benign tumors of the female reproductive tract 輔仁大學實習醫師核心課程...

Benign Tumors of the Benign Tumors of the Female Reproductive Female Reproductive Tract Tract

輔仁大學實習醫師核心課程輔仁大學實習醫師核心課程新光吳火獅紀念醫院婦產科新光吳火獅紀念醫院婦產科

黃莉文黃莉文

Benign tumors of the Benign tumors of the Female Reproductive Female Reproductive

TractTract Pelvic massPelvic mass A pelvic mass may be gynecologic in A pelvic mass may be gynecologic in

origin or it may arise from the urinarorigin or it may arise from the urinary tract or bowel. y tract or bowel.

The gynecologic causes of a pelvic The gynecologic causes of a pelvic mass may be uterine, adnexal, or mmass may be uterine, adnexal, or more specifically ovarian.ore specifically ovarian.

Prepubertal Age GroupPrepubertal Age Group - Differential Diagnosis - Differential Diagnosis

Differential Diagnosis Differential Diagnosis < 5% of ovarian malignancies < 5% of ovarian malignancies Germ cell tumors make up 1/2 to 2/Germ cell tumors make up 1/2 to 2/

33 35%35% of all ovarian neoplasms occurr of all ovarian neoplasms occurr

ing during childhood and adolescening during childhood and adolescence were ce were malignantmalignant

< 9y/o, 80% malignant< 9y/o, 80% malignant


Symptoms: abdominal or pelvic painSymptoms: abdominal or pelvic pain Pelvic mass very quickly becomes Pelvic mass very quickly becomes

abdominal in location as it enlarges abdominal in location as it enlarges because of the small size of the pelvic because of the small size of the pelvic cavity. cavity.

Diagnosis is difficult because of the Diagnosis is difficult because of the rarity of the condition (and therefore a rarity of the condition (and therefore a low index of suspicion) low index of suspicion)

Many symptoms are nonspecificMany symptoms are nonspecific Acute symptoms are more likely to be Acute symptoms are more likely to be

attributed to more common entities attributed to more common entities such as appendicitis. such as appendicitis.


Abdominal palpationAbdominal palpation bimanual rectoabdominal examinatibimanual rectoabdominal examinati

onon Abdominal in location: can be confuAbdominal in location: can be confu

sed with other abdominal massessed with other abdominal masses Acute pain: torsion. Acute pain: torsion.

The ovarian ligament becomes elongated The ovarian ligament becomes elongated as a result of the abdominal location, thas a result of the abdominal location, thus creating a predisposition to torsion.us creating a predisposition to torsion.

Prepubertal Age GroupPrepubertal Age Group- Diagnosis and Management - Diagnosis and Management

UltrasonographyUltrasonography Unilocular cysts are virtually always Unilocular cysts are virtually always

benign and will regress in 3 to 6 mobenign and will regress in 3 to 6 months do not require surgical managenths do not require surgical management with oophorectomy or oophorment with oophorectomy or oophorocystectomy.ocystectomy.

Prepubertal Age GroupPrepubertal Age Group - Diagnosis and Management - Diagnosis and Management

Close observation recommended (discusClose observation recommended (discuss risk of ovarian torsion with the child's ps risk of ovarian torsion with the child's parents.)arents.)

Recurrence rates after cyst aspiration - 50Recurrence rates after cyst aspiration - 50%.%.

Attention: long-term effects on endocrinAttention: long-term effects on endocrine functioning, future fertility, preservatioe functioning, future fertility, preservation of ovarian tissuen of ovarian tissue

Premature surgical therapy - ovarian and Premature surgical therapy - ovarian and tubal adhesions that can affect future ferttubal adhesions that can affect future fertility.ility.

