benign gynecologic lesions
TRANSCRIPT
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Benign Gynecologic Lesions
Eileen M. Manalo, M.D., FPOGS, FPSREI
Associate Professor IV
UP- Philippine General Hospital
Obstetrics and Gynecology
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Benign Lesions of the Genital
Tract
• lesions of the vulva, vagina, cervix, uterine corpus, ovaries and fallopian tubes
Benign Characteristics:1. slow-growing2. well-circumscribed 3. not associated with hemorrhage, necrosis or evidence of
widespread dissemination (metastasis)4. no constitutional signs and symptoms of weight loss and
anorexia
• a tissue biopsy is needed to make a specific diagnosis.
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Topic Objectives
1. To describe and discuss the more common lesions and conditions of the female genital tract
2. To discuss their pathophysiology, as well as their corresponding treatment
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Benign Lesions of the
Vulva
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Urethral Caruncle
• fleshy outgrowth of the distal edge of the urethra• frequently in postmenopausal women • must be differentiated from urethral carcinomas • generally small, single and sessile but may be
pedunculated and grow to be 1 to 2 cm in diameter
• tissue is soft, smooth, friable and bright red and initially appears as an eversion of the urethra
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Urethral Caruncle
• believed to arise from an ectropion of the posterior urethral wall associated with retraction and atrophy of the postmenopausal vagina
• histologically composed of transitional and stratified squamous epithelium with loose connective tissue
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Urethral Caruncle
• Growth is secondary to chronic irritation or infection
• Symptoms may be variable– mostly asymptomatic– dysuria frequency, and urgency
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Urethral Caruncle
• differential diagnosis• primary carcinoma of the urethra • prolapse of the urethral mucosa
• not a precursor for urethral carcinoma
• diagnosis is established by biopsy under local anesthesia
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Urethral Caruncle
Treatment– Initially
1. oral or topical estrogen 2. avoidance of irritation
– cryosurgery, laser therapy, fulguration, or operative excision
– following operative destruction - a foley catheter should be left in place for 48 to 72 hours
– follow-up is necessary to ensure that the patient does not develop urethral stenosis
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Urethral Prolapse
• predominantly in premenarchal females
• Grossly– does not have the bright-red color of
a caruncle – is not as circumscribed in gross
configuration – it may be ulcerated with necrosis or
grossly edematous
• Majority are asymptomatic but some may have dysuria
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Urethral Prolapse
Therapy
1. hot sitz baths
2. antibiotics
3. topical estrogen cream
4. excision of the redundant mucosa – rarely done but may be necessary
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Vulvar Cysts
• Bartholin’s duct cyst is the most common of the large vulvar cysts
• treatment is not necessary in women younger than 40 unless the cyst becomes infected or enlarges enough to produce symptoms
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Vulvar Cysts
• the most common small vulvar cysts are epidermal inclusion cysts or sebaceous cysts
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Sebaceous Cysts
• located immediately beneath the epidermis• mostly discovered on the anterior half of the
labia majora• multiple, freely movable, round, slow growing,
and nontender with firm consistency• grossly appear white or yellow with caseous
contents on cut section• local scarring of the adjacent skin sometimes
occurs when rupture of the contents of the cyst produces inflammatory reaction in the subcutaneous tissue.
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Inclusion Cysts
• develops when an infolding of squamous epithelium has occurred beneath the epidermis in the site of an episiotomy or obstetric laceration
• When found in the vagina – most likely related to previous trauma
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Inclusion Cysts
• alternative theories of histogenesis – include embryonic remnants – occlusion of pilosebaceous ducts of sweat
glands
• Treatment– usually none– If infected – local heat as well as incision and
drainage– Recurrent cysts require excision.
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Nevus
• commonly referred to as a mole
• a localized nest or cluster of melanocytes
• arise from the embryonic neural crest and are present from birth
• one of the most common benign neoplasms in females
• generally asymptomatic
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Nevus
• Histologic groups:– junctional– compound– intradermal nevi
• 5% to 10% of all malignant melanomas in women arise from the vulva
• 50% of malignant melanomas arise from a preexisting nevus
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Nevus
• symptoms of an early malignancy include1. asymmetry
2.border irregularity
3.color variegation
4. diameter usually greater than 6 mm (ABCD)
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Nevus
• all flat vulvar nevi should be excised and examined histologically
• flat junctional nevus and dysplastic nevus have high malignant potential
• proper excisional biopsy should be three dimensional and adequate in width and depth
– Approximately 5 -10 mm of normal skin surrounding the nevus should be included,
– the biopsy should include the underlying dermis as well
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• are rare malformations of blood vessels rather than true neoplasms.
