BENIGN TUMORS

OF THE OVARIES
 EPIDEMIOLOGY
BENIGN OVARIAN TUMORS MAKE
UP 75-80% OF ALL OVARIAN
TUMORS, ALTHOUGH THIS INDEX
VARIES WITH AGE.
AMONG THE TUMORS THAT
REQUIRE SURGICAL TREATMENT
IN THE PREMENOPAUSAL PERIOD,
13% ARE MALIGNANT, AND AFTER
THE MENOPAUSE, THIS INDEX
REACHES 45%.
• OVARIAN TUMORS ARE VERY COMMON AMONG ALL
GYNECOLOGIC DISEASES. THE MOR­TALITY RATE IS HIGH
BECAUSE NO EFFECTIVE SCREENING DEVICES ARE
AVAILABLE FOR EARLY DETECTION.
• ACCORDING TO PATHOGENIC THEORY OF OVARIAN
TUMORS, GONADOTROPIC OVARIAN HYPERSTIMULATION
IS THE LEADING FACTOR IN THE DEVELOPMENT OF
OVARIAN TUMORS. THIS THEORY SHOULD BE
RECOMMENDED FOR PATHOGENETICAL EXPLAINATUM OF
MALIGNANT OVARIAN TUMORS DIAGNOSIS AND
TREATMENT.
 THE CLASSIFICATION OF BENIGN
OVARIAN TUMORS (FOR THE
HISTOLOGICAL CONCLUSION)
• I. EPITHELIAL TUMORS: • II. SEX CORD STROMAL
A. SEROUS TUMORS:

B. MUCINOUS A. GRANULOSASTROMAL CELL

C. ENDOMETRIOD B. ANDROBLASTOMA

D. CLEAR CELL C. GYNANDROBLASTOMA

E. BRENNER D. UNCLASSIFIED

F. MIXED EPITHELIAL • III. LIPID CELL TUMORS

G.UNDIFFERENTIATED
H. UNCLASSIFIED.
 • VII. UNCLASSIFIED TUMORS.
• IV. GERM CELL TUMORS:
• VIII. SECONDARY (METABOLIC) TUMORS.
• A. DYSGERMINOMA
• VIII. TUMOR-LIKE CONDITIONS:
• B. ENDODERMAL SINUS TUMOR
• A. PREGNANCY LUTEOMA
• C. EMBRYONAL CARCINOMA
• B. OVARIAN STROMA HYPERPLASIA AND
• D. POLYEMBRYOMA HYPERKERATOSIS
• E. CHORIOCARCINOMA • C. CONSIDERABLE OVARIAN EDEMA
• F. TERATOMA • D. FUNCTIONAL FOLLICLE CYST AND LUTEAL
CYST
• G. MIXED FORMS
• E. MULTIPLE LUTEAL FOLLICLE CYSTS AND (OR)
• V. GONADOBLASTOMA:
LUTEAL CYSTS
• A. ONLY BLASTOMA (WITHOUT ANY
• F. ENDOMETRIOSIS
FORMS);
• G. SUPERFICIAL EPITHELIAL CYSTS-INCLUSIONS
• B. MIXED WITH DISGERMINOMA AND
• H. SIMPLE CYSTS
OTHER FORMS OF GERM CELL TUMORS.
• I. INFLAMMATORY PROCESSES
• VI. SOFT TISSUE TUMORS NOT SPECIFIC
TO THE OVARY. • J. PARAOVARIAN CYSTS
 THE BENIGN TUMORS OF THE OVARIES INCLUDE SUCH
CONCEPTS AS CYSTS AND CYSTIC OVARIES.

• OVARIAN CYSTS ARE TUMOR-SHAPED ENTITIES

CHARACTERIZED BY FLUID ACCUMULATION, AMONG NORMAL
OVARIAN TISSUE SURROUNDED BY A CLEAR CAPSULE. THESE
INCLUDE: FOLLICULAR CYSTS OF THE OVARY, YELLOW BODY
CYSTS, PARA-EVASIVE CYST.
• CYSTOMA IS A REAL TUMOR OF THE OVARY, WHICH HAS ALL
THE CHARACTERISTICS OF TUMOR GROWTH (BENIGN).
 FOLLICULAR CYSTS
Follicular cysts - tumorous formations
• educe on a background of inflammatory process owing to
accumulation of fluid in a cystatretic follicle,
• can be caused by infringement of hypothalamic-hypophysial
regulation of function of ovaries;
• cavitary, thin-walled unicameral formation, unilateral, 2-7 cm
in diameter;
• sometimes hormonactivity as contain estrogens.
 CLINIC
*low abdominal pain,
*menstrual cycle impairment
*uterine bleeding
*signs of acute abdomen

