Ovarian tumor, benign
KEY
POINTS
The tumors
are often clinically silent until well developed; they may be solid, cystic, or
mixed; and they may be functional (producing sex steroids as with arrhenoblastomas and gynandroblastomas)
or nonfunctional
CYSTS functional,
severe pain & hge, usually self limiting, Sx if uncontrolled bleeding
EPITHELIAL serous cystadenocarcinoma,
increases chance of malig, Rx excise
GERM CELL Teratoma
(dermoid cyst)
rarely malignant,
STROMAL
CELL
Ovarian
Cyst
2 ages: premenarche & post meno
12yrs & 52yrs
types
OVARIAN
CYST
Dx
US
if >6cm then Sx
if <6cm f/u in 2months
follicular
resolves
if growing - Sx
if same - leave
Sx
laparoscopy
if >6cm - as risk of torsion
OCP some
prefer for 2m observation to help resolve luteal
cysts
OVARIAN
TORSION
S/S
sudden
severe adnexal pain
adnexal
mass
vs ectopic pregnancy
spotting
less pain
Rx -
Steps
1. Sx - lap
& detortion
observe for 30 mins
2. Oophorectomy
If necrosis/
poor perfusion
otherwise cystectomy,
leave ovary
COMPLEX
CYST
dermoid
-
-
PRE-MEnarche cyst (rare)
Rx
if >2cm
exploratory laparotomy
POST
Menopausal
Rx
Any size laparatomy
GENITAL
WART
Rx
CryoSx
Topical
cream
podophyline
flurouracyl
imiquimol
If larger
excise
CO2 laser
Sensitivity
PAP 50%
DNA 80%
SIGNS
AND SYMPTOMS
Usually asymptomatic
Pain related to torsion, endometriosis, or
rupture
Increased abdominal girth
Bowel pressure or bladder pressure sensations
Menstrual irregularities
Hirsutism or sexual
precocity
Early satiety
Dyspepsia/bloating
LABORATORY
CBC
Pregnancy test
Urinalysis
Endometrial biopsy or dilatation/curettage if
mass accompanied by menstrual abnormality
Pap smear
ESR
Guaiac stool testing
Serum tumor markers as indicated
Cancer antigen (CA) 125
Alpha fetoprotein
Chorionic gonadotropin (beta-hCG)
Serum LDH
Serum estrogens and androgens
PATHOLOGICAL
FINDINGS
Follicular (fluid distention of atretic follicle) and corpus luteum
cysts (corpus luteum hematoma)
Endometrioma
Pregnancy luteoma
(composed of hyperplastic stromal
theca-lutein cells)
Serous and mucinous cystadenomas and mixed serous/mucinous
cystadenomas
Granulosa cell
tumors
Benign connective tissue tumors (thecomas, fibromas, Brenner
tumors)
Cystic teratoma (dermoid cyst)
Germinal inclusion cyst (regarded by some as
the precursor for epithelial ovarian cancer)
APPROPIATE
HEALTH CARE Inpatient if surgery necessary
SURGICAL
MEASURES
Cystectomy or wedge
resection for cyst with benign features
Surgical removal of tumor to establish
diagnosis when:
Premenopausal cysts
greater than 5 cm that persist more than 6-8 wks
Mass that is solid
Mass greater than 10 cm
Mass in a premenarchal
or postmenopausal female
Suspicion of torsion or rupture
Postmenopausal cysts
Cysts with worrisome ultrasound features
(e.g., papillations)
DRUG(S)
OF CHOICE
In premenopausal patients with cystic lesions less than 10 cm
in diameter, simple observation for 4-6 wks is acceptable. There is no evidence
that use of a contraceptive pill is more effective than time alone in
facilitating ovarian cyst resorption. If the cyst
remains unchanged after 4-6 wks of observation, then surgical exploration is
indicated.
Contraindications:
Those established for OCPs (e.g., hypercoagulable
state or history of DVT, ischemic heart disease, history of CVA, hypertension,
hepatic adenoma).
Precautions:
Refer to manufacturer's profile of each drug
Significant
possible interactions: Refer to manufacturer's profile of each drug
PREVENTION/AVOIDANCE
Although
oral contraceptives do not appear to increase rates of cyst resorption,
they do decrease risk for forming new ovarian cysts
POSSIBLE
COMPLICATIONS
Complications
of untreated dermoid and mucinous
cysts may include pseudomyxoma peritonei
EXPECTED
COURSE/PROGNOSIS
Complete
cure
PREGNANCY
The
majority of cysts discovered during pregnancy are corpus luteum
or follicular cysts. The two most commonly encountered tumors during pregnancy
are cystadenomas (serous or mucinous)
and dermoid cysts.