Benign Ovarian Tumours Flashcards
What are benign ovarian cysts
Benign Fluid filled sacs found in the ovaries
Symptoms are due to their complications rather than the cyst themselves
Related to ovulation e,g
Follicular cysts= follicular phase
Corpus luteal cysts= luteal phase
females at any stage of life, from the neonatal period to postmenopaus
Morphological types of ovarian cysts
Follicular
- mx cysts of diff sizes lined w/ GRANULOSA/THECA cells
Chocolate cysts pathognomic for endometriosis
Classification of ovarian cysts
Functional
- follicular Cyst( most common)
- corpus luteal custs
- theca lutein cyst
Non functional
- PCOS
- chocolate cysts In endometriosis
- teratoma
Describe follicular cysts
Most common type of ovarian cyst
result from a lack of physiologic release of the ovum due to excessive FSH stimulation or lack of the normal LH.
Hormonal stimulation causes these cysts to continue to grow.
Follicular cysts are typically larger than 2.5 cm in diameter and manifest as a discomfort and heaviness.
Granulosa cells that line the follicle persist, leading to excess estradiol production, which, in turn, leads to decreased frequency of menstruation and menorrhagia
Describe a corpus luteal cyst
defined as a corpus luteum that grows to 3 cm in diameter.
Occurs after ovulation
Corpus luteum is usually the remnants of a follicle in which the ovum has moved to the Fallopian tube and degrades after 5-9 days
If degradation doesn’t occur in a timely manner
Fluid/ blood can enter the corpus luteum and a cyst forms
can cause dull, unilateral pelvic pain and may be complicated by rupture, which causes acute pain and possibly massive blood loss.
What is a theca lutein cyst ( normal)
Usually bilateral and assoc w/ GTD, mx preg, exo hyperstim of ovaries
luteinization and hypertrophy of the theca interna cell layer in response to excessive stimulation from human chorionic gonadotropin (hCG)
These cysts are predisposed to torsion, hemorrhage, and rupture.
Resolve when hCG drops
Diagnosis of ovarian cysts
US
Premenopausal women present w/
Size/5-7 cm
Thickened septation If posterior wall
7cm or above req mri/ surgical exploration as large size can’t be properly observed on US
Specific US signs
- Dermoid cyst= pathognomic exogenous fat!!
- pentaneal inclusion cyst= tissue paper appearance that follows the contour of the adjacent organ
- multiloculated cysts= thin septa less than 3cm
- surgical eval needed as they suggest neoplasm
Diagnostic laparoscopy
Sx of ovarian cysts
Abdominal/lower back pain
Bloating
Weight gain
Nausea & Vom
D/2 complications
1) RUPTURE
- self limiting
- abdominal pain, peritoneal hemmorhage, shock
2) TORSION (cysts over 4cm)
- causes obstruction, reduced BF, ischemia, INFARCTION
Rx of ovarian cysts
1)Treatment of underlying condition related medical conditions
-juvenile hypothyroidism= mx cysts
-fertility rx causes larger bilateral thecal cysts d/2 increased HCG
-PCOS- metformin, clomiphene,
Endometriosis= OCP
2) pain relief
- NSAIDS
- OPIODS
3) surgical
- cyst removal
- oophorectomy
Surgical indications in ovarian cysts
Persistent complex cyst
Persistent sx
Complex cysts over 5cm
Simple cysts over 10 cm
Simple cysts that grow
Peri/menopausal women : BSO
Rf for ovarian cysts
Infertility treatment - ovulation induction with gonadotropins may develop cysts as part of ovarian hyperstimulation syndrome
Tamoxifen - Tamoxifen can cause benign functional ovarian cysts that usually resolve following discontinuation of treatment
Pregnancy - In pregnant women, ovarian cysts may form in the second trimester, when hCG levels peak
Hypothyroidism - Because of similarities between the alpha subunit of thyroid-stimulating hormone (TSH) and hCG, hypothyroidism may stimulate ovarian and cyst growt
Normal ovary US
normal ovary 2.5-5 cm long, 1.5-3 cm wide, and 0.6-1.5 cm thick. In the follicular phase, several follicles are usually visible within the ovarian tissue.
US cyst classification
Simple: uniformly thin, rounded wall and a unilocular appearance that is either hypoechoic or anechoic. They usually measure 2.5-15 cm in diameter, and posterior acoustic enhancement (a hyperechoic area) may be visible deep to the fluid-filled cyst.[2] These cysts are unlikely to be cancerous. Most commonly, they are functional follicular or luteal cysts or, less commonly, serous cystadenomas or inclusion cysts.
Complex
US complex cyst classification
multilocular thickening of the wall, papulations sticking into the lumen or on the surface,
abnormalities within the cyst contents.
Malignant cysts usually fall within this category, as do many benign neoplastic cysts.