• frequently discovered initially during childhood
• approximately 60% of vulvar hemangiomas spontaneously regress in size by the time the child goes to school
Hemangioma
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• appear histologically as predominantly thin-walled capillaries arranged randomly and separated by thin connective tissue septa.
• most are asymptomatic
• may occasionally become ulcerated and bleed
Hemangioma
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Fibroma
• most common benign solid tumor of the vulva• commonly found in the labia majora• occur in all age groups• have smooth surface and distinct contour• with low grade potential for becoming malignant• smaller fibromas are asymptomatic • large tumors may produce chronic pressure
symptoms or acute pain• treatment - operative removal if the fibromas
are symptomatic and/or continue to grow
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Lipoma
• benign, slow growing, circumscribed tumors of fat cells arising from the subcutaneous tissue of the vulva.
• second most frequent benign vulvar mesenchymal tumor
• most lipomas are discovered in the labia majora and are superficial in location
• malignant potential is extremely low
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Hidradenoma
• benign vulvar tumor that originates from apocrine sweat glands of the inner surface of the labia majora and nearby perineum.
• found in white women between 30 and 70 years of age.
• asymptomatic but may cause pruritus or bleeding if the tumor undergoes necrosis
• excisional biopsy is the treatment of choice
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Endometriosis
• Rare in the vulva• firm, small nodule or nodules • varies from a few millimeters to several centimeters in
diameter • found at the site of an old, healed obstetric laceration,
episiotomy site, an area of operative removal of a Bartholin’s cyst, or along the canal of Nuck
• Pathophysiology– secondary to metaplasia– retrograde lymphatic spread, or – potential implantation of endometrial tissue during operation
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Endometriosis
• commonly present with introital pain and dyspareunia
• classic history - cyclic discomfort and enlargement of the mass during menses
• Treatment– wide excision or laser vaporization depending
on the size of the mass
• Recurrence after treatment are common
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Hematoma
• usually secondary to blunt trauma - (straddle injury)
• spontaneous hematomas are rare and usually occur from rupture of a varicose vein during pregnancy or the postpartum period
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Hematoma
• Management – usually conservative unless the hematoma is
greater than 10 cm in diameter or is rapidly expanding
– direct pressure may be applied to control the bleeding
– compression and application of an ice pack to the area
– Identification and ligation of bleeders if the hematoma continues to expand
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Dermatologic Lesions
• skin of the vulva is susceptible to any generalized skin disease or involvement by systemic disease.
• most common skin diseases include– contact dermatitis– neurodermatitis – Psoriasis– seborrheic dermatitis– cutaneuos candidiasis – lichen planus
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Dermatologic Lesions
• majority are scalelike rashes and usually presents with pruritus
• diagnosis and treatment are often obscured or modified by the environment of the vulva
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Vulvar Edema
• may be a symptom of either local or generalized disease
• Most common causes:– secondary reaction to inflammation
– lymphatic blockage
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Benign Lesions of the
Vagina
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Urethral Diverticulum
• a saclike projection arising from the posterior urethra• often present as a mass of the anterior vaginal wall• symptoms are identical to lower genital tract infection
• Diagnosis:• voiding cystourethrograph • cystourethroscopy. • Other diagnostic tests: urethral pressure profile recordings, vaginal
ultrasound, positive-pressure urethrography and MRI
• Treatment:– Excisional surgery in acute infection
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Inclusion Cyst
• most common cystic structures of the vagina• usually discovered in the posterior or lateral
walls of the lower third of the vagina• common in parous women• often results from birth trauma or gynecologic
surgery• majority are asymptomatic• if symptomatic, excisional biopsy is indicated
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Tampon Problems
• risks with its usage:– vaginal ulcers– toxic shock syndrome from toxins produced by
Staphylococcus aureus
• associated with microscopic epithelial changes• the classic “forgotten” tampon presents with a
foul vaginal discharge and occasional spotting• Treatment: antibiotic vaginal cream for the next
5 to 7 days
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Local Trauma
• Coitus is the most frequent etiology
• most common injury is a transverse tear of the posterior fornix
• Manifests with profuse or prolonged vaginal bleeding
• Management: – prompt suturing under adequate anesthesia
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Benign Lesions of the
Cervix
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Endocervical and Cervical Polyp
• most common benign neoplastic growth of the cervix
• Seen in multiparous women in their 40s and 50s
• usually secondary to inflammation or due to abnormal focal responsiveness to hormonal stimulation
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Endocervical and Cervical Polyp
• Symptoms– classic symptom is intermenstrual bleeding– many are asymptomatic – recognized for the first time during a routine
speculum examination
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Endocervical and Cervical Polyp
• Management– Polypectomy may be an office procedure– most can be managed by grasping the base of the
polyp with an appropriately sized clamp. – The polyp is avulsed with a twisting motion and sent
to the pathology for microscopic evaluation.– if bleeding ensues, the base may be treated with
chemical cautery, electrocautery, or cryocautery
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Nabothian Cysts
• so common that they are considered a normal feature of the adult cervix
• retention cysts of endocervical columnar cells occurring where a tunnel or cleft has been covered by squamous metaplasia.
