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

Young ,reproductive age Old age

Fuctional cyst, benign germ cell T.

Benign epithelial T.

Causes of benign disease of ovary

Functional

Follicular cyst

Corpus luteal cystTheca luteal cyst

Inflammatory Tubo-ovarian abscess

Endometrioma

Germ cell Bengin teratoma

Epithelial Serous cystadenoma

Mucinous cystadenomaBrenner tumour

Sex cord stromalFibroma 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

Tumour makers Tumour type Uses

Ca 125 Epithelial O. cancer (serous),borderline O.T

Preoperative, follow up

Ca19-9 Epithelial O. cancer (mucinous), borderline O.T

Preoperative, follow up

Inhibin Granulosa cell tumour Follow up

Beta- hCG Dysgerminoma, Choriocarcinoma

Preoperative , follow up

AFP Endodermal yolk sac, teratoma Preoperative , follow up

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 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.

Theca luteal cyst • 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

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 cystif 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, mobile1-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