TREATMENT
• Observation for 2-3 menstrual cycles.
• Surgical intervention-ovarian resection or oophorectomy.
• in climacteric and postmenopausal women - total hysterectomy.
 CORPUS LUTEAL CYSTS (LUTEIN CYSTS)
• Anatomical variant of normal constitution of corpus luteum.
• Can be consequence of inflammatory diseases of ovaries.
• Hyperproduction of gonadotrophic hormones by adenohypophysis.
• At girls appearance of cyst is connected to hypersecretion of prolactinum, arise in the
period of sexual maturity.

MANAGEMENT - observation.
• Contraceptive suppressing ovarian activity
• ovarian cystectomy (failure of conservative therapy)
 PAROVARIAN CYST
 Fluid retention in ovarian adnexa which has been situated in the broad ligament.
 Arises in reproductive period ovarian epoephoron is well developed and it undergoes atrophic
changes in climacteric women.
CLINIC
• Pain in the lower abdomen and sacral region
• Symp­toms of adjacent organs compression
• Symptoms of acute abdomen - in the case of pedicle cyst torsion.
• Bimanual examination - painless and immobile smooth surface and elastic consistency.
TREATMENT
 Puncture of the cyst.
 Surgical removal of cyst.
 FIBROMA AND THECOMA
• Are usually secretes estrogens, invokes signs of a feminization (a premature puberty in girls of prepuberty age) or later
fading of menstrual function (55-60 years) (early or late a feminizing syndrome).
• At children's age prematurely there are the secondary sexual attributes (mammas educe, occur cyclic or acyclic uterine
bleeding, growth of a hair on a pubis).
• In the period of a menopause are occurring acyclic bleeding, the uterus is enlarged due to a hypertrophy and a
hyperplasia of cells of a myometrium, mammas are enlarged, the hyperplasia of a mucosa of a vagina and cervix of a
uterus, and also are developed the sexual drive strengthens.

THECOMA
• educes at women after 40 years,
• tumor onesided of dense consistency or dense elastic consistency more often,
• can reach the big dimensions.
• quite often is accompanied by disturbance of a menstrual cycle such as a menometrorrhagia, and also
infertility.
 FIBROMA
o Educes more often at young women on the one hand.
o Mobile tumor, on a peduncle, grows sluggishly.
CLINICAL SIGNS
o Hemorrhages and a necrobiosis
o Torsion peduncle of tumor
o Signs of a irritation of a peritoneum.
o A malignant degeneration - MEIGS TRIAD (an ascites – a polyserositis, an anemia, a
cachexia).
o In senior children - an anemia, an ascites.
TREATMENT
Surgical - removal of the damaged ovary.
GERMINOGENIC BENIGN OVARIAN TUMORS

Can be benign mature or immature teratomas.

They contain elements from all three embryonic germ lines
(mesoderm, ectoderm, and endoderm).
 DERMOID CYSTS
• may occur at any age,
• dermoids are bilateral,
• have 5-10 cm in diameter.
At operation, the tumors are found to be round with smooth, glistening, grey surface.
CLINIC
No symptoms are common for small sizes tumor. Pain is present in case of large tumor.
Ultrasonography, laparoscopy are used for diagnosis.
TREATMENT
Surgical - excision of the cyst, conserving the remaining portion of the ovary.
 BRENNER TUMOR
Fibroepithelial tumor with gross characteristics (shape, sizes and consistency)
similar to those of fibroma.
CLINIC
• Postmenopausal bleeding (may contain hormonally active stroma).
DIAGNOSTICS
• Bimanual examination, ultrasonography and laparoscopy.
TREATMENT
• Consists in simple excision or oophorectomy.
 ENDOMETRIOID CYSTS
Chocolate cysts of endometriosis
CLINICAL FEATURES
• Typically dysmenorrhea, dyspareunia, pain, irregular bleeding and infertility
• Endometriosis is reported in up to 50% of women with infertility rarely, infection or
rupture of an endometriotic cyst with ascites or hemoperitoneum
• TREATMENT
• Laparoscopic or hormonal
• Hormonal treatment is aimed at suppression of menstrual cycles using danazol, oral
contraceptives or gonadotropin releasing hormone analogues
 TERATOBLASTOMA
Low differentiated tumors,
Have very malignant course,
An irregular consistence tumor quickly grows,
Metastasis in retroperitoneal lymphonodules, hematogenic - in a liver, lungs, a brain.
In a blood - high level of α-fetoprotein.

