Ovarian cysts

Objectives

• Types • Diagnosis • Treatment • Complications

1- types

Ovarian cysts

functional

Follicular cysts

Corpus luteum cysts

Theca lutein cysts

pathological

benign

Serous cystadenoma pcos endometrioma

Mucinous cystadenoma

Dermoid cyst

malignant

Serous cystadenocarcinom

aMucinous

cystadenocarcinoma

Functional cysts

• Functional ovarian cysts are not neoplasms,and arise as a result of normal ovarian function.

• They may be asymptomatic • Include: Follicular cysts Corpus luteum cysts Theca lutein cysts

1- the follicular cysts

• It is the most common ovarian cyst. • When an ovarian follicle fails to rupture • Fluid contained in them is rich in estrogen • May causes irregular bleeding.

2- the corpus luteum cysts

• Enlarged corpus luteum, continue to produce progesterone

• Corpus hemorrhagicum (if spontaneous hemorrhage occurs)

3- the theca lutein cyst

• The least common functional cyst.

• Associated with pregnancy and usually bilateral.

• They are more common in multiple gestations, trophoblastic disease, and also with ovulation induction.

Pathological cysts

1- serous cystadenoma:-

➢ It is The most common ➢ 70% of serous tumors are benign.

2- mucinous cystadenoma:-

➢ can become large, sometimes filling the entire pelvis.

➢ They are multilocular with mucin content. ➢Rupture of mucinous tumour into peritoneral cavity

Myxoma peritonii (= pseudomyxoma peritonii) where the abdominal and pelvic cavity fills with gelatinous masses.

3- dermoid cyst:➢it is a benign germ cell tumour (Mature cystic

teratoma) ➢Dermoids may contain tissues from all three

embryonic germ layers (ectoderm, mesoderm, and endoderm).

➢Mainly ectodermal origin, such as skin appendages (sweat, sebaceous glands) with associated hair follicles and sebum.

3- dermoid cyst:

The endometriotic cyst

• The Chocolate cyst of the ovary. • It is caused by endometriosis . • It is filled with dark , reddish brown blood.

2- the malignant cysts

1- serous cystadenocarcinoma:-

• It is the most common malignant epithelial cell tumor.

• They are typically multiloculated. • Calcified, laminated structures,

psammoma bodies, are common

2- mucinous cystadenocarcinoma :-

• They may be associated with widespread peritoneal extension

Polycystic ovary syndrome

• PCOS is the most common endocrine disorder affecting 20% at reproductive age.

• It is defined by presence of 2 of 3 criteria:-

PCOS

PCO in US

anovulationhyperandrogenis

m

1. Torsion 2. Rupture 3. Infection 4. Malignancy 5. Haemorrhage 6. Calcification “psammomatous change” 7. Incarceration

Complications of ovarian cysts:

• The most common complication • Precipitated by:

Torsion

•Trauma • Violent Physical movements

Torsion

➢Clinical picture: • Clinical presentation of acute abdomen • U/S: decreased vascularity of the tumor ➢Treatment: • Immediate surgery for UNTWISTING

Torsion (cont.)

Causes:

• Traumatic ex: abdominal trauma • Spontaneous ex: degeneration of the cyst

wall

Rupture

• If small cyst • innocent

• If large serous cyst • non persistant ascites

• If bloody cyst • hemoperitoneum

• chemical peritonitis

• intraperitoneal dissemination

• If dermoid cyst:

• If malignant:

➢Clinical picture: • Acute abdomen • Fever ➢Treatment: • Antibiotic therapy • Drainage of pelvic abscess

Infection

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