• produced by the spontaneous healing process of the cervix
• asymptomatic • treatment is not necessary
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Cervical Lacerations
• frequently occur with both normal and abnormal deliveries• vary from minor superficial lacerations to extensive full-
thickness lacerations
Management• Acutely bleeding cervical lacerations should be sutured• should be palpated to determine the extent of cephalad
extension of the tear
Complications• extensive cervical lacerations especially those involving the
endocervical stroma may lead to incompetence of the cervix during a subsequent pregnancy
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Cervical Myomas
• smooth, firm masses similar to myomas of the fundus• most are small and asymptomatic• may become pedunculated and protrude through the
external os of the cervix• diagnosis is by inspection and palpation
management – similar to uterine myomas– observation/ expectant management– medical therapy with GnRH agonists – myomectomy or hysterectomy
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Cervical Stenosis
• most often occurs in the region of the internal os• may be divided into congenital or acquired• causes of acquired cervical stenosis:
– Operative (i.e. cone biopsy, cautery)– Radiation– Infection– Neoplasia– atrophic changes
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Cervical Stenosis
Symptoms– in premenopausal women: dysmenorhea,
pelvic pain, abnormal bleeding, amenorrhea and infertility
– postmenopausal women are usually asymptomatic
– diagnosis is established by inability to introduce a 1 to 2 mm dilator into the uterine cavity
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Cervical Stenosis
Management– dilation of the cervix with dilators– if stenosis recurs, monthly
laminaria tents may be used– after a cervical dilation - a stent is
left in the cervical canal for a few days to maintain patency.
– Treatment success depends on the proper use of the laser and the quality and quantity of residual columnar epithelium remaining in the endocervix.
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Benign Lesions of the
Uterus
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• localized overgrowths of endometrial glands and stroma that project beyond the surface of the endometrium
• most arise from the fundus of the uterus
• may vary from a few millimeters to several centimeters in diameter
• may have a broad base or be attached by a slender pedicle.
Endometrial Polyp
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• peak incidence between ages 40 and 49• etiology is unknown • often associated with endometrial hyperplasia
– unopposed estrogen may be the cause– May be associated with chronic administration of
tamoxifen
• majority are asymptomatic• those that are symptomatic are associated with
a wide range of abnormal bleeding patterns.
Endometrial Polyp
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Components 1. endometrial glands
2. endometrial stroma
3. central vascular channels
Endometrial Polyp
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• malignant transformation has been estimated to be as high as 0.5%
• Diagnosis:– Hydrosonography– hysteroscopy and/or
hysterosalpingography
• management - removal by curettage or via the hysteroscope.
Endometrial Polyp
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• benign tumors of muscle cell origin
• often referred to as fibroids or myomas
• most frequent tumors of the pelvis
• highest prevalence occurring during the fifth decade of a woman’s life
• majority are found in the corpus of the uterus
Leiomyoma
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Leiomyoma
• classified into subgroups by their relative anatomic relationship and position to the layers of the uterus.
• 3 most common types a.intramuralb.subserousc.submucous
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Leiomyoma
• submucosal tumors – associated with abnormal vaginal bleeding or
distortion of the uterine cavity that may produce infertility or abortion
• subserosal myomas give the uterus its knobby contour during pelvic examination
• parasitic myoma - myoma that outgrows its blood supply and obtains a secondary blood supply from another organ
• broad ligament myoma – results from lateral growth of myoma
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Leiomyoma
Etiology
• each tumor results from an original single muscle cell (monoclonal theory)
• somatic mutation of normal myometrium to leiomyomas influenced by estrogen and progesterone and local growth factors
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Leiomyoma
• rare before menarche • most diminish in size following menopause with
the reduction of a significant amount of circulating estrogen.
