(28) Benign Ov. Tum.
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بسم ال الرحمن الرحيم
BENIGN TUMOURS OF THE OVARY
Classification of benign ovarian tumours
Benign surface epithelial tumours: Cystic Serous cystadenoma Mucinous cystadenoma Endometrioid cystadenoma Solid Brenner tumour
Classification of benign ovarian tumours (ctd.)
Benign germ cell tumours: Cystic Benign cystic teratoma (BCT)
Solid Struma Ovarii Gonadoblastoma
Classification of benign ovarian tumours (ctd.)
Benign sex cord stromal tumours: (Solid)
Fibroma
Theca cell tumour
Pathology of benign ovarian tumours
I. BENIGN EPITHELIAL OVARIAN TUMOURS
Serous Cystadenoma:
This is the commonest ovarian tumour representing nearly 10-15% of all ovarian neoplasms. Bilateral in up to 30% of cases Of moderate sizes (ranging 1015 cm)
it may present in one of the following three types: Simple serous cysts Multilocular serous cyst Papillary serous cystadenoma
Microscopically: cyst wall is lined by cuboidal cells which may be ciliated or non ciliated (tubal like epithelium).
Mucinous Cystadenoma
These are the second most common benign ovarian neoplasms. commonly unilateral bluish or yellowish transparent colour multilocular containing thick gelatinous like mucin material may reach huge size
Microscopically: Cyst wall is lined by tall columnar epithelium with basally situated nuclei similar to endocervical epithelium, rich in Goblet cells .
N.B. Pseudomyxoma peritonii
Brenner tumour
Rare tumours accounting for only 1-2% of all ovarian neoplasms. Solid in consistency. Usually of small (<2.0cm) to moderate size. More prevalent in women >40 years.
Microscopically: the tumour is characterized by epithelial cell nests with characteristic coffee bean nuclei. They probably arise from Wolffian metaplasia of the surface ovarian epithelium.
II. BENIGN GERM CELL TUMOURS
Benign Cystic Teratoma (BCT) It is the only germ cell tumour which is common, representing almost 40% of all ovarian neoplasms. It is the commonest tumour encountered below 20 years, during pregnancy and during the child bearing period.
Bilateral in up to 12 % of cases. Usually of moderate size (8-10 cm). Most have a long pedicle. Greyish in colour Mostly unilocular, but may contain few small locules. The cut section; usually shows
Being derived from toti-potent germ cells, they can differentiate to three elements: Ectoderm Mesoderm Endoderm
Microscopically: the cyst wall is lined by stratified squamous epithelium with sebaceous glands.
Struma Ovarii
It is an example of monodermal teratoma, composed of hormonally active thyroid tissue. They comprise only 1-4% of cystic teratomas. Only 5% produce sufficient thyroid hormone to produce symptoms. Some 5-10% of tumours develop into carcinoma.
Gonadoblastoma A benign solid tumour composed of germ cells mixed with other cells resembling granulosa and sertoli cells. Patients have an abnormal gonad, with a Y chromosome in 90% of cases. Predispose to development of Dysgerminoma or other malignant germ cell tumours.
III. BENIGN SEX CORD STROMAL TUMOURS
Fibroma rare tumours are mostly seen around age of 50 years. Usually mobile with a long pedicle They have lobulated glistening white surface. N.B. Meig's syndrome
Theca Cell Tumour: (Thecoma) The majority occurs in post menopausal women. Many are functioning tumours, producing oestrogen. Microscopically: tumour is formed from cells resembling theca interna cells.
COMPLICATIONS OF BENIGN OVARIAN NEOPLASMS 1. TORSION 2. HAEMORRHAGE 3. RUPTURE 4. INFECTION 5. INCARCERATION 6. MALIGNANT TRANSFORMATION
Torsion
Traumatic rupture
Malignant transformation
CLINICAL PICTURE OF BENIGN OVARIAN NEOPLASMA
Symptoms: Asymptomatic Abdominal swelling Menstrual disorders Pressure symptoms Lower abdominal pain
Detected only by bimanual examination or ultrasonography
Physical Signs: These will depend largely on the size of the tumour. a. Small tumours: Felt only by bimanual pelvic examination on one side of the uterus, rounded, smooth, mobile, usually cystic ( rarely solid) mass, separate from the uterus (the movement of the mass is not transmitted to the cervix)
b. Large tumours:
Inspection: symmetrical abdominal enlargement Palpation: - Abdominal mass that may be central or to one side
- Well defined upper and lateral border
- Smooth or lobulated surface - Commonly mobile from above downwards.
Percussion: central dullness with resonant flanks
N.B. Ovarian cachexia
Diagnosis: clinical examination Ultrasonography I.V.P C.T. scan and MRI
TREATMENT OF BENIGN OVARIAN NEOPLASMS 2.