TREATMENT:
A hysterectomy with bilateral removal of ovaries,
an omentum, an appendix.
In the postoperative period - a chemotherapy.
 SEROUS CYSTADENOMAS
THE MOST COMMON EPITHELIAL TUMORS

BILATERAL UNILOCULAR SEROUS TUMORS , CAN REACH THE HUGE DIMENSIONS WITH
TENDENCY TO TORSION, CONTAIN A STRAW COLOURED FLUID (LIGHT SEROUS CONTENTS).

SIMPLE SEROUS CYSTOMA

UNICAMERAL FORMATION WITH SMOOTHCAPSULE WALL, SEROUS CONTENTS,.
TREATMENT - SURGICAL.
THE PAPILLARY CYSTOMA (PROLIFERATING)
BILATERAL,MULTICHAMBER, HAS SEROUS OR SEROBLOOD CONTENTS, ABUNDANT
PAPILLARY GROWTHS ON AN INTERNAL SURFACE OF CAPSULE. AT MALIGNANT
DEGENERATION THE GROWTH PASS ON VISCERAL
PERITONEUM AND A PERITONEUM OF THE NEXT ORGANS, ACCOMPANYING BY AN
ASCITES.
MUCINOUS TUMOR (MUCINOUS CYSTADENOMA)

Mucinous cystadenoma – multiloculated, multichamber with a plenty of

septum, filled gel-similar contents with a finely divided suspension, are more
often onesided, are characterized by a fast growth.
These form about 20% of ovarian cysts and are benign 90% of the time.
When benign they are usually unilateral but 20% of malignant mucinous
tumors occur on both sides.

Contents of cystoma cavity of - a pseudomucin - heavy-bodied jelly-like fluid

of various colour (yellowish, brown, pale or dark green, dark red).
 THE PSEUDOMUCINOUS CYSTOMA
• Educes asymptomatically,
• The tumor is not accompanied by any clinical exhibiting.
• Peduncle torsion or a necrosis of a capsule - pain in the abdominal low or loin.
• Signs of compression of the next organs (urinary bladder, rectum, sacral neuroplex,
lymphatic and venous vessels) occur late.

TREATMENT:
Cystadenomas (serous and mucinous cystoma) removal of an ovary
At young age the tumour is removed together with an ovary.
Bilateral removal of ovaries are after 48 years.
 PSEUDOMYXOMA
type of pseudomucinous tumor. A cystoma is multichamber.
The breakage of a capsule descends spontaneously or at gynecologic research. Contents of
capsule get in abdominal cavity. The pseudomucin is not soaked up by a peritoneum, and
incapsulating, there is dissemination of pseudomucin over all abdominal cavity.
CLINIC
abdominal distention,
pain at palpation of abdomen.
Schotkin’s sign is weak positive in the inferior departments of an abdomen.
acute irritation of a peritoneum
TREATMENT
surgical. It is impossible to remove jelly-like masses from an abdominal cavity considerably.
After
 GRANULOSA CELL TUMOR (FOLLICULOMA)
A hormone inactive solid – cystic tumor, a degree malignancy - 1628%
A denselyelastic or mild consistence contain serous or hemorrhagic fluid;
• Can result to early sexual maturity, early menarche, to development of the secondary sexual
attributes, and in puberty - in juvenile uterine bleedings.
• Asociation of feminizing syndrome, infringements of menstrual function, infertility with an
onesided ovary always specifies on hormoneproduce character of a tumor.