Prepubertal Age GroupPrepubertal Age Group - Diagnosis and Management - Diagnosis and Management Additional imaging : CT, MRI, Additional imaging : CT, MRI,

Doppler flow studies.Doppler flow studies. Risk of a germ cell tumor is high, Risk of a germ cell tumor is high,

the finding of a solid component the finding of a solid component mandates surgical assessment.mandates surgical assessment.

Adolescent Age GroupAdolescent Age Group

Differential DiagnosisDifferential Diagnosis Ovarian MassesOvarian MassesUterine MassesUterine Masses Inflammatory MassesInflammatory MassesPregnancyPregnancy

Adolescent Age GroupAdolescent Age Group- Ovarian masses- Ovarian masses

The risk of malignant neoplasms lower.The risk of malignant neoplasms lower. Germ cell tumors - most common tumors Germ cell tumors - most common tumors

of the first decade of life but occur less frof the first decade of life but occur less frequently during adolescence.equently during adolescence.

Epithelial neoplasms - increasing frequenEpithelial neoplasms - increasing frequency with age.cy with age.

Mature cystic teratoma - most frequent nMature cystic teratoma - most frequent neoplastic tumor of children and adolesceeoplastic tumor of children and adolescents, accounting for > 1/2 of ovarian neoplnts, accounting for > 1/2 of ovarian neoplasms in women < 20 y/oasms in women < 20 y/o

Adolescent Age GroupAdolescent Age Group - Ovarian masses - Ovarian masses

Neoplasia can arise in dysgenetic goNeoplasia can arise in dysgenetic gonads. nads.

25% of dysgenetic gonads of patien25% of dysgenetic gonads of patients with a Y - malignant.ts with a Y - malignant.

Gonadectomy - recommended for pGonadectomy - recommended for patients with XY gonadal dysgenesis atients with XY gonadal dysgenesis or its mosaic variations.or its mosaic variations.


Functional ovarian cysts Functional ovarian cysts Incidental finding on examinationIncidental finding on examination Pain caused by torsion, leakage, or Pain caused by torsion, leakage, or

rupture. rupture. Endometriosis is less common Endometriosis is less common

during adolescence than in during adolescence than in adulthood. adulthood. In series of adolescents referred with In series of adolescents referred with

chronic pain, 50% to 65% have been chronic pain, 50% to 65% have been found to have endometriosis.found to have endometriosis.


Most adolescents with endometriosMost adolescents with endometriosis do not have associated obstructivis do not have associated obstructive anomalies.e anomalies.

In young women, endometriosis maIn young women, endometriosis may have an atypical appearance, with y have an atypical appearance, with nonpigmented or vesicular lesions, nonpigmented or vesicular lesions, peritoneal windows, and puckering.peritoneal windows, and puckering.

Adolescent Age GroupAdolescent Age Group- Uterine Masses- Uterine Masses

Uterine leiomyomas - not commonUterine leiomyomas - not common Obstructive uterovaginal anomalies Obstructive uterovaginal anomalies

occur during adolescence, at the tioccur during adolescence, at the time of menarche, or shortly thereaftme of menarche, or shortly thereafter.er.

The diagnosis is frequently neither sThe diagnosis is frequently neither suspected nor delayed, particularly uspected nor delayed, particularly when the patient is seen by a generwhen the patient is seen by a general surgeon.al surgeon.

Adolescent Age GroupAdolescent Age Group- Uterine Masses- Uterine Masses

Uterine anomalies - imperforate hymen, tUterine anomalies - imperforate hymen, transverse vaginal septa, vaginal agenesis ransverse vaginal septa, vaginal agenesis with a normal uterus and functional endowith a normal uterus and functional endometrium, vaginal duplications with obstrmetrium, vaginal duplications with obstructing longitudinal septa, and obstructed ucting longitudinal septa, and obstructed uterine horns. uterine horns.

Cyclic pain, amenorrhea, vaginal discharCyclic pain, amenorrhea, vaginal discharge, or an abdominal, pelvic, or vaginal mge, or an abdominal, pelvic, or vaginal mass.ass.

