Benign Ovarian Tumuors3

BENIGN OVARIAN TUMOURS INTRODUCTION 

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Benign ovarian tumours are non-malignant tumours of the ovary and are very common in our environment. They are frequently asymptomatic. Occur mainly in the premenopausal age group. Mostly cystic tumour Significant proportion of benign ovarian tumours undergo spontaneous regression.

EPIDEMIOLOGY 

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Benign ovarian tumours constitute about 90% of all ovarian tumours. Occur mostly in young women between the ages of 2045 87% of ovarian tumours occuring in premenopausal women are benign, while it is about 55% in menopausal age group The incidence in U.P.T.H from1995 to 2000 was 3.37% in admitted gynaecological cases. Epithelial tumours are the commonest ovarian tumours. However studies done in 1992 (Briggs N.D and Katehy K.C) revealed a preponderance of primary ovarian germ cell tumours over epithelial tumours in the Rivers state of Nigeria. Ovarian teratomas have been shown to occur in the reproductive years. This was confirmed to be the case in U.P.T,H in another study in 2002 (John Ikimalo and Daye seleye Fubara) Which showed peak age of incidence from 30-39 years

PATHOLOGY GENERAL CHARACTERISTICS  Mostly cystic: Solid elements may be a pointer to malignancy except fibromas, thecomas, dermoid and brenner tumours.  Capsule usually smooth and intact  Mostly unilateral and unilocular HISTOLOGICAL CLASSIFICATION W.H.O in 1993 classified ovarian tumours according to tissue of origin namely; the surface (coelomic) epithelium,

tumour of germ cell origin and those from ovarian stroma or sex cord. PHYSIOLOGICAL TUMOUR  Follicular  Luteal BENIGN GERM CELL TUMOUR 

Dermoid cyst or Benign cystic teratomas

BENIGN EPITHELIAL TUMORS  Serous cystadenoma  Mucinous cystadenoma  Endometrioid cystadenoma  Brenner tumour  Clear cell tumour. BENIGN SEX CORD STROMAL TUMOURS   

Theca cell tumour Sertoli-Leydig cell tumour Fibroma

CLINICAL FEATURES  Asymptomtic: Many are discovered incidentally during investigation for other problems     

Lower abdominal pain Torsion Rupture Haemorrhage Infection

 Abdominal swelling  Pressure symptoms  Urinary symptoms  Gastrointestinal symptoms ⇒ constipation, dyspepsia.  Pressure on the large veins ⇒ reduced venous return with varicose veins, Haemorrhoids and genital prolapse.  Symptoms of abnormal oestrogen production

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Precocious puberty Endometrial hyperplasia and cancer Menorrhagia, Breast enlargement Post menopausal bleeding

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Effect of abnormal androgen production Hirsuitism Acne Deepening voice Clitoral hypertrophy

 Thyrotoxicosis DIFFERENTIAL DIAGNOSIS  Full bladder  Gravid uterus  Fibroids  Fimbrial cyst  Ectopic pregnancy  Appendicitis  Pelvic inflammatory disease  Pelvic kidney  Rectal tumour  Diverticulitis  All other causes of menstrual irregularities, precocious puberty and post menopausal bleeding  ovarian cancer