• TREATMENT:
Removal of the damaged ovary, a biopsy of the second;
removal of uterus with appendages and omenectomy with the further polychemotherapy.
 USA
STATISTICS
A 22-year-old GO presents for routine examination. She is
without complaints. Her LMP was 3 weeks ago and was normal.
On pelvic examination, you detect a large mobile mass in the
right lower quadrant. Her urine pregnancy test is negative.
Pelvic ultrasound shows a 8 cm right ovarian mass. The mass is
cystic with a focal solid component, calcifications, and teeth.
What is the next step in the management of this patient?
• A. Repeat ultrasound in 6 weeks
• B. Exploratory laparotomy, TH/BSO
• C. Right ovarian cystectomy
• D. Removal of the right ovary and tube (RSO)
• E. Expectant management
A 37-year-old G2P2 reports irregular menses,
intermittent pelvic pain, and a recent increase in facial
and body hair. On physical examination, the patient
has acne, facial hair, and a 10-cm left adnexal mass.
Pelvic ultrasound confirms a solid lobulated 10-cm
mass arising from the left ovary. Which of the
following serum concentrations were most likely
elevated?
a. LDH
b. Estradiol and FSH
c. Testosterone and androstenedione
d. AFP
e. Ca-125
 The patient of 38 years old consulted the doctor of the female dispensary with com­plaints of periodic
pain in the lower abdomen, mainly in the left part. The menstrual func­tion is normal. In anamnesis:
there were two deliveries and two spontaneous abortions without complications. She suffered from the
chronic inflammation of appendages of the uterus; she was treated upon ambulatory. Gynaecological
state: the vagina is normal; the cervix of the uterus isn't erased; the external ostium is slit-like; the
uterus in anteflexio is not enlarged, painless; the appendages to the right side are not determined, to the
left side there is an oval formation of 10 to 12 cm with smooth surface, of tight elastic consistency,
mobile, painless; the vaginal vault is deep with mucous discharges.

1. YOUR DIAGNOSIS: 2. WHAT ADDITIONAL INSPECTION OF 3. WHAT IS THE DOCTOR'S TACTIC OF THE
THE PATIENT WOULD YOU CONDUCT IN TREATMENT?
A) INTENSIFYING OF THE CHRONIC
AMBULATORY CONDI­TIONS? A) SEND THE PATIENT TO THE ONCOLOGY
SALPINGOOOPHORITIS WITH THE TUBO-
DISPENSARY;
OVARIAN FORMATION ON THE LEFT; A) THE ULTRASONIC RESEARCH OF THE
INTERNAL GENITAL ORGANS; B) PUT THE PATIENT INTO THE CLINICAL ACCOUNT
B) THE HYSTEROMYOMA WITH THE
WITH REPEATED EXAMINATION IN A MONTH;
SUBPERITONEAL LOCATION OF ONE OF B) THE ROENTGENOLOGICAL OR
THE NODES; C) PRESCRIBE THE COURSE OF ANTIBACTERIAL
ENDOSCOPIC RESEARCH OF THE
THERAPY, IF IT WON'T HELP, SHE'LL BE HOSPITALIZED;
STOMACH AND INTESTINES;
C) THE CYSTOMA OF THE LEFT OVARY;
D) IMMEDIATELY HOSPITALIZE THE PATIENT FOR
C) THE ENLARGED COLPOSCOPY; MAKING THE OPERATIVE INTERVENTION;
D) THE CANCER OF THE OVARIES;
D) ALL LISTED ABOVE; E) THE PLANNED HOSPITALIZATION OF THE PATIENT
E) THE ENDOMETRIOID CYST OF THE
FOR THE SURGICAL TREATMENT.
LEFT OVARY. E) NONE LISTED ABOVE.
 REFERENCE
• WILLIAMS. GYNECOLOGY. SECOND EDITION. 2012.
• HACKER. ESSENTIALS OF OBSTETRICS AND GYNECOLOGY. FIFTH EDITION.
2010. - 443 P.
• DEWHURST’S TEXTBOOK OF OBSTETRICS AND GYNAECOLOGY. – 7TH ED. /
EDITED BY D. KEITH EDMONDS. – 2007. - 717 P.
• GENERAL GYNECOLOGY: THE REQUISITES IN OBSTERTICS & GYNECOLOGY /
EDITED BY ANDREW I.SOKOL, ERIC R. SOKOL. – 1ST ED. - 2007. – 811 P.
• SMITH, ROGER P. NETTER’S OBSTETRICS AND GYNECOLOGY / ROGER P.
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