Ovarian cyst and tumour

Types of Cysts
• Follicular
• Corpus luteum
• Dermoid
• Endometriomas
When cystic change proceeds beyond the normal range, the condition
is referred to as cystic to as cystic ovary , this represents a disturbance
of function only , where as an ovarian cyst may be neoplasm ,
Distension cysts are of several types and any of them can become
complicated.By intracystic haemorragic this ultimately results in
serosanguinos comtents to cause confusion with endometriosis.
 FOLLICULAR CYST
• Most common type of cyst
• Formed during 1st half of menstrual cycle (dominant follicles fails to
ovulate )
• Can be upto 6cm or more
• Can be very large with hyperstimulation of exgenousgonadotropins
• In POCS the follicles in which the eggs normally mature fail to open
and cysts form.
CORPUS LUTEUM CYST
• formed by haematoma or excessive growth of corpus luteum
• less common but more clinically significant then follicular cysts
• Formed in the later half of the menstrual cycle
• Not larger than 6cm
• Formed due to excess Physiologic blesding during the vasculisation of
corpus luteum formation.
• This type of cysts contains tissue similar to that in other parts of the
body.That includes skin hair and teeth.
• Benign cystic teratoma
• Most common germ cell neoplasma and mostly seen in women under
20yrs of age.
• 18-15% of all ovarian tumors.
Endometriomas
• In women with endometriosis, tissue from the lining of the uterus
grows in other areas of the body . This includes the ovaries .
• Endometriosis is very painful and can affect fertility.
• This chocolate cyst is caused by endometriosis and formed when a
tiny patch of endometrial tissue (the mucous membrane which makes
up the layer of Uterine wall) bleeds ,sloughs off, becomes transparent
and grows and enlarges the ovaries.
Symptoms:
The majority of cystic are symptomless and are discovered incidently at
operation or during examination , Any symptoms which are produced
depend on their hormone activity and vary as follows
• Menstrual disturbance
• Dysfunctional Uterine bleeding
• Ammenorhea
• Infertility
• Pain
Treatment
If cystic ovaries are associated with pelvic inflammatory or other
disease, treatment is directed to later
In absence of gross pelvic disease ,the treatment of the cystic ovaries is
governed by the fact that they tend to be self – curative If left alone the
cyst become inactive and disappear, any temporary menstrual
disturbance can meanwhile be treated Symptomatically
 OVARIAN TUMORS
Ovarian malignancies:

Non epithelial
• Germ cell tumors
• Stromal tumors

Epithelial
• Epithelial cell tumor
Germ cell tumors:
• Start in the cells that produce the eggs
• They can either be benign or cancerous
• Most are benign
• Derived from :
Ectoderm,mesoderm and endoderm or any combination
• Germ cell tumors can be cancerous or pre cancerous tumors
CLINICAL FEATURES
• Age incidence : primary ovarian neoplasm are most commonly found in
women aged 40-60, Benign tumors usually commence their growth
before the menopause
• Genetic factors:
site specific familial ovarian cancer – pattern of inheritance is autosomal
dominant
Breast/ovarian familial cancer syndrome: here there is combination of 2
types of cancer
Lynch II syndrome: This includes multiple adenocarcinoma
Classification
• Teratoma :
Mature cystic teratoma_”Rokitansky protuberence”
Immature teratoma-Monodermal teratoma.
Dysgerminoma
Yolk sac tumor (endodermal sinus tumor)
Embryonal carcinoma
Choriocarcinoma
MATURE CYSTIC TERATOMA
• Most common ovarian teratoma and most common ovarian germ cell
tumor
• Cystic tumor with firm capsule,filled with sabaceous material and hair
(occasionally teeth can be found)
• Thickened area from which hair and teeth arise is called “Rokitansy
protuberance”
 MONODERMAL TERATOMA
• Monodermal teratoma is composed predominantly of one tissue
element
• Most common type is “struma ovarii”, Which is mature thyroid tissue
IMMATURE TERATOMA
• Occurs in children and young adults
• Usually a unilateral solid tumor
• Similar to mature teratoma but contains immature or Embryonal
tissue
• Malignant neoplasm
DYSGERMINOMA
• Most common malignant ovarian germ cell tumor