• often enlarge during pregnancy and occasionally enlarge secondary to oral contraceptive therapy
• lower incidence among smokers• -however, the relationship between estrogen
and progesterone levels and myoma growth is complex
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Leiomyoma
pathology• grossly, has a lighter color than the
normal myometrium• on cut surface it has a glistening, pearl-
white appearance, with the smooth muscle arranged in a trabeculated or whorled configuration
• histologically there is a proliferation of mature smooth muscle cells; the nonstriated muscle fibers are arranged interlacing bundles.
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Leiomyoma
Types of Degeneration1. Hyaline2. Myxomatous3. Calcific4. Cystic5. Fatty6. Red degeneration
• occurs in pregnancy in 5% to 10% of gravid women with myomas
– medically treated during pregnancy, otherwise, myomectomy is done
7. Necrosis8. Malignant - 0.3% and 0.7%
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Leiomyoma
symptoms• most common are pressure from an enlarging
pelvic mass, pain and abnormal uterine bleeding• severity of symptoms is usually related to the
number, location, and size of the myomas• majority are asymptomatic• rapid growth after menopause is a disturbing
symptom
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Leiomyoma
diagnosis1. pelvic examination2. Ultrasound
management• if small, symptomatic, judicious observation is made• at first discovery, a pelvic examination at 6 month
intervals to determine the rate of growth should be done• women with abnormal bleeding and leiomyomas should
be investigated thoroughly for concurrent problems such as endomterial hyperplasia
• surgery when persistently symptomatic
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Leiomyoma
Medical Management• Medical treatment involves reduction in the size of the myoma by reducing the
level of estrogen and progesterone• e.g.GnRh agonists
Advantages1. Facilitate easier surgery2. induction of amenorrhea
Disadvantages1. delay in final tissue diagnosis2. degeneration of some leiomyomas, necessitating piece-meal enucleation at
myomectomy3. hypoestrogenic side effects (e.g. trabecular bone loss, vasomotor flushes)4. cost5. need to self-administer or receive injections in many cases
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Leiomyoma
Surgical Management
Indications for Surgery1. rapidly expanding pelvic mass2. persistent abnormal bleeding3. pain or pressure4. enlargement of an asymptomatic myoma
to more than 8 cm in a woman who has not yet completed child bearing
Contraindications to Surgery1. pregnancy2. advanced adnexal disease3. malignancy
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Leiomyoma
Transcatheter uterine artery embolization• newest modality in managing uterine myomas• multiple embolic materials have been used including
gelatin sponge, silicon spheres, metal coils, and polyvinyl alcohol particles of various diamters
• postprocedural abdominal and pelvic pain is common for the first 24 hours
• success rates in regard to decreasing menorrhagia and reduction in uterine size are promising
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• growth of glands and stroma into the uterine myometrium to a depth of at least 2.5 mm from the basalis layer
• sometimes known as internal endometriosis
• pathogenesis remains unknown.
Adenomyosis
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Pathology1. diffuse involvement of the anterior
and the posterior alls of the uterus, with the posterior being more often involved
2. there is a focal area of the lesion - adenomyoma.
• results in a asymmetric uterus where there is usually a pseudocapsule.
Criteria for diagnosis– a finding of inactive or proliferative
glands, more than one low power field (2.5 mm) from the basalis layer of the endometrium.
Adenomyosis
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Adenomyosis
Diagnosis• majority of women are asymptomatic• May present with secondary dysmennorhea and
menorrhagia. severity of symptoms increases proportionally with depth of invasion and penetration.
• Usually presents with uterine enlargement palpated through pelvic examination
• Ultrasound and MRI are helpful in diagnosis.
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Adenomyosis
Treatment• no satisfactory
proven medical treatment for adenomyosis.
• Hysterectomy is the definitive treatment
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Benign Lesions of the
Fallopian Tubes
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• most prevalent benign tumor of the oviduct
• small,gray-white, circumbscribed nodules, 1 to 2 cm in diameter
• usually unilateral
• asymptomatic
• do not become malignant but may be mistaken for low-grade neoplasm
Adenomatoid Tumors
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• Diagnosis is incidental• often multiple and may vary from
0.5 cm to more than 20 cm in diameter
• when pedunculated and near the fimbrial end of the oviduct - hydatid cysts of Morgagni
• treatment is simple excision• Complications: torsion
Paratubal Cysts
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• rare event however has been reported with both normal and pathologic fallopian tubes
• pregnancy predisposes to this problem• usually accompanies torsion of the ovary in 50-60% of
cases• right tube more frequently involved than the left• presents with acute lower abdominal and pelvic pain
Management• exploratory operation • with a minor degree of torsion, it is possible to restore
normal circulation to the tube and salvage it
Torsion
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Benign Lesions of the
Ovaries
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• most frequent cystic structure in normal ovaries
• arises from temporary variation of a normal physiologic process
• may result from either – the dominant mature follicle’s
failing to rupture (persistent follicle) or
– an immature follicle’s failing to undergo the normal process of atresia.