Hematocolpos, hematometraHematocolpos, hematometra

Obstructive Genital Obstructive Genital AnomaliesAnomalies

HematocolposHematocolpos

Bulging vaginal massBulging vaginal mass

Cruciate/Circular IncisionCruciate/Circular Incision

Uterine anomaliesUterine anomalies

Adolescent Age GroupAdolescent Age Group- Inflammatory Masses- Inflammatory Masses

Adolescents have the highest rates of PIDAdolescents have the highest rates of PID An adolescent who has pelvic pain may bAn adolescent who has pelvic pain may b

e found to have an inflammatory mass.e found to have an inflammatory mass. The diagnosis is primarily clinical, based The diagnosis is primarily clinical, based

on the presence of lower abdominal, pelvon the presence of lower abdominal, pelvic, and adnexal tenderness; cervical motiic, and adnexal tenderness; cervical motion tenderness; a mucopurulent dischargon tenderness; a mucopurulent discharge; elevated temperature, white blood cell e; elevated temperature, white blood cell count, or sedimentation ratecount, or sedimentation rate

Adolescent Age GroupAdolescent Age Group - Inflammatory Masses - Inflammatory Masses

Associated with the risks STDAssociated with the risks STD Inflammatory masses may consiInflammatory masses may consi

st ofst of Tuboovarian complexTuboovarian complex Tuboovarian abscessTuboovarian abscess PyosalpinxPyosalpinx HydrosalpinxHydrosalpinx

Adolescent Age GroupAdolescent Age Group - Inflammatory Masses - Inflammatory Masses

Adolescent Age GroupAdolescent Age Group- Pregnancy- Pregnancy

Pregnancy should always be consideredPregnancy should always be considered Adolescents more likely to deny the possiAdolescents more likely to deny the possi

bility of pregnancy.bility of pregnancy. Ectopic pregnancies may cause pelvic paiEctopic pregnancies may cause pelvic pai

n and an adnexal mass.n and an adnexal mass. Quantitative measurements of b-hCG, ectQuantitative measurements of b-hCG, ect

opic pregnancies are being discovered beopic pregnancies are being discovered before rupture, allowing conservative manafore rupture, allowing conservative management with laparoscopic surgery or medgement with laparoscopic surgery or medical therapy with methotrexate. ical therapy with methotrexate.

Adolescent Age GroupAdolescent Age Group- Diagnosis- Diagnosis

A history and pelvic examination A history and pelvic examination Anxiety associated with a first pelvic Anxiety associated with a first pelvic

examinationexamination Issues of confidentiality related to qIssues of confidentiality related to q

uestions of sexual activity.uestions of sexual activity. Always include a Always include a pregnancy testpregnancy test (re (re

gardless of stated sexual activity)gardless of stated sexual activity) CBC/DC. CBC/DC. Tumor markers (AFP, hCG…) Tumor markers (AFP, hCG…)

Adolescent Age GroupAdolescent Age Group - Diagnosis - Diagnosis

Ultrasonography.Ultrasonography. TVS provide more detail than Abd sTVS provide more detail than Abd s

onographyonography TVS may not be well tolerated by adTVS may not be well tolerated by ad

olescentsolescents CT or MRICT or MRI

Adolescent Age GroupAdolescent Age Group - Management - Management

LaparoscopyLaparoscopy Acute PID to confirm the Acute PID to confirm the

diagnosisdiagnosis Persisted symptoms in patient Persisted symptoms in patient

with the clinical diagnosis of PID with the clinical diagnosis of PID or TOAor TOA

The surgical management of The surgical management of inflammatory masses is rarely inflammatory masses is rarely necessary in adolescents, except necessary in adolescents, except ruptured TOA or failure of medical ruptured TOA or failure of medical management with broad-spectrum management with broad-spectrum antibiotics antibiotics

Reproductive Age GroupReproductive Age Group

Differential DiagnosisDifferential Diagnosis Uterine MassesUterine MassesOvarian MassesOvarian MassesNonneoplastic Ovarian MassesNonneoplastic Ovarian MassesOther Benign MassesOther Benign MassesNeoplastic MassesNeoplastic MassesOther Adnexal MassesOther Adnexal Masses

Reproductive Age GroupReproductive Age Group- Uterine Masses- Uterine Masses

Uterine leiomyomas - most commoUterine leiomyomas - most common benign uterine tumors.n benign uterine tumors.

