Skip to main content
UploadLanguage (EN)Support
BusinessMobileSocial MediaMarketingTechnologyArt & PhotosCareerDesignEducationPresentations & Public SpeakingGovernment & NonprofitHealthcareInternetLawLeadership & ManagementAutomotiveEngineeringSoftwareRecruiting & HRRetailSalesServicesScienceSmall Business & EntrepreneurshipFoodEnvironmentEconomy & FinanceData & AnalyticsInvestor RelationsSportsSpiritualNews & PoliticsTravelSelf ImprovementReal EstateEntertainment & HumorHealth & MedicineDevices & HardwareLifestyle
SREEVIDYA UMMADISETTI, profile picture
Uploaded bySREEVIDYA UMMADISETTI
PPTX, PDF10,104 views

Ovarian tumors

1. Ovarian tumors are the most common medical problems affecting the ovaries and can be benign or malignant. 2. Benign ovarian tumors are more common than malignant tumors, accounting for approximately 80% of ovarian tumors. Common types of benign ovarian tumors include serous cystadenomas, mucinous cystadenomas, dermoid cysts, and Brenner tumors. 3. Malignant ovarian tumors tend to grow silently and spread widely before causing symptoms, making early detection challenging. Epithelial ovarian cancers account for about 70-80% of ovarian cancer cases.

Health & Medicine◦
Downloaded 139 times
OVARIAN TUMORS Mrs. U SREEVIDYA, Msc. NURSING, Associate Professor, Apollo college of nursing, CHITTOOR
CONTENT - Non neoplastic cyst & benign neoplastic tumours - Clinical features - Diagnosis - Differential diagnosis - Management - Complications
2 OVARIES • The most important medical problems in ovaries are the neoplasms • Death from ovarian cancers is more than that of cervix and uterus together • Silent growth of ovarian tumors is the rule ,which make them so dangerous
OVARY THE HUMAN OVARY HAS A STRICKING PROPENSITY TO DEVELOP A WIDE VARITY OF TUMORS MOST OF WHICH ARE BENIGN. 80% OF ALL OVARIAN TUMORS ARE BENIGN,ALTHOUGH THIS VARIES WITH AGE.
BENIGN LESIONS OF OVARY NON NEOPLASTIC NEOPLASTIC(BENIGN) FUNCTIONAL PATHOLOGY 1.Follicular cyst 1.PCOS A. SURFACE EPITHELIUM 2.Corpus luteal cyst 2.Endometrial cyst 1. Serous 3.Theca lutein & (Chocolate cyst) 2. Mucinous granulosa lutein cyst 3. Endometroid 4. Brenner B.GERM CELL TUMOUR (BENIGN) C. SEX CORD STROMAL TUMORS 1. Granulosa cell tumours 2. Thecoma/fibroma 3. Androblastoma 4. gynandro blastoma 5. unclassified tumours D. Lipid cell tumors E. Gonadoblastoma
FOLLICULAR CYST (commonest) CORPUS LUTEUM CYST THECA LUTEIN CYST AGE GROUP Adolescent, reproductive age groups ,can occur in perimenopause Reproductive age Reproductive age CAUSE Hyper estronism Over activity of corpus luteum Excess chorionic gonadotropin secretion, following to ovulation induction drugs Size Laterality Grow ≥3 & ≤8 cm B/L or U/L 3 – 10 cm U/L Large upto 30 cm B/L
FOLLICULAR CYST CORPUS LUTEUM CYST THECA LUTEIN CYST GROSS Thin walled , unilocular , filled with straw coloured fluid Pink or haemorrhagic cyst, cut section yellowish orange, filled with blood clots Multicystic, greyish blue colour, filled with straw colour fluid or blood Histology Lining epithelium Granulosa cells Luteinised granulosa cell Theca lutein cells,granulosa lutein cells C/F Usually asymptomatic , diagnosis incidental -Dull pelvic pain with U/L -Rupture with hemoperitoneum more common Small are asymptomatic, large -discomfort , pain Rupture/torsion (more common)