• most commonly found in young, menstruating women
Follicular Cysts
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• majority are asymptomatic • May be discovered during ultrasound imaging of the pelvis or a
routine pelvic examination • May also present with signs and symptoms of ovarian enlargement
and therefore must be differentiated from a true ovarian neoplasm
Management• Conservative observation• majority disappear spontaneously by either reabsorption of the cyst
fluid or silent rupture within 4 to 8 weeks on initial diagnosis• persistent ovarian mass necessitates operative intervention to
differentiate it from a true neoplasm of the ovary• cystectomy and oophorectomy
Follicular Cysts
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• less common than follicular cysts, but clinically more important
• minimum of 3 cm in diameter• may be associated with either
normal endocrine function or prolonged secretion of progesterone.
• associated menstrual pattern may be normal, delayed menstruation or amenorrhea
• vary from being asymptomatic to those causing catastrophic and massive intraperitoneal bleeding with rupture.
Corpus Luteum Cyst
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Differential Diagnosis1. ectopic pregnancy2. ruptured endometrioma 3. adnexal torsion
Management• Conservative if unruptured• With persistent bleeding - treatment is
cystectomy.
Corpus Luteum Cyst
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• least common of the three types of physiologic ovarian cysts
• almost always bilateral and produce moderate to massive enlargement of the ovaries
• arise from either prolonged or excessive stimulation of the ovaries by endogenous or exogenous gonadotrophins
• Seen in 50% of molar pregnancies and 10% of choriocarcinoma
• also discovered in the latter months of pregnancies often with conditions that produce a large placenta, such as twins, diabetes and Rh sensitization
Theca Lutein Cysts
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• hyperreactio luteinalis – is the condition of ovarian enlargement
secondary to the development of multiple luteinized follicular cysts.
• Luteoma of pregnancy– not a true neoplasm but rather a specific,
benign, hyperplastic reaction of ovarian theca lutein cells
Theca Lutein Cysts
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• produce vague symptoms, such as pressure in the pelvis
• presence is established by palpation and often confirmed by ultrasound examination
• treatment is conservative
Theca Lutein Cysts
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• Benign cystic teratoma• most common ovarian neoplasm
in prepubertal females and in teenagers
• vary from a few millimeters to 25 cm in diameter, may be single or multiple
• usually discovered either in the cul-de-sac or anterior to the broad ligament
Dermoid Cyst
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• composed of mature cells, usually, from all three germ layers
• most solid elements arise are contained in a protrusion or nipple (mamila) in the cyst wall termed the prominence or tubercle of Rokitansky
Dermoid Cyst
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• adult thyroid tissue is discovered microscopically in approximately 12% of benign teratomas
• Struma ovarii – teratoma in which the thyroid tissue has
overgrown other elements and is the predominant tissue
Dermoid Cyst
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• presenting symptoms include pain, sensation of pelvic pressure• 50% to 60% are asymptomatic • Some are discovered during a routine pelvic examination,
coincidentally visualized by an abdominal x-ray or ultrasound examination
management• cystectomy with preservation of as much normal ovarian tissue as
possible
Complications 1. Torsion2. Rupture3. Infection4. Hemorrhage5. malignant degeneration
Dermoid Cyst
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• areas of ovarian endometriosis that become cystic
• usually associated with endometriosis in other areas of the pelvic cavity
• large chocolate cysts of the ovary may reach 15 to 20 cm
Endometrioma
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• the most common symptoms associated1. pelvic pain
2. Dyspareunia
3. infertility
• Tender and immobile ovaries on pelvic examination– dense adhesions on surrounding
structures is a common finding
Endometrioma
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management• the choice of management depends on:
1. patient’s age
2. future reproductive plans
3. severity of symptoms
• medical therapy is rarely successful in treating ovarian endometriosis
• surgical therapy is complicated by formation of de novo and recurrent adhesions
Endometrioma
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• the most common benign, solid neoplasm of the ovary
• comprise approximately 5% of benign ovarian neoplasms and approximately 20% of all solid tumors of the ovary
• arises from undifferentiated fibrous stroma of the ovary
• commonly presents in postmenopausal women
• malignant potential is low, less than 1%
Fibroma
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• Manifest with pressure symptoms and abdominal enlargement
• Meigs’ syndrome– the association of an ovarian fibroma, ascites and hydrothorax– both resolve after the removal of an ovarian tumor
management• Exploratory operation• in postmenopausal women, often a bilateral salpingo-
oophorectomy and total abdominal hysterectomy are performed
Fibroma
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• the epithelial element is most commonly serous, but histologically may be mucinous and endometrioid or clear cell
• are usually small tumors that arise from the surface of the ovary
• bilateral in 20% to 25% of women
• usually occur in postmenopausal women
Cystadenoma
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• smaller tumors are asymptomatic or pelvic operations.• large tumors may cause pressure symptoms, rarely
adnexal torsion.
