Benign ovarian pathology Flashcards
What are some forms of ovarian pathology
Ovarian cysts
Rupture ovarian cyst
Endometrioma
Ovarian torsion
What are some forms of ovarian cyst?
- Follicular (E.g. polycystic ovaries)
- Luteal
- Endometriotic
- Epithelial
- Mesothelial (Neoplastic)
- Serous and mucinous cystadenoma
- Dermoid cysts (Teratoma)
- Sex cord-stomal tumours
What is a cyst?
A cyst is afluid-filled sac.
What is meant by a functional ovarian cyst?
Ovarian cysts that are related to the fluctuating hormones of the menstrual cycle
Who is most at risk of malignancy in ovarian cysts
Post-menopausal women
How do ovarian cysts present?
- Asymptomatic
- pelvic pain
- Bloating
- Fullness in the abdomen
- Palpable pelvic mass
What are follicular ovarian cysts
Cysts that form when the developing follicle fails to release the egg
Describe the characteristics of follicular cysts
- Often disappear after a few cycles
- Thin walled
- No internal structures
What is a corpus luteum cyst?
A cyst forming when the corpus luteum fails to break down and instead fills with fluid
How do corpus luteum cysts usually present?
Pelvic discomfort
Pelvic pain
Delayed menstruation
In early pregnancy
What is a serous cystadenoma
benign tumour of epithelial cells
What is a mucinous cyst adenoma
Benign tumour of epithelial cells that can grow very large
What are dermoid cysts?
Teratomas in the ovary that arise from germ cells and so can contain many tissue types such as skin, teeth, hair, fat and bone
What are sex cord-stromal tumours
Rare benign or malignant tumours arising from either the stroma (Connective tissue) or sex cords (Embryonic structures associated with follicles)
What are examples of a sex cord-stromal tumour
Sertoli-Leydig cell tumours
Granulosa cell tumours
What are some features that suggest malignant transformation of an ovarian cyst
- Abdominal bloating
- Reduce appetite
- Early satiety
- Weight loss
- Urinary symptoms
- Pain
- Ascites
- Lymphadenopathy
Who does not need further testing in ovarian cysts
Pre-menopausal women with a simple cyst <5cm on USS
Management of dermoid cysts
Referral to gynaecology for further investigation and surgery
Management of simple ovarian cyst < 5cm
Conservative (Will usually resolve in a few cycles)
Management of simple ovarian cyst 5-7cm
Routine gynae referral and yearly US monitoring
Management of simple ovarian cysts >7cm
MRI or surgical evaluation (Difficult to characterise with US
Investigation of cysts in post-menopausal women
CA125
Complications of ovarian cysts
Torsion
Haemorrhage into the cyst
Rupture into peritoneum
What is Meig’s syndrome
Meig’s syndrome involves atriadof:
- Ovarian fibroma(a type of benign ovarian tumour)
- Pleural effusion
- Ascites
How is Meig’s syndrome managed?
Surgical removal of the tumour (Will resolve ascites and effusion)
What are the most common ovarian cysts that rupture
Functional cysts (Most common)
Dermoid and endometrioma
What are some causes of ovarian cyst rupture?
Spontaneous
Post-trauma (E.g. Sex, Contact sports)
What are some symptoms of ovarian cyst rupture?
Acute pelvic pain
Afebrile
What are some signs of ovarian cyst rupture
Rebound tenderness
Haemorrhage occasionally causes shock
What investigations are required in ovarian cyst rupture?
US - Shows rupture and haemorrhage
How is ovarian cyst rupture managed?
Treated conservatively if pre-menopausal unless evidence of shock
Surgical evaluation if post-menopausal
What is an endometrioma?
A cystic lesion in the ovary arising from the disease process of endometriosis
Describe the macroscopic characteristics of endometrioma
Filled with dark-brown endometrial fluid and so are known as chocolate cysts
Also fibrous adhesions and peritoneal spots or nodules
What are some symptoms of endometrioma
- Pelvic pain
- Heavy menses
- Painful menses
- Back pain
- Painful sexual intercourse (dyspareunia)
- Painful defecation (dyschezia)
- Painful urination (dysuria)
- Urinary frequency
- Nausea/vomiting
- Bloating
How do endometriomas usually form?
seeding of ectopic endometrial tissue occurs, most often on the ovary, bleeds, causing a hematoma. This typically occurs with the natural menstrual cycle of a woman because the ectopic endometrial tissue is still hormonally active. Therefore, this tissue will naturally shed with the withdrawal of progesterone after the breakdown of the corpus luteum.
How is endometrioma diagnosed?
Can be visualised on imaging but pathology is only discovered through surgery
How is endometrioma usually managed
Endometriomas suggest a more severe endometriosis so are treated surgically
What are some complications of endometriomas?
Pain
Cyst formation
Adhesions
Infertility
Ectopic pregnancy
Malignancy (Endometrioid carcinoma)
What is ovarian torsion?
A condition where the ovary twists in relation to the surrounding tissue, fallopian tube and blood supply (Adnexae)
What are the usually causes of ovarian torsion?
Ovarian mass >5cm (E.g. cyst, tumour)
Who is most at risk of ovarian torsion?
Pregnant women
Girls pre-menarche (Longer infundibulopelvic ligaments)
Describe the pathophysiology of ovarian torsion
twisting leads to ischaemia followed by necrosis if it lasts long enough
How does ovarian torsion present?
Sudden onset severe unilateral pain
Progressively worse
Nausea and vomiting
Localised tenderness
Possible palpable mass
What investigations are required in ovarian torsion
Pelvic US - Whirlpool sign (Free fluid and oedema)
laparoscopic surgery
How is ovarian torsion managed?
De-torsion and fixing OR
Oophorectomy
What are some complications of ovarian torsion?
Infection
Abscess
Sepsis
Rupture -> Peritonitis
