Leydig cell tumour - Ovarian Fibroma – Meig’s syndrome: ascites, pleural eff, fibroma – 1%
estrogen producing tumour
androgen producing tumour
Granulosa cell tumour has nests of cells which are forming primitive follicles.
Granulosa cell tumour with variegated cut surface.
• Derived frm the ovarian stroma and mostly malignant.
• Produce large amounts of estrogen.• Accelerated skeletal growth &
appearance of sex hair• 5% (children) – precocious puberty• 60% (childbearing age) – irreg menses• 30% (post-menopausal) – PM bleeding
Estrogen excess causes hyperplasia of:
1. Myometrium ~ enlarged uterus
2. Endometrium ~ irreg bleeding. Occ amenorrhea
3. Mammary gland tissue ~ enlargement, tender breast
Metastatic Tumours
Most common: from breast carcinomaalso from: colon ca
endometrial caKrukenberg tumour 1° growth : stomach, Age 30 – 40 yrs Clinically silent Bilat, equal size, mobile, smooth & lobulated HPE : very cellular stroma
: signet-ring appearance + clear mucin- filled cytoplasm
Metastatic adenocarcinoma to ovary appears as a large mass and resembles a primary tumor: Seen here extending out of the pelvis at autopsy is a large right ovarian mass. Metastases are also present in the lower right portion of liver.
Krukenberg tumor of ovary
Adnexal/Tubal
Endometrioma
Hydrosalphinx
Tubo-Ovarian Abcess
Endometrioma/ endometrioid cyst Part of the condition known
as endometriosis. Commonly seen in nulliparaous/women
of reproductive years.It may cause pelvic pain associated with menstruation.
‘Chocolate cyst’, often filled with dark, reddish-brown blood, may range in size from 0.75-8 inches
Th cyst arise from recurrent bleeding from endometric foci placed within substance of ovary.
Hydrosalphinx
Tubal masses that – a long-term sequale of pelvic inflammatory disease.
The tubes are dilated & distended with clear fluid.
Hydrosalpinx fluid is highly embryotoxic and is a likely cause for the decreased fertility in women with a hydrosalpinx. In fact, spontaneous abortion risk is doubled.
Tubo-Ovarian Abcess
Collection of pus and bacteria within the part of the fallopian tube.
Symptoms include lower abdominal pain, back pain, vaginal discharge and fever.
Treatment includes antibiotic and NSAIDS.In severe abcess may require narcotic pain medication and drainage of abcess/surgery.