Hemorrhagic cyst with unusual appearance simulating a neoplasm
PCOS: - 0.5-4%, infertile women, young reproductive age -due to excess androgen , chronic anovulation -Pathology: ovaries enlarged, stroma increased, capsule thickened, pearly white appearance -Gross appearance: multiple follicles in cortex -Histology: thickened tunica albuginea, stromal hyperthecosis -CF: amenorrhoea, hirsutism, obesity, enlarged PCO. -Investigations: Hormonal investigations- Blood tests can be used to measure the levels of FSH, LH and circulating male hormones. •Ultrasound- TVS •Laparoscopy •Hysteroscopy. -Management – Wt. reduction COCP(Combined oral contraceptive pills) Treatment Of hirsutism Treatment Of infertility
Definition • Ovarian tumors may arise at any age, but are commonest between 30 and 60. • 1.Ovarian tumors are particularly liable to benign or to become malignant. • 2.In their early stages they are asymptomatic and painless. • 3.They may grow to a large size and tend to undergo mechanical complications such as torsion and perforation. OVARIAN TUMOURS
BENIGN OVARIAN TUMORS These are the benign Ovarian neoplasms, may be divided generally by cell type of origin into three types: 1.Epithelial 2.Stromal 3.Germcell Incidence: It varies from 1-3 percent. About 75% of these are benign.
ETIOLOGY Etiology not well known May be considered as, • Repeated trauma to epithelium • Hereditary or familial ovarian cancer 1) Gene mutations 2) Oncogenes
RISK MODIFIERS • Nulliparity • Infertility • Early menarche • Late menopause • Endometriosis • Family history • Prolonged use of ovulation inducing drugs • HRT • Oral contraceptive usage • Multi parity • Breast feeding • Tubal –ligation • Hysterectomy • Prophylactic salpingo- oophorectomy. RISK FACTORS PROTECTIVE FACTORS
OVARIAN TUMORS Epithelial tumors: These tumors arise from a layer of cells that surrounds the outside of the ovary called the germinal epithelium. • About 70-80% of all ovarian cancers are epithelial. • These are most common in women who have been through menopause (aged 45-70 years).
 Stromal tumors: Stromal tumors develop from connective- tissue cells that form the structure of the ovary and produce hormones. • These account for 5-10% of ovarian cancers and also these tumors typically occur in women aged 40-60 years. Germ cell tumors: Tumors that arise from germ cells (cells that produce the egg) account for about 15% of all ovarian cancers. • These tumors develop most often in young women (including teenaged girls). Although 90% of women with this type of cancer are successfully treated, many become permanently infertile.
27 1. EPITHELIAL OVARIAN TUMORS • 70 – 80 % of overall tumors • Age 40+ • Traditionally divided into Benign, Malignant, and Borderline in malignancy • Can be strictly epithelial (serous, Mucinous) • Only 25% diagnosed in Stage I
EPIDEMOLOGY: -Incidence: 1-3% among outpatient , 75% -benign -Racial factors: higher in white population, lowest in japan -Economic status: higher in industrialised countries PATHOLOGY: -Origin: mesoepithelial cells on ovarian surface -Incidence: epithelial tumours—80% of all ovarian tumours serous cystadenoma– 50% of all epithelial tumours mucinous cysts—12-15% endometroid—10% unspecified—25-27%