• Typically occurs in 2nd and 3rd decades typically unilateral,solid , firm to

fleshy tumor composed of malignant germ cells ,similar to primordial
germ cells
YOLK SAC TUMOR
• Second most common malignant ovarian germ cell tumor
• Occurs in childhood, adolescence and adult life (most < 30, years)can
be pure or a component of a mixed germ cell tumor
• Almost always a unilateral solid or solid and cystic tumor
EMBRYONAL CARCINOMA
• Uncommon ovarian germ cell neoplasm occurs in children and young
adults
• Usually occurs in combination with yolk sac tumor
• Typically a unilateral,solid tumor with haemorrhage and necrosis
composed of undifferentiated, pleomorphic,large cells
CHORIOCARCINOMA
• Very rare as a pure ovarian neoplasm Or as a component of mixed
germ cell tumor
• Occurs in children and young adults
• Asoociated with elevated serum HCG levels
• Typically a unilateral,solid haemorrhagic tumor composed of
malignant cytotrophoblast and syncytiotrophoblast
STROMAL CELL TUMORS
• Also known as sex cord stromal tumor is a group of tumors of sex cord
derived tissues of the ovary and testis .
• Originate in the Cells that produce female hormones
• This group of tumors is significantly less common than testicular germ
cell tumors in men , and slightly less common than ovarian germ cell
tumors in women
CLASSIFICATION

• Granulosa cell tumor

• Sertoli leydig cell tumor

GRANULOSA CELL TUMOR
• Adult form typically occurs at any age after puberty but is more
common in postmenopausal women
• Most common clinically estrogenic ovarian tumor
• Can present with abnormal vaginal bleeding
• Can be associated with endometrial hyperplasia and carcinoma
• Typically a unilateral solid or solid and cystic tumor often with
haemorrhagic areas
SERTOLI LEYDIG CELL TUMOR
• Accounts for less than 0.5% of ovarian tumors
• Occurs in all age groups but encountered most often in young women
• Present with viralisation in ~1/3 of cases ( oligomenorrhea ,
amenorrhea, loss of female secondary sex characteristics with
hirsutism , clitoromegaly , deepening of voice)
• Almost always a unilateral tumor,that can be solid ,solid and cystic, or
even papillary
EPITHELIAL CELL TUMORS
• Start from the cells on the surface of the ovaries i.e germinal
epithelium or ovary
• This is the most common form of ovarian cancer and occurs primarily
in adults
• Accounts to 95% of ovarian tumors
RISK FACTORS OF OVARIAN TUMORS
• Age – specifically women who have gone through menopause
• Smoking
• Obesity
• Not having children or not breastfeeding (however using birth control pills
seems to lower the risk)
• Fertility drugs (such as clomid)
• Hormone replacement therapy
• Family or personal history of ovarian , breast or collorectal cancer(having
BRCA gene can increase the risk)
SYMPTOMS
• Pain or bloating in the abdomen
• Difficulty in urinating or frequent need to urinate
• Dull ache in the lower back
• Pain during sexual intercourse
• Painful menstruation and abnormal bleeding
• Weight gain
• Nausea or vomiting
• Loss of appetite, feeling full quickly
COMPLICATION OF OVARIAN TUMORS
• Torsion: common with dermoid/ fibroma
Severe abdominal pain/vomiting

• Rupture
• Haemorrage
• Impaction
• Infection
PHYSICAL SIGNS
Benign
• Usually mobile unless large or complicated
• Dermoid cyst anterior to bladder
Malignant
• Bilateral
• Ascites
• Hard deposits in pelvis
• Leg oedema
• Signs of bowel obstruction,of uteretic obstruction
INVESTIGATION
• CT scan
• Tumor markers (ca125,HCG,alpha FP)
• Urea and electrolyte
• Chest xray
• Ultrasound
• PAP smear
Treatment:
There are basically three forms of treatment in ovarian cancer which
depends upon stage of the disease , histologic cell type , Patients age
and overall condition
• Surgery
• Chemotherapy
• Radiation therapy
Other therapies
• Vaccines
• Gene therapy
• Immunotherapy
• Accupuncture
• Massage therapy
• Herbal supplements
• Vitamin supplements
• Special diets
• Medication/ relaxation therapy