Transcript 2-Disease of ovary 1

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.
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 cyst
Theca luteal cyst
Inflammatory
Tubo-ovarian abscess
Endometrioma
Germ cell
Bengin teratoma
Epithelial
Serous cystadenoma
Mucinous cystadenoma
Brenner tumour
Sex cord stromal
Fibroma
Thecoma
Presentations
Benign & malignant
diseases usually
diagnosed by the
presence of pelviabdominal mass .
*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.
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,
Preoperative , follow
Choriocarcinoma
up
Endodermal yolk sac, teratoma Preoperative , follow
up
AFP
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
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.
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 cyst
if torsion is complete---oophorectomy
If viable ovary …cysectomy by laparotomy &
laparoscopic often
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, mobile
1-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