26 CLASSIFICATION OF SURFACE EPITHELIAL TUMORS -Serous Tumors : Benign ,Borderline and malignant -Mucinous T. : Benign ,Borderline , and malignant -Endometrioid T. : Benign, Borderline, and malignant Clear cell carcinoma -Transitional cell T. :Brenner tumors, Benign ,Borderline ,and malignant -Undifferentiated Carcinoma
SEROUS CYSTADENOMA  Generally benign  Bilateral – 10-25%  Risk of malignancy : 5 – 10 % borderline malignant 20 -25% malignant  GROSS : multilocular with papillary components.  MICRO : low columnar epithelium with cilia.  Associated fibrosis may lead to “cystadenofibroma”
29 SEROUS TUMORS • Most are large ,spherical to ovoid ,cystic structures • 5 – 10 cm and might be 30-40 cm • 25% of benign tumors are bilateral • The surface of the benign is smooth and glistening . • In contrast to the malignant forms, the surface is nodular and irregular
SEROUS CYSTADENOMA
31
MUCINOUS CYSTADENOMA  Have tendency to become huge masses  Round to ovoid masses with smooth capsules that are usually translucent or bluish to whitish gray.  Interior divided by discrete septa into loculi containing clear , viscid fluid.  Epithelium – tall, pale staining, secretary with basal nuclei and goblet cells  5 – 10% are malignant
43 MUCINOUS TUMORS • Epithelium consists of mucin-producing cells • Less likely to be malignant • 10% of ovarian cancers • 80% of them benign • 10% Low malignant potential • 10% malignant
MUCINOUS CYSTADENOMA
SEROUS /MUCINOUS CYSTADENOMA Gross appearance of a mucinous (A) and serous (B) cystadenoma of the ovary. The mucinous type is generally multiloculated and can be quite large.
►Usually benign. occur in reproductive life ►They can be malignant. ►May be associated with endometrial hyperplasia ►May coexist with mucinous cystadenoma BRENNER TUMORS
BENIGN BRENNER TUMOR
Gross appearance of a cut-open Brenner tumor
BRENNER TUMOR  Uncommon tumor grossly identical to fibroma  Arise from Walthard cell nests ,also from surface epithelium, and ovarian stroma  On microscopy – markedly hyperplastic fibromatous matrix with nests of epitheloid cells showing coffee bean pattern  Considered uniformly benign. But scattered reports of malignant Brenner's available.  Endocrinologically inert, but could spread with virilization and endometrial hyperplasia
► Clear cell ovarian tumors are part of the surface epithelial tumor group of ovarian cancers, ► Accounting for 6% of these cancers. ► Polypoid masses that protrude into the cyst. ► On microscopic examination, composed of cells with clear cytoplasm (that contains glycogen) ► The pattern may be glandular, papillary or solid. CLEAR CELL CARCINOMA
ENDOMETROID TUMOUR: -2% of all ovarian tumours -Lined by glandular epithelium -Moderate size, solid, with cystic areas with haemorrhagic fluid.
2. GERM CELL TUMORS • Ovarian germ cell tumor is a disease in which malignant (cancer) cells form in the germ (egg) cells of the ovary. • CAN OCCUR ATANY AGE • 12-15% OF OVARIAN NEOPLASM • 60% OF GCTS OCCURS IN CHILDREN • MOST COMMON BENIGN TYPE IS ‘BENIGN CYSTIC TERATOMA’
GERM CELL TUMORS ► Dermoid cyst (benign cystic teratoma) • 25% of all ovarian neoplasm • Contain tissue derived from two or more germ cell layers • Unilocular cyst. May contain teeth, bone , cartilage, nerves, hair, Tissues • Almost always benign. Malignant changes may occur in any component • Occur at any age. peak is 20-30 years. • Bilateral in 20%
