Benign ovarian masses Flashcards
Types of physiological/functional cyst
Follicular- due to non-rupture of dominant follicle or failure of atresia of a non-dominant follicle
Corpus luteum cyst- failure of corpus luteum to degenerate
Types of epithelial cyst and the age range they commonly occur in
Serous (40-50) and mucinous (20-40)
Rupture of a mucinous cyst can cause…
Pseudomyxoma peritonei
In what age group are benign germ cell tumours such as teratoma most common?
Young women
Which syndrome are ovarian fibromas associated with?
Meig’s syndrome- (ascites + pleural effusion + benign ovarian tumour)
What is teratoma also known as?
Dermoid cyst
Risk factors for benign ovarian masses
Obesity Tamoxifen Early menarche Infertility FHx (of dermoid cysts)
How might a symptomatic benign ovarian mass present?
Dull ache in lower abdomen/back
Dyspareunia
Swollen abdomen with a palpable mass
Pressure effects causing urinary frequency, leg oedema
Torsion or rupture may lead to severe abdominal pain
Ascites
Under what circumstances might a benign mass cause virilisation?
If secreting hormones (testosterone)
Investigations in suspected ovarian mass
Pregnancy test
TVUS
CA-125
FNA cytology
Which serum measurements should be carried out in young women and why?
AFP and bHCG- risk of germ cell tumours higher in younger women
Why is CA-125 not measured in younger women?
Increased false positive rate and low specificity
What score should be used to assess the risk of ovarian malignancy in post-menopausal women?
Risk of malignancy index 1= ultrasound score x menopause score x CA-125 score
How should small (
Small- likely to resolve on its own
Larger- annual ultrasound follow-up
Bigger than 7cm should be considered for further imaging +/- surgery
How should persistent cysts or complex cysts be managed?
Surgical removal by either laparoscopic cystectomy or oophorectomy
How is ovarian torsion treated?
Uncoiling +/- oophorexy (seperation from the uterus and attachment to the abdominal wall)
Vascular compromise/necrosis may necessitate oophorectomy
Complications of benign ovarian masses
Torsion
Haemorrhage (more common in right-sides masses)
Rupture
Infertility (surgery may reduce the ovarian reserve)
Which type of cyst is bilateral in 20% of cases and bears a resemblance to serous carcinoma of the ovary?
Serous cyst
When might an asymptomatic cyst be discovered?
During pelvic exam, or US scan
