1
Benign ovarian tumor
L1
Ovarian tumor the 4
th
commonest gynecological cause of admission to hospital.
Most common in pre-menopausal women and mostly asymptomatic and
resolved
spontaneously,
but
about
10%
of
them
undergo
to
surgery.90%ofovarian tumor who managed surgically are benign in pre-
menopausal woman and about 60% in post-menopausal women. Ovarian tumor
may be physiological or pathological and may arise from any tissue in the
ovary.
Most benign tumor are cystic like cystadenoma, mucinous adenoma but
fibroma-thecoma- dermoid usually solid.
Classification of benign ovarian tumor
A. physiological cyst
Most common in young age and discovered accidently during pelvic
examination or pelvic u/s.
1-follicular cyst
The commonest benign ovarian n tumor resulted from non-rupture Graafian
follicle. Smaller cyst resolved spontaneously over several menstrual cycles but
large cyst may need surgical intervention.
2. Luteal cyst
Less common and result from persist corpus luteum more than 3cm.
B. pathological cyst
1. Epithelial tumor
The majority of tumor are epithelial arise from surface epithelium of ovary
about 60-65% of all ovarian tumor the coelemic epithelium that cover the ovary
give rise to Varity of epithelia of mullerian origin which line other genital tract
include fallopian tube(serous),uterus (endometroid) cervix (mucinous)or uro
epithelium (Brenner)
Serous cyst adenoma
The most common benign tumor epithelial tumor about 40%and it is bilateral
in 10% .it unilocular cyst with papilliferous process in inner surface by u/s .the
risk of malignancy in these tumor is 30%
2
Mucinous cyst adenoma
The second most common ovarian tumor about 15-20%of ovarian tumor they
are unilateral large multilocular.
Endometroid cystadenoma
Brenner tumor
They account about 1-2%of ovarian tumor and bilateral in 10-15%.the majority
are benign some secrete estrogen causing abnormalvaginal bleeding
Clear cell tumor
2.Benign germ cell tumor
They are account 30%of all ovarian tumor they are the commonest tumor seen
in women less than 30 yrs they are classified into cystic or solid germ cell
tumor malignant potential of these tumor are more than 5%
They arise from germ cell of ovary.
Dermoid tumor (mature cystic teratoma)
It account about 40% of all ovarian tumor it is bilateral in 10% it is usually
unilocular in which ectodermal structures are predominant
The majority of cases are asymptomatic but 3-10% undergo to torsion.1% may
be rupture spontaneously causing acute abdomen or chemical peritonitis .2% of
them said to contain malignant component.
Mature solid teratoma
3. Sex cord stromal tumor
these tumor composed of granulosa, theca cell ,sertoli cell ,leydig cell,
fibroblast or precursor of these cell. They may be associated with estrogenic
,androgenic or progestogenic effects. these tumor composed about 4%of benign
ovarian tumor.
Theca cell tumor
They are benign and many of these tumor secreted estrogen present with
systemic manifestation like precocious puberty, postmenopausal bleeding or
abnormal vaginal bleeding.
3
Fibroma
These tumor derived from stromal cells and may be associated with ascites and
pleural effusion cause meigs syndrome.
Clinical presentation
Asymptomatic
Pain
Abdominal swelling
Other symptom like GIT or urinary symptoms
Management
History
Examination
general
abdominal
Bimanual
Investigation
Blood test tumor marker
CBC+ESR
Ca 125,B-HCG,&-fetoprotein-LDH
u/s +radiological imaging like CT and MRI
Treatment
Treatment depend on symptoms, desire fertility, risk of malignancy and age of
patient.
Criteria for observation of asymptomatic ovarian tumor
unilateral
unilocular
normal ca-125
size of tumor
o Less than 5 cm in menopausal women
o Less than 7 cm in premenopausal women
no free fluid or mass
4
Therapeutic aspiration under u/s guided
The best candidate women with unilateral ,unilocular, thin wall and less than
10 cm in diameter
Trauma to adjacent organs and recurrence rate high.
Laproscopic cystectomy
It used if there is suspicion about nature of pelvic mass and if tumor suitable
for laparoscopic procedure. Disadvantage of this procedure spillage of content
,incomplete excision and unexpected histological diagnosis of malignancy .
laprotomy