BENIGN OVARIAN TUMOURS/CYSTS

Question 1

What are the 4 main broad types of benign ovarian tumour which divide tumours based on the type of cell they are derived from?

Answer 1

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)

Question 2

Apart from physiological tumours, what is the most common type of benign ovarian tumour found in women under 40?

Answer 2

Germ cell tumours

Question 3

Apart from physiological tumours, what is the most common type of benign ovarian tumour found in women over 40?

Answer 3

Epithelial tumours

Question 4

What are the risk factors for benign ovarian tumours?

Answer 4

Obesity

Infertility

Early menarche

Hypothyroidism

Tamoxifen therapy

Question 5

What are the three types of physiological ovarian cyst?

Answer 5

Follicular cyst - most common

Luteal cyst

Theca lutein cyst

Question 6

Which type of physiological ovarian cyst is most likely to rupture?

Answer 6

Luteal cysts

Question 7

What are the 4 types of benign epithelial ovarian tumour?

Answer 7

Serous cystadenoma - most common

Mucinous cystadenoma

Endometrioid cystadenomas

Brenner tumours

Question 8

What are the 2 types of benign germ cell ovarian tumour?

Answer 8

Mature cystic teratoma (also called a dermoid cyst)

Mature solid teratomas

Question 9

What are the 2 types of benign sex cord stromal ovarian tumour?

Answer 9

Theca cell tumours

Fibromas

Question 10

What are the symptoms associated with benign ovarian tumours/cysts?

Answer 10

Pain
Abdominal swelling
Pressure effects on bowel or bladder
Hormonal effects secondary to secretion from tumour

Question 11

What are the hormonal effects that might be associated with an oestrogen secreting tumour?

Answer 11

Menstrual irregularity
Postmenopausal bleeding
Precocious puberty

Question 12

How might you be able to exclude gastrointestinal aetiology in a patient who presents with pain consistent with an ovarian cyst?

Answer 12

Bimanual examination will reveal either adnexal tenderness or a mass.

Question 13

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)?

Answer 13

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)

Question 14

What two factors does your management of a patient with a benign asymptomatic ovarian cyst/tumour depend on?

Answer 14

Age

Size of tumour

Question 15

How would you manage a 25 year old patient found to have a 3 cm ovarian cyst?

Answer 15

Reassure

Observe cyst with US

Question 16

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?

Answer 16

Above 5 cm. Above this size, the risk of ovarian torsion is significant.

Question 17

How do you manage a patient found to have a physiological cyst on their ovaries?

Answer 17

Reassurance. Most will spontaneously resolve. You can monitor with ultrasound.

Question 18

What are the complications associated with benign ovarian cysts?

Answer 18

Ovarian torsion

Rupture of cyst - can cause sepsis or peritonism

Continued pain and dyspareunia

Question 19

What is Meig’s syndrome?

Answer 19

Triad of ascites, pleural effusion and benign ovarian tumour

Question 20

What are the benign ovarian tumours most commonly associated with Meig’s syndrome?

Answer 20

Fibroma

Brenner tumour (epithelial tumour)

Occasionally granulosa cell tumour