BENIGN OVARIAN TUMOURS/CYSTS Flashcards
What are the 4 main broad types of benign ovarian tumour which divide tumours based on the type of cell they are derived from?
Physiological cysts
Benign epithelial tumours
Benign germ cell tumours
Benign sex cord stromal tumours
(There are other benign ovarian tumours such as endometriotic cysts, but these 4 are the most important)
Apart from physiological tumours, what is the most common type of benign ovarian tumour found in women under 40?
Germ cell tumours
Apart from physiological tumours, what is the most common type of benign ovarian tumour found in women over 40?
Epithelial tumours
What are the risk factors for benign ovarian tumours?
Obesity
Infertility
Early menarche
Hypothyroidism
Tamoxifen therapy
What are the three types of physiological ovarian cyst?
Follicular cyst - most common
Luteal cyst
Theca lutein cyst
Which type of physiological ovarian cyst is most likely to rupture?
Luteal cysts
What are the 4 types of benign epithelial ovarian tumour?
Serous cystadenoma - most common
Mucinous cystadenoma
Endometrioid cystadenomas
Brenner tumours
What are the 2 types of benign germ cell ovarian tumour?
Mature cystic teratoma (also called a dermoid cyst)
Mature solid teratomas
What are the 2 types of benign sex cord stromal ovarian tumour?
Theca cell tumours
Fibromas
What are the symptoms associated with benign ovarian tumours/cysts?
Pain
Abdominal swelling
Pressure effects on bowel or bladder
Hormonal effects secondary to secretion from tumour
What are the hormonal effects that might be associated with an oestrogen secreting tumour?
Menstrual irregularity
Postmenopausal bleeding
Precocious puberty
How might you be able to exclude gastrointestinal aetiology in a patient who presents with pain consistent with an ovarian cyst?
Bimanual examination will reveal either adnexal tenderness or a mass.
What investigations should be done for someone who presents with any of the symptoms of an ovarian cyst (pain, swelling, pressure effects on bladder/bowel, hormonal effects)?
FBC CRP High vaginal and endocervical swab Urine pregnancy test/or serum hCG Pelvic ultrasound Serum CA125 Serum alpha fetoprotein (if US reveals complex ovarian mass)
What two factors does your management of a patient with a benign asymptomatic ovarian cyst/tumour depend on?
Age
Size of tumour
How would you manage a 25 year old patient found to have a 3 cm ovarian cyst?
Reassure
Observe cyst with US
What is the cut off in terms of size of benign ovarian tumour above which you would proceed to surgery despite a lack of symptoms? Why?
Above 5 cm. Above this size, the risk of ovarian torsion is significant.
How do you manage a patient found to have a physiological cyst on their ovaries?
Reassurance. Most will spontaneously resolve. You can monitor with ultrasound.
What are the complications associated with benign ovarian cysts?
Ovarian torsion
Rupture of cyst - can cause sepsis or peritonism
Continued pain and dyspareunia
What is Meig’s syndrome?
Triad of ascites, pleural effusion and benign ovarian tumour
What are the benign ovarian tumours most commonly associated with Meig’s syndrome?
Fibroma
Brenner tumour (epithelial tumour)
Occasionally granulosa cell tumour
What is a follicular cyst?
Occurs when rupture does not occur & follicle continues to growh
What is a corpus luteal cyst?
When the CL fails to involute and continues to enlarge after ovulation
How do follicular cysts appear?
smooth, thin walled & unilocular
usually < 10cm
How do CL cysts appear?
can look complex
grossly yelllow
unilocular
thick walls
What are theca lutein cysts?
What does it look like?
Luteinised follicle cysts that form as a result of overstimulation from high HCG/sensitivity to hCG
(GTD, multiple gestation, ovarian hyperstimulation)
can appear complex - bilateral multiseptated cystic
How do follicular/CL cysts present?
asymptomatic
can rupture/haemorrhage
How to theca lutein cysts present?
asymptomatic
maternal virilisation, hyperemesis gravidarum, pre-eclampsia or thyroid dysfunction
resolve after hCG eliminated
PCOS presentation (in terms of adnexal mass)
enlarged ovaries w multiple follicles
rarely presents w adnexal masses
List pregnancy related adnexal masses
corpus luteum of pregnancy
luteoma
decidualisation of endometrioma
ectopic pregnancy
List adnexal masses that are stimulated by hormones?
endometrioma
leiomyoma
List 2 infectious/inflammatory causes of adnexal masses?
tubo-ovarian abscess
hydrosalpinx
What are the most common benign neoplasms in reproductive age patients?
mature cystic teratoma (dermoid)
serous cystadenoma
mucinous cystadenoma
Which tumour secretes bHCG & LDH?
dysgerminoma (malignant germ cell tumour)
Which tumour secretes AFP?
yolk sac tumour (malignant germ cell tumour)
Which tumour is associated w Schiller-Duval bodies
yolk sac tumour (malignant germ cell tumour)
What are the 3 types of sex-cord stromal tumours?
granulosa cell tumour (malignant)
Sertoli Leydig (benign)
fibroma (benign)
Which tumour can become huuuuge?
mucinous cystadenoma
List benign ovarian differentials for adnexal mass
follicular cyst CL cyst luteoma of pregnancy theca lutein cyst PCOS endometrioma cystadenoma benign ovarian germ cell tumours (mature teratoma) benign sex cord stromal tumour (sertoli-leydig, fibroma)
List malignant ovarian causes for adnexal masses
epithelial cancers
malignant ovarian germ cell tumour (choriocarcinoma, dysgerminoma, yolk sac tumour)
malignant sex cord stromal tumour (granulosa cell tumour)
List 2 benign tubal causes
ectopic pregnancy
hydrosalpinx (from scarring of PID)
List a malignant tubal causes
epithelial carcinoma
List benign extraovarian/tubal causes
paraovarian cyst
paratubal cyst
pedunculated/cervical fibroid
tubo-ovarian abscess
List malignant extraovarian/tubal causes
metastatic endometrial cancer
cystadenocarcinoma (rare)
List benign non-gynae causes
constipation appendiceal abscess diverticular abscess pelvic abscess bladder diverticulum ureteral diverticulum pelvic kidney peritoneal cyst
List malignant non-gynae causes
appendiceal neoplasm
bowel cancer
mets
retroperitoneal sarcoma