Usually diagnosed on physical examUsually diagnosed on physical examination. ination.

Incidence: 20% (reproductive age)Incidence: 20% (reproductive age) 40% to 50% of women older than 35 40% to 50% of women older than 35

years of age.years of age.

Types of fibroidsTypes of fibroids


Malignant degeneration < 0.5%Malignant degeneration < 0.5% Leiomyosarcoma -rare malignant nLeiomyosarcoma -rare malignant n

eoplasm composed of cells that haveoplasm composed of cells that have smooth muscle differentiation.e smooth muscle differentiation.

Most diagnoses are determined (poMost diagnoses are determined (postoperatively) after microscopic exastoperatively) after microscopic examination. mination.


Symptoms Symptoms MenorrhagiaMenorrhagia Chronic pelvic painChronic pelvic pain Acute painAcute pain Urinary symptoms: Frequency, Partial Urinary symptoms: Frequency, Partial

ureteral obstruction, complete urethraureteral obstruction, complete urethral obstructionl obstruction

InfertilityInfertility


SymptomsSymptoms Rectosigmoid compression, with constRectosigmoid compression, with const

ipation or intestinal obstructionipation or intestinal obstruction Prolapse of a pedunculated submucouProlapse of a pedunculated submucou

s tumors tumor Venous stasis of the lower extremities Venous stasis of the lower extremities

and possible thrombophlebitis secondand possible thrombophlebitis secondary to pelvic compressionary to pelvic compression

PolycythemiaPolycythemia AscitesAscites


Management of LeiomyomasManagement of Leiomyomas Nonsurgical ManagementNonsurgical Management

Intervention is reserved for specific indIntervention is reserved for specific indications and symptoms. ications and symptoms.

Periodic examinationsPeriodic examinations GnRH agonistsGnRH agonists


GnRH agonistsGnRH agonists 40% to 60% decrease in uterine vol40% to 60% decrease in uterine vol

ume ume Hypoestrogenism: reversible bone lHypoestrogenism: reversible bone l

oss and symptoms: hot flashes. oss and symptoms: hot flashes. limited to short-term uselimited to short-term use Regrowth of leiomyomas within a feRegrowth of leiomyomas within a fe

w months after stopping therapy in w months after stopping therapy in about 1/2 women treatedabout 1/2 women treated


Indications for GnRH agonist:Indications for GnRH agonist: 1.Preservation of fertility in women with large leiomyoma1.Preservation of fertility in women with large leiomyoma

s before attempting conception, or preoperative treatmes before attempting conception, or preoperative treatment before myomectomynt before myomectomy

2.Treatment of anemia to allow recovery of normal hemo2.Treatment of anemia to allow recovery of normal hemoglobin levels before surgical management, minimizing the globin levels before surgical management, minimizing the need for transfusion or allowing autologous blood donatineed for transfusion or allowing autologous blood donationon

3.Treatment of women approaching menopause in an eff3.Treatment of women approaching menopause in an effort to avoid surgeryort to avoid surgery

4.Preoperative treatment of large leiomyomas to make va4.Preoperative treatment of large leiomyomas to make vaginal hysterectomy, hysteroscopic resection or ablation, oginal hysterectomy, hysteroscopic resection or ablation, or laparoscopic destruction more feasibler laparoscopic destruction more feasible

5.Treatment of women with medical contraindications to 5.Treatment of women with medical contraindications to surgerysurgery

6.Treatment of women with personal or medical indicatio6.Treatment of women with personal or medical indications for delaying surgery.ns for delaying surgery.


