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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 & para-aortic 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 examination-bimanual 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.
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Differential dg-
• Midline swelling due to full bladder.
• Pregnancy- 16-18wk 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 ( salpingo-oophorectomy) 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 salpingo-oophorectomy 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.

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