pg1 Report on Benign ovarian tumors, risk groups, diagnosis, differential diagnosis, management.
Risk groups • Exposure to environmental asbestos, talc. •Genetic factors estrogen depending cancers( breast, rectum,, ovaries, uterine cancer in the family,/ 1st degree relatives. •Hormonal disturbances • nullipara •Pregnancy at a later age. •congenital abnormalities , eg.. Turner’s syndrome. Has ↑ risk for Dysgerminoma.& gonadoblastoma. • Repeated ovulation will help for somatic gene deletions & mutations to occur which can lead to tumor initiation & progression. Diagnosis In many pt the dg of an ovarian tu is made when they present with one of the complications, recognized by them. They are torsion, hemorrhage, in the or from the cyst. , rupture , infection, Larger tu produce pressure symptoms (↑ frequency of mictuiration, pain in lower abdomen, if very big tu it may cause respiratory embarrassment & edema varicosities in the legs.) or abdominal distension. Many are dg sed as a result of US scanning in disease or as a screening procedure. General physical examination general condition may remain unaffected mucinous cyst adenoma pt may be cachectic, anemia. Icterus, enlargement of supraclavicular & paraaortic lymph nodes, hepatomegaly, pleural effusion , edema in lower limbs. Abdominal ex An ovarian tu which is enlarged sufficiently so as to occupy the lower abdomen presents with the following symptoms. Inspection There is bulging of the lower abdomen over which the abdominal wall moves freely with respiration. If it fills the entire abdominal cavity everting the umbilicus veins are visible under the skin. The flanks remain flat. •Palpation is cystic or tense cystic. Benign solid tu such as fibroma is rare, freely mobile from side to side. But restricted from above down. Unless the pedicle is long.( too big tu or adhesions restricts its mobility.) Upper & lateral borders are well defined, but lower pole is difficult to reach. Suggestive of pelvic origin, surface over the tu is smooth. But often grooved in lobulated tu. , it is usually not tender. •Percussion dull in the center & resonant in the flanks. ( in ascites it is the opposite). • Auscultation a friction rub may be present over the tu. ( hissing sound over a vascular fibroid, gargling sound in ascites, fetal heart sounds over a pregnant uterus.) • Pelvic examinationbimanual ex reveals the uterus is separated. From the mass, a groove is felt between the uterus & the mass. Movement of per abdomen fails to move the cervix, lower pole of the cyst can be felt through the fornix. Absence of pulsation of the uterine vessels through the fornices. • Xray of abdomen over the tu finding of a shadow of teeth or bones is a direct evidence of a dermoid cyst. An outline of a soft tissue shadow may also be visible. • Laparoscopy/ Laparotomy – if if clinical or axillary aids fail to dg. • Nature of the tu may only be determined after histological ex.
pg2 Differential dg • Midline swelling due to full bladder. • Pregnancy 1618wk of gestation. • Fibroid. • Functional cyst. • Pancreatic cysts. • Rectal sheet hematoma. • Inflammatory adnexal processes. Eg pyosalphinx. • Fluid retention syndrome. • Ascites. • Ectopic kidney or spleen. • Broad ligament cysts. • Hydronephrotic kidney. • Hydatid cyst. • bowel tumors • Retroperitoneal tu. • uterine tu. Management –The only available method of treatment is surgical. Once an ovarian tu is dg. sed the pt should be admitted for operation as soon as possible, bec the complications can occur at any time & the nature of the tu cannot be assessed clinically. In young pt ovarian cystectomy leaving behind the healthy ovarian tissue is the operation of choice. Ovariotomy ( salpingooophorectomy) is reserved for a big tu destroying almost all the ovarian tissue or gangrenous cyst with axial rotation of the pedicle. If both ovaries are involved ovarian cystectomy has to be done in at least one ovary to preserve its function. In parous women around 40 yrs total hysterectomy with bilateral salpingooophorectomy is to be done. In women in between these age groups individualize the type of surgery in consideration to the reproductive & menstrual function. Ovarian tumor classification. (1) Non neoplastic functional cysts • follicular cysts ( solitary/ PCOS) • corpus luteum cysts • theca lutean cysts & granuloma lutean cysts. • endometriotic cysts. (2) Primary ovarian neoplasms . A) Tu originating from the surface epithelium. • serous • mucinous • endometroid • clear cell tu mesonephroid. • Brenner tu . B) Germ cell tu – 1 Benign• cystic teratoma • solid teratoma 2 Malignant • Dysgerminoma • malignant solid teratoma • yolk sac tu C) Sex cord & gonadal stromal tu. • Granulosa theca cell tu • Androblastoma ( sertoli leydig cell tu ) • Fibroma. (3) Secondary metastatic tumors .
Report on Benign ovarian tumors, risk groups, diagnosis, differential diagnosis, management. Report prepared by 1. Dr. Sajid Mahmood, MD (EU), Accident & Emergency Department, NHS Royal infirmary Liverpool United Kingdom.
2. Dr. Adnan Akram, MD (EU), Department of Infectious Diseases. University Hospital Riga Latvia. 3. Dr. Aftab Ahmed, MD (EU), Infection Control Department, Kaunas Medical University Clinic. Lithuania. Contact: publications [at] infekcijas.eu