Indications for surgery :Indications for surgery : Abnormal uterine bleeding - anemia, unresponsiAbnormal uterine bleeding - anemia, unresponsi

ve to hormonal managementve to hormonal management Chronic pain with severe dysmenorrhea, dysparChronic pain with severe dysmenorrhea, dyspar

eunia, or lower abdominal pressure or paineunia, or lower abdominal pressure or pain Acute pain, as in torsion of a pedunculated leioAcute pain, as in torsion of a pedunculated leio

myoma, or prolapsing submucosal fibroidmyoma, or prolapsing submucosal fibroid Urinary symptoms or signs such as hydronephroUrinary symptoms or signs such as hydronephro

sis after complete evaluationsis after complete evaluation Infertility, with leiomyomas as the only abnormInfertility, with leiomyomas as the only abnorm

al findingal finding Markedly enlarged uterine size with compressioMarkedly enlarged uterine size with compressio

n symptoms or discomfort.n symptoms or discomfort.


Indications for surgery because Indications for surgery because of the inability to exclude uterinof the inability to exclude uterine sarcoma:e sarcoma: Rapid enlargement of the uteRapid enlargement of the ute

rus during premenopausal yerus during premenopausal years ars

or any increase in uterine size or any increase in uterine size in a postmenopausal womanin a postmenopausal woman


Hysterectomy has long been viewed as thHysterectomy has long been viewed as the definitive management of symptomatic e definitive management of symptomatic uterine leiomyomas. uterine leiomyomas.

Myomectomy is an alternative to hystereMyomectomy is an alternative to hysterectomy for patients who desire childbearictomy for patients who desire childbearing, who are young, or who prefer that the ng, who are young, or who prefer that the uterus be retained. Recent studies suggesuterus be retained. Recent studies suggest that the morbidity of abdominal myomet that the morbidity of abdominal myomectomy and hysterectomy are similarctomy and hysterectomy are similar

Laparoscopic myomectomy minimizes thLaparoscopic myomectomy minimizes the size of the abdominal incision, although e size of the abdominal incision, although several small incisions are required.several small incisions are required.


Vaginal myomectomy is indicated in the cVaginal myomectomy is indicated in the case of a prolapsed pedunculated submucoase of a prolapsed pedunculated submucous fibroid. us fibroid.

Hysteroscopic resection of small submucoHysteroscopic resection of small submucous leiomyomas us leiomyomas

The recurrence risk for leiomyomas has beThe recurrence risk for leiomyomas has been reported to be as high as 50% after myoen reported to be as high as 50% after myomectomy, with up to 1/3 requiring repeat smectomy, with up to 1/3 requiring repeat surgery. urgery.

Endometrial ablation can decrease bleediEndometrial ablation can decrease bleeding for women with primary intramural fibrng for women with primary intramural fibroidoid

hysteroscopy hysteroscopy


Nonextirpative approaches:Nonextirpative approaches: Myolysis - use of lasers to coagulate or needle Myolysis - use of lasers to coagulate or needle

electrodes to deliver an electrical current to ielectrodes to deliver an electrical current to individual leiomyomasndividual leiomyomas

Uterine artery embolization - have serious coUterine artery embolization - have serious consequences, including infection, massive blensequences, including infection, massive bleeding, and necrosis requiring emergency surgeding, and necrosis requiring emergency surgery. Still consider investigational. ery. Still consider investigational.

Long-term safety and efficacy have not yeLong-term safety and efficacy have not yet been demonstrated. t been demonstrated.

Reproductive Age GroupReproductive Age Group- Ovarian Masses- Ovarian Masses

During the reproductive years, the most cDuring the reproductive years, the most common ovarian masses are benign. ommon ovarian masses are benign.