Ovarian Cystectomy:
2. Oophorectomy: 3. Panhysterectomy:
Ovarian cystectomy
Ovariotomy
Thank you
BENIGN TUMOURS OF THE OVARY
Classification of benign ovarian tumours
Benign surface epithelial tumours: Cystic Serous cystadenoma Mucinous cystadenoma Endometrioid cystadenoma Solid Brenner tumour
Classification of benign ovarian tumours (ctd.)
Benign germ cell tumours: Cystic Benign cystic teratoma (BCT)
Solid Struma Ovarii Gonadoblastoma
Classification of benign ovarian tumours (ctd.)
Benign sex cord stromal tumours: (Solid)
Fibroma
Theca cell tumour
Pathology of benign ovarian tumours
I. BENIGN EPITHELIAL OVARIAN TUMOURS
Serous Cystadenoma:
This is the commonest ovarian tumour representing nearly 10-15% of all ovarian neoplasms. Bilateral in up to 30% of cases Of moderate sizes (ranging 1015 cm)
it may present in one of the following three types: Simple serous cysts Multilocular serous cyst Papillary serous cystadenoma
Microscopically: cyst wall is lined by cuboidal cells which may be ciliated or non ciliated (tubal like epithelium).
Mucinous Cystadenoma
These are the second most common benign ovarian neoplasms. commonly unilateral bluish or yellowish transparent colour multilocular containing thick gelatinous like mucin material may reach huge size
Microscopically: Cyst wall is lined by tall columnar epithelium with basally situated nuclei similar to endocervical epithelium, rich in Goblet cells .
N.B. Pseudomyxoma peritonii
Brenner tumour
Rare tumours accounting for only 1-2% of all ovarian neoplasms. Solid in consistency. Usually of small (<2.0cm) to moderate size. More prevalent in women >40 years.
Microscopically: the tumour is characterized by epithelial cell nests with characteristic coffee bean nuclei. They probably arise from Wolffian metaplasia of the surface ovarian epithelium.
II. BENIGN GERM CELL TUMOURS
Benign Cystic Teratoma (BCT) It is the only germ cell tumour which is common, representing almost 40% of all ovarian neoplasms. It is the commonest tumour encountered below 20 years, during pregnancy and during the child bearing period.
Bilateral in up to 12 % of cases. Usually of moderate size (8-10 cm). Most have a long pedicle. Greyish in colour Mostly unilocular, but may contain few small locules. The cut section; usually shows
Being derived from toti-potent germ cells, they can differentiate to three elements: Ectoderm Mesoderm Endoderm
Microscopically: the cyst wall is lined by stratified squamous epithelium with sebaceous glands.
Struma Ovarii
It is an example of monodermal teratoma, composed of hormonally active thyroid tissue. They comprise only 1-4% of cystic teratomas. Only 5% produce sufficient thyroid hormone to produce symptoms. Some 5-10% of tumours develop into carcinoma.
Gonadoblastoma A benign solid tumour composed of germ cells mixed with other cells resembling granulosa and sertoli cells. Patients have an abnormal gonad, with a Y chromosome in 90% of cases. Predispose to development of Dysgerminoma or other malignant germ cell tumours.
III. BENIGN SEX CORD STROMAL TUMOURS
Fibroma rare tumours are mostly seen around age of 50 years. Usually mobile with a long pedicle They have lobulated glistening white surface. N.B. Meig's syndrome
Theca Cell Tumour: (Thecoma) The majority occurs in post menopausal women. Many are functioning tumours, producing oestrogen. Microscopically: tumour is formed from cells resembling theca interna cells.
COMPLICATIONS OF BENIGN OVARIAN NEOPLASMS 1. TORSION 2. HAEMORRHAGE 3. RUPTURE 4. INFECTION 5. INCARCERATION 6. MALIGNANT TRANSFORMATION
Torsion
Traumatic rupture
Malignant transformation
CLINICAL PICTURE OF BENIGN OVARIAN NEOPLASMA
Symptoms: Asymptomatic Abdominal swelling Menstrual disorders Pressure symptoms Lower abdominal pain
Detected only by bimanual examination or ultrasonography
Physical Signs: These will depend largely on the size of the tumour. a. Small tumours: Felt only by bimanual pelvic examination on one side of the uterus, rounded, smooth, mobile, usually cystic ( rarely solid) mass, separate from the uterus (the movement of the mass is not transmitted to the cervix)
b. Large tumours:
Inspection: symmetrical abdominal enlargement Palpation: - Abdominal mass that may be central or to one side
- Well defined upper and lateral border
- Smooth or lobulated surface - Commonly mobile from above downwards.
Percussion: central dullness with resonant flanks
N.B. Ovarian cachexia
Diagnosis: clinical examination Ultrasonography I.V.P C.T. scan and MRI
TREATMENT OF BENIGN OVARIAN NEOPLASMS 2.
Ovarian Cystectomy:
2. Oophorectomy: 3. Panhysterectomy:
Ovarian cystectomy
Ovariotomy
Thank you
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