DERMOID CYST  GROSS: thick, opaque , whitish wall.  CONTENTS: hair, bone, cartilage, and a large amount of greasy sebaceous material.  MICROSCOPICALLY : all the three germ layers (ectoderm, mesoderm and endoderm)  Malignant change occurs in 1-3%. Usually of a squamoustype.  Risk of torsion is 15%  An ovarian cystectomy is almost always possible, even if it appears that only a small amount of ovarian tissue remains
Benign ovarian tumors MUCINOUS CYST ADENOMA SEROUS CYST ADENOMA BRENNER BENIGN CYSTIC TERATOMA INCIDENCE 12-15 % of Epithelial tumors 50 % of all Epithelial tumors 2 – 3 % of all Epithelial tumors 95 % of Germ cell tumors 20-25% of all OV.tumors 40% of all ovarian tumors 1 -2% of all ovarian tumors 15 – 25% of all ovarian tumors Bilateral 10% 40% 8 -10% 15 -20% Malignant chance 5 –10% 40% rare 1 -2% 20- 40 % of all ov. Tumors in pregnancy
TUMOR MUCINOUS SEROUS DERMOID ORIGIN Totipotent surface epithelium of ovary Totipotent surface epithelium of ovary germ cells arrested after 1st meoitic division PATHOLOGY naked eye : huge size & wt 5-10 kg pedunculated, largest. smooth, lobulated with whitish or bluish white , translucent tumor. naked eye: smooth, shiny, greyish white exuberant papillary projections . naked eye: moderate size, capsule tense & smooth c/s: thick, visid mucin (glycoprotein) colourless multiloculated with papillary. honey combed appearance c/s:multilobulated clear fluid (serum) proteins (albumin & globulin) c/s: trabeculated appearance , sebaceous material with hair , clear protruberance
-microscopy: lined by 1 layer of tall coloumnar epithelium with dark staining basal nuclei without any cilia. Epithelium resemble to those of endocervix. -complication: rupture pseudomyxoma peritonei & shows adhesions with visera . microscopy:- lined by cubical epithelium - papillary structures – dense fibrous stroma covered by single or multiple layers of columnar epithelium. ciliated secretory & peg cells. Epithelium resemble to those of endosalpingeal epithelium micro: stratified squamous epithelium,granulat ion tissue, may be transitional/ columnar .
3. SEX CORD STROMAL OVARIAN NEOPLASMS • Hormone secreting tumors of the ovary. • These tumors include fibromas, Sertoli-Leydig cell tumors (Arrheno–blastomas or androblastomas).
FIBROMA  Most common benign, solid neoplasms of the ovary.  Compose approx 5% of benign ovarian neoplasms and 20% of all solid tumors of the ovary.  Frequently seen in middle-aged women.  Characterized by their firmness and resemblance to myomas  Misdiagnosed as exophytic fibroids or primary ovarian malignancy  Not hormonally active  Fibromas may be associated with ascites or hydrothorax as a result of increased capillary permeability.
Gross appearance of an ovarian fibroma.
FIBROMA: -origin: stromal cells of ovarian cortex -small nodule with long pedicle ,solid, smooth surfaced tumour -microscopy: interlacing bundles of spindle shaped cells -complication: torsion ,meig syndrome ANDROBLASTOMA/SERTOLI-LEYDIG CELL TUMOR -testicular adenoma -androgen secreting tumour -seen in women less than 30 years -gynandroblastoma (granulosa + androblastoma cells) -cf: amennorhoea, atrophy of breasts, enlargement of clitoris, body hair growth, deepening of voice.