About 2/3 ovarian tumors are encountereAbout 2/3 ovarian tumors are encountered during the reproductive years. d during the reproductive years.

Most ovarian tumors (80% to 85%) are beMost ovarian tumors (80% to 85%) are benign, and 2/3 of these occur in women benign, and 2/3 of these occur in women between 20 and 44 y/o.tween 20 and 44 y/o.

The chance that a primary ovarian tumor The chance that a primary ovarian tumor is malignant in a patient < 45 y/o is less this malignant in a patient < 45 y/o is less than 1 in 15.an 1 in 15.


Pelvic findings in patients with beniPelvic findings in patients with benign and malignant tumors differ. gn and malignant tumors differ.

Benign - unilateral, cystic, mobile, aBenign - unilateral, cystic, mobile, and smoothnd smooth

Malignant -bilateral, solid, fixed, irreMalignant -bilateral, solid, fixed, irregular, and associated with ascites, cgular, and associated with ascites, cul-de-sac nodules, and a rapid rate ul-de-sac nodules, and a rapid rate of growthof growth

Reproductive Age GroupReproductive Age Group- Nonneoplastic Ovarian Mass- Nonneoplastic Ovarian Mass

eses Nonneoplastic Ovarian Masses Nonneoplastic Ovarian Masses Functional ovarian cysts include Functional ovarian cysts include

follicular cystsfollicular cysts corpus luteum cystscorpus luteum cysts theca lutein cyststheca lutein cysts

All are benign and usually do not caAll are benign and usually do not cause symptoms or require surgical muse symptoms or require surgical management. anagement.


eses Follicular cystFollicular cyst

the most common functional cystthe most common functional cyst cystic follicle can be defined as cystic follicle can be defined as

follicular cyst when diameter > 3 follicular cyst when diameter > 3 cm. cm.

found incidental to pelvic found incidental to pelvic examinationexamination

usually resolve in 4 to 8 weeks, usually resolve in 4 to 8 weeks, seldom rupture causing pain and seldom rupture causing pain and peritoneal signsperitoneal signs


eses Corpus luteum cystsCorpus luteum cysts

less common than follicular cysts. less common than follicular cysts. may rupture, leading to a hemoperitonmay rupture, leading to a hemoperiton

eum and requiring surgical managemeeum and requiring surgical management. nt.

High risk - anticoagulant therapy. High risk - anticoagulant therapy. Rupture - more often on the right side Rupture - more often on the right side

and during intercourse. and during intercourse. Most ruptures on cycle days 20 to 26.Most ruptures on cycle days 20 to 26.


eses Combination monophasic oral contracepCombination monophasic oral contracep

tive therapy has been reported to markedtive therapy has been reported to markedly reduce the risk of functional ovarian cyly reduce the risk of functional ovarian cysts.sts.

It appears that, in comparison with previIt appears that, in comparison with previously available higher-dose pills, the effeously available higher-dose pills, the effect of cyst suppression with current low-dct of cyst suppression with current low-dose oral contraceptives is attenuated.ose oral contraceptives is attenuated.

Most studies have suggested that the use Most studies have suggested that the use of triphasic oral contraceptives is not assof triphasic oral contraceptives is not associated with an appreciable increased risociated with an appreciable increased risk of functional ovarian cysts. k of functional ovarian cysts.


Other Benign MassesOther Benign Masses Women with endometriosis may deWomen with endometriosis may de

velop ovarian endometriomas (“chvelop ovarian endometriomas (“chocolate” cysts), which can enlarge ocolate” cysts), which can enlarge to 6 to 8 cm in size.to 6 to 8 cm in size.