THECOMA  Solid fibromatous lesions that show varying degrees of yellow or orange discoloration.  Almost always confined to one ovary.  Usually >40 years, 65% after menopause  May be hormonally active and hence associated with estrogenic or occasionally androgenic effects.  Luetinised thecoma – younger, sclerosing peritonitis and ascites  Leydeig cell thecoma – associated with Reinke crystals  Rarely malignant
4. GONADOBLASTOMAS  Gonadoblastoma is a rare benign tumor that has the potential for malignant transformation and affects a subset of patients with an intersex disorder or disorder of sex development (DSD).  Contain both germ cells and sex cord stromalcells.  Arise in patients with dysgenetic gonads - 44 XXY / 45XO  Presents usually as phenotypic female <30 years with primary amenorrhea and virilization.  Treatment – laparoscopy or laparotomy with removal of b/l dysgenetic gonads.  Further treatment depends on malignant germ cell component
ON CLINICAL EXAMINATION (DIFFERENCES B/W BENIGN & MALIGNANT) Character 1. Age 2. Laterality 3. Mobility 4. Feel 5. Surface 6. Ascites 7. Growth 8. nodules Malignant • older • Bilateral • Fixed • Solid • Irregular • Present • Rapid • Present Benign  younger  unilateral  Mobile  Cystic  Smooth  Absent  Slow  Absent
DIAGNOSTIC CRITERIA ON USG • BENIGN • U/L ,uni/multi locular Cystic areas with regular thin wall, thin septa and nonechogenic cavity • TVS(doppler) shows regular vascular branching MALIGNANT • B/L, thick wall, thick septa, echogenic areas in cavity. Irregular heterogenous parts • TVS neovascularisation
USG: • Benign • Malignant
CLINICAL FEATURES AGE:- late child bearing age -dermoid, mucinous adenoma common in reproductive period. -dermoid common in pregnancy symptoms: -asymptomatic - detected accidently -heaviness in lower abdomen, a gradually increasing mass in lower abdomen - dull aching pain, - cardiorespiratory & gastrointestinal upset (nausea, indigestion) -menstrual pattern unaffected except in hormone producing tumours signs: cachetic due to protein loss, pitting edema of legs
ABDOMINAL EXAMINATION Inspection -- bulging of lower abdomen mass – central/ one side/ whole abdomen visible veins , flanks – flat Palpation -- cystic / tense cystic • freely mobile from side to side but restricted from above down, smooth surface, nontender Percussion -- dull in center and resonant in flanks fluid thrill + Auscultation -- friction rub + Bimanual pelvic examination -- uterus separated from mass Groove is felt between uterus & mass movement of mass p/a fails to move cx lower pole of cyst felt through fornix absence of pulsation of ut vessels through the fornices
INVESTIGATIONS Toconfirm diagnosis USG Straight x-ray abdomen CT Laproscopy Laparotomy Cytology
DIFFERENTIAL DIAGNOSIS 1.Full bladder 2. Pregnancy 3. Pregnancy with fibroid 4. Ascites 5. Fibroid uterus 6. Encysted peritonitis 7. Functional ovarian cyst
COMPLICATIONS 1. Torsion of the pedicle 2. Intracystic haemorrhage 3. Infection 4. Rupture 5. Malignancy 6. Pseudomyxoma peritonei Torsion: (axial rotation) • 10 – 15% cases • moderate size & moderate wt • free mobility & long pedicle • common in dermoid or serous cystadenoma Causes: -Trauma, violent physical movement, contraction of pregnant uterus, intestinal peristalsis.
• Symptoms- acute pain + lump, vomiting, fever, shock , tachycardia. P/A: tense, tender, cystic mass with restricted mobility P/v: mass abdomen separate from uterus DD: 1. Disturbed ectopic pregnancy 2. Acute hydramnios 3. Perforating hydatidiform mole 4. Torsion of subserous pedunculated fibroid Rx: Pain– morphine Laparotomy ( cystectomy/ salpingoophorectomy)
INTRACYSTIC HAEMORRHAGE: -serous cystadenoma, malignancy. -venous congestion. INFECTION: -following torsion -organisms – from intestine, uterine tubes. RUPTURE: -big & tense cyst -trauma, malignancy, papillary type. PSEUDOMYXOMA PERITONEI: -mucinous ascites -associated with mucinous cyst adenoma ovary, mucocele appendix & gall bladder, intestinal malignancy. -spontaneous perforation -recurrence high, prognosis poor ( infection, intestinal obstruction) -Rx: hystrectomy, BSO (Bilateral salphingo-OOphorectomy) with removal of mucin, peritoneal implants with appendix.
METASTATIC TUMORS (SECONDARY METASTASIS) ►Always bilateral. From mucin secreting tumors, stomach and colon (krukenberg tumors) ►May be secondary to breast
METASTATIC OVARIAN CANCER Kurkenberg tumor
• Second most common gynaecological malignancy • Major cause of death from gyn. Cancer • 2% lifetime risk (1.4% in general population.) • Mean age – 64y • Rare in young (3% <35y)
• Present with late stage (66% - stage 3 or more) • Most common, – Persistent pelvic/abdominal pain – Abdominal distention/bloating – Early satiety – Constitutional ( fatigue,weight loss) – Abnormal uterine bleeding – Ascites , effusions – Urinary symptoms (frequency, urgency)
• Benign ovarian tumour or cyst. • Uterine or tubal mass. • Endometriosis. • Bowel mass or primary peritoneal carcinoma. • Secondary carcinoma: breast, gastrointestinal tract, lymphomas and pelvic-organ tumours.
• Fixed, Hard mass arising from pelvis • Ascites • Adenexal mass – In premenopausal <20% malignant – In postmenopausal 50% malignant • Pleural effusions • Lymphadenopathy (cervical, inguinal)
• Toconfirm the diagnosis • Toidentify the extent of lesion • Todetect the primary site
• USG abdomen and pelvis • CXRAY – pleural effusions, lung metastasis • Colonoscopy – bowel involvement • MRI – nature of neoplasm, retroperitoneal tumors
• USG for suggestive of malignancy – Solid + cystic areas – Ascites – Multilocular/complex cyst – Papillary projections – Neovascularization – Bilateral tumor – Liver deposits
MANAGEMENT • Once an ovarian tumor is diagnosed, the patient should be admitted for operation, sooner the better. • The complication can occur at any time and the nature of the tumor cannot be assessed clinically. • Differentiation between benign and malignant ovarian tumours could be made by clinical examination, ultrasonography, laparotomy and finally biopsy.
MANAGEMENT ►Surgery ►Chemotherapy
• Primarily surgical – Diagnosis – Staging – Treatment • Ideally done by Gynaecological oncologist • Objective is, – Accurate staging – Removing all visible tumor • No residual disease after laparotomy
INDICATIONS FOR SURGERY  Any solid ovarian lesion  Any ovarian lesion with papillary vegetation on the cyst wall  Any adnexal mass >10cm in diameter  Palpable adnexal mass in a premenarcheal or postmenopausal women  Torsion or rupture suspected
OVARIAN MASS IN REPRODUCTIVE AGE GROUP <5 cms. >/= 5 cms USG USG cystic observation Complex, solid, suspiciou s Persistence or progression surgery
GUIDELINES FOR SURGERY IN BENIGN TUMOR • Incision should be vertical paramedian & sufficiently big enough to deliver the cyst intact. • Inspect the nature of the peritoneal fluid – clear, straw colour, hemorrhagic or infective • Deliver the tumor intact and note it carefully about its nature. • Inspect and palpate the other ovary, pelvic organs, omentum and liver. • Proceed for the definitive surgery • Cut the tumor and inspect the inner side for any evidence of malignancy.
DEFINITIVE SURGERY: • In young women- ovarian cystectomy leaving behind the healthy ovarian tissue • Ovariotomy (salpingo-oophorectomy) – For a big tumor. • In parous women Around 40 years - TAH+BSO • Others (any age other than above)- individualisation.
OPERATIVE MODALITIES  Laparoscopic cystectomy / ovariotomy laparoscopy/ USG guided aspiration of cyst/Laparotomy.  Laparoscopy vs laparotomy – decision based on suspicion of malignancy and technical expertise  No recurrence rates following laparoscopy or laparotomy.  The objective is to try cystectomy if possible.  Laparoscopic surgery for benign ovarian tumours is associated with less pain, shorter hospital stay, and fewer adverse events than with laparotomy.
The standards for laparoscopy in benign tumours 1. careful examination of the external surface of the tumour and sampling of the peritoneal cavity 2. avoidance of any tumoral rupture 3. protection of the ovarian tumour with an endoscopic bag before removal
• Borderline malignant epithelial tumours have got some features of malignancy but not all. • Young females – U/L: salpingo-oophorectomy • Older females – TAH + BSO • If unfit for surgery – Primary chemotherapy – If responds, interval surgery after 3-6 cycles
THANK YOU