A mass that does not resolve with oA mass that does not resolve with observation may be an endometriombservation may be an endometrioma.a.

ovarian endometriomas (“chovarian endometriomas (“chocolate” cysts)ocolate” cysts)

EndometriomaEndometrioma

Endometrioma Endometrioma – “chocolate” content– “chocolate” content


In one study, 257 volunteers were examinIn one study, 257 volunteers were examined with ultrasonography; 22% were founed with ultrasonography; 22% were found to have polycystic ovaries.d to have polycystic ovaries.

The finding of bilateral generously sized The finding of bilateral generously sized ovaries on examination or polycystic ovarovaries on examination or polycystic ovaries on ultrasonographic examination shoies on ultrasonographic examination should prompt evaluation for the full-blown uld prompt evaluation for the full-blown syndrome which includes hyperandrogensyndrome which includes hyperandrogenism and chronic anovulation as well as pism and chronic anovulation as well as polycystic ovaries.olycystic ovaries.

Therapy for PCOS is medical and generallTherapy for PCOS is medical and generally not surgical.y not surgical.

Polycystic OvariesPolycystic Ovaries

http://bjr.birjournals.org/content/vol75/issue889/images/large/BI75983.10.1.jpeg

Reproductive Age GroupReproductive Age Group- Neoplastic Ovarian Masses- Neoplastic Ovarian Masses

More than 80% of benign cystic teraMore than 80% of benign cystic teratomas (dermoid cysts) occur during tomas (dermoid cysts) occur during the reproductive years, although dethe reproductive years, although dermoid cysts have a wider age distribrmoid cysts have a wider age distribution than other ovarian germ cell tution than other ovarian germ cell tumors.umors.


Benign cystic teratomas have an adBenign cystic teratomas have an admixture of elements. mixture of elements.

comprising more than a single cell tcomprising more than a single cell type derived from more than one gerype derived from more than one germ layer, usually all 3.m layer, usually all 3.

Cells differentiate along various gerCells differentiate along various germ lines, essentially recapitulating am lines, essentially recapitulating any tissue of the body. Examples inclny tissue of the body. Examples include hair, teeth, fat, skin, muscle, anude hair, teeth, fat, skin, muscle, and endocrine tissued endocrine tissue


Malignant transformation: < 2%Malignant transformation: < 2% Bilateral: 10%Bilateral: 10% Torsion: 15%, it occurs more Torsion: 15%, it occurs more

frequently than with ovarian frequently than with ovarian tumors because the high-fat tumors because the high-fat content allowing them to float content allowing them to float within the abdominal and pelvic within the abdominal and pelvic cavity.cavity.

As a result, frequently is anterior As a result, frequently is anterior in location. in location.


Cystectomy is almost always possible, evCystectomy is almost always possible, even if it appears that only a small amount en if it appears that only a small amount of ovarian tissue remains. of ovarian tissue remains.

Preserving a small amount of ovarian corPreserving a small amount of ovarian cortex in a young patient with a benign lesiotex in a young patient with a benign lesion is preferablen is preferable

Laparoscopic cystectomy is often possiblLaparoscopic cystectomy is often possible, e,

Intraoperative spill of tumor contents is rIntraoperative spill of tumor contents is rarely a cause of complications.arely a cause of complications.

KUBKUB

SonographySonography

Mature Teratoma Mature Teratoma / Dermoid Cyst/ Dermoid Cyst

TorsionTorsion

Laparoscopic SurgeryLaparoscopic Surgery

Spill of contentsSpill of contents


serous cystadenomasserous cystadenomas The risk of epithelial tumors increThe risk of epithelial tumors incre

ases with ageases with age 5% to 10% have borderline malig5% to 10% have borderline malig

nant potential nant potential 20% to 25% are malignant20% to 25% are malignant often multilocular, sometimes witoften multilocular, sometimes wit

h papillary components.h papillary components.


Surface epithelial cells secrete serous fluiSurface epithelial cells secrete serous fluid, resulting in a watery cyst content. d, resulting in a watery cyst content.

Psammoma bodies are areas of fine calcifPsammoma bodies are areas of fine calcific granulation, may be scattered within tic granulation, may be scattered within the tumor and are visible on radiograph.he tumor and are visible on radiograph.

Frozen section is necessary to distinguish Frozen section is necessary to distinguish between benign, borderline, and malignabetween benign, borderline, and malignant serous tumors, because gross examinant serous tumors, because gross examination alone cannot make this distinction. tion alone cannot make this distinction.

Serous CystadenomaSerous Cystadenoma

Serous CystadenomaSerous Cystadenoma

Psammoma bodies


Mucinous ovarian tumorsMucinous ovarian tumorsmay grow to large dimensionsmay grow to large dimensions lobulated, smooth surface, mullobulated, smooth surface, mul

tiloculartilocularBilateral in up to 10% of casesBilateral in up to 10% of casesFive to ten percent of mucinouFive to ten percent of mucinou

s ovarian tumors are malignants ovarian tumors are malignant..


Mucoid material is present within thMucoid material is present within the cystic loculationse cystic loculations

may be difficult to distinguish histolmay be difficult to distinguish histologically from metastatic gastrointesogically from metastatic gastrointestinal malignanciestinal malignancies


Other benign ovarian tumors includOther benign ovarian tumors include fibromas (a focus of stromal cells), e fibromas (a focus of stromal cells), Brenner tumors (which appear grosBrenner tumors (which appear grossly similar to fibromas and which arsly similar to fibromas and which are frequently found incidentally), ane frequently found incidentally), and mixed forms of tumors such as the d mixed forms of tumors such as the cystadenofibroma.cystadenofibroma.

FibromaMeig’s Syndrome• defined as the triad of benign ovarian tumor with ascites and pleural effusion that resolves after resection of the tumor. •40% of ovarian fibromas are associated with ascites and pleural effusion

Brenner TumorBrenner Tumor

Postmenopausal Age Postmenopausal Age Group Group

Differential DiagnosisDifferential Diagnosis of Ovarian of Ovarian MassesMasses

During the postmenopausal years, the During the postmenopausal years, the ovaries become smaller.ovaries become smaller.

Before menopause, the dimensions Before menopause, the dimensions are approximately 3.5 × 2 × 1.5 cm.are approximately 3.5 × 2 × 1.5 cm.

In early menopause, the ovaries are In early menopause, the ovaries are approximately 2 × 1.5 × 0.5 cm.approximately 2 × 1.5 × 0.5 cm.

In late menopause, they are even In late menopause, they are even smaller: 1.5 × 0.75 × 0.5 cm.smaller: 1.5 × 0.75 × 0.5 cm.

Postmenopausal Age Postmenopausal Age GroupGroup

Barber has described the Barber has described the postmenopausal palpable ovary postmenopausal palpable ovary (PMPO) syndrome, suggesting that (PMPO) syndrome, suggesting that any ovary that is palpable on any ovary that is palpable on examination beyond the menopause examination beyond the menopause is abnormal and deserves evaluationis abnormal and deserves evaluation

Ovarian cancer is predominantly a Ovarian cancer is predominantly a disease of postmenopausal women; disease of postmenopausal women; the incidence increases with age, and the incidence increases with age, and the average patient age is about 56 to the average patient age is about 56 to 60 years60 years

ReferencesReferences

Novak's Gynecology: JonaNovak's Gynecology: Jonathan S. Berek, 2002 by Lipthan S. Berek, 2002 by Lippincott Williams & Wilkins. pincott Williams & Wilkins. 13/e13/e

Atlas of Human Anatomy, Atlas of Human Anatomy, Student Edition, 3rd EditioStudent Edition, 3rd Edition n By Frank H. Netter, MDBy Frank H. Netter, MD

benign tumors of the female reproductive tract 輔仁大學 實習醫師核心課程...

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benign tumors of the female reproductive tract 輔仁大學實習醫師核心課程...