Management• postmenopausal women: bilateral salpingo-
oophorectomy and total abdominal hysterectomy• in younger women: simple excision of the tumor and
inspection of the contralateral ovary is appropriate
Cystadenoma
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• a complication of benign ovarian tumors in the postmenopausal woman
• important cause of acute lower abdominal and pelvic pain
• commonly affects both fallopian tube and ovaries• pregnancy appears to predispose women to adnexal
torsion
Symptoms• Acute abdominal and pelvic pain• nausea and vomiting• fever
Torsion
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management
• conservative operation for young women– laparoscope or via laparotomy
• with severe vascular compromise - unilateral salpingo-oophorectomy
Torsion
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• a benign disease but a progressive one
• the presence or growth of the glands and stroma of the lining of the uterus in an aberrant or heterotopic location– Aberrant endometrial tissue
grows under the cyclic influence of ovarian hormones
• mid 30s, nulliparous and involuntarily infertile with symptoms of secondary dysmenorrhea and pelvic pain
Endometriosis
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1. RETROGRADE MENSTRUATION– pelvic endometriosis is secondary to implantation of endometrial cells
shed during menstruation2. METAPLASIA
– arises from the metaplasia of coelomic epithelium or proliferation of embryonic rests.
3. LYMPHATIC AND VASCULAR METASTASIS– endometrial tissue is transplanted via lymphatic pathways and the
vascular system. 4. IATROGENIC DISSEMINATION5. IMMUNOLOGIC CHANGES
– the altered function of the immune-related cells are directly involved on the pathogenesis of endometriosis
6. GENETIC PREDISPOSITION
Etiology of Endometriosis
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PATHOLOGY• ovaries are the most common
site• grossly exhibit wide variation in
color, shape, size and associated inflammatory and fibrotic changes.
• cardinal histological features 1. ectopic endometrial glands2. ectopic endometrial stroma 3. hemorrhage into the adjacent
tissue.
Endometriosis
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Signs and Symptoms– Classic symptoms include cyclic pelvic pain and infertility.– Pelvic pain is often inversely proportional to the amount of
endometriosis.– cyclic pelvic pain is related to the sequential swelling and the
extravasations of blood and menstrual debris in to the surrounding tissue and mediated by prostaglandins and cytokines
– Dyspareunia– GI and urinary symptoms– catamenial hemothorax and massive ascites - rare– classic pelvic findings of a retroverted uterus with scarring and
tenderness posterior to the uterus
Endometriosis
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Diagnosis
1. Ultrasound
2. Laparoscopy
Endometriosis
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Goals of Management
1.relief of pain
2.promotion of fertility
• Primary long term goal in management is to prevent progression of the disease process
Endometriosis
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Endometriosis
Medical Management– primary goal of hormonal treatment is
induction of amenorhea.– DOES NOT provide a long lasting cure of the
disease
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Endometriosis
Medications for Endometriosis
1. Danazol
2. GnRH Agonists*
3. Oral contraceptives
4. Medroxyprogesterone acetate (DMPA)
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Endometriosis
SURGICAL THERAPY
• Often occurs concurrently during laparoscopy to establish diagnosis • only option after failed medical treatment• for women who have moderate to severe endometriosis• Conservative surgery has as its goal the removal of macroscopic
visible areas of endometriosis with preservation of fertility.
Types of Surgical Therapy Used1. laparoscopy2. laser3. Total hysterectomy with ovarian preservation4. total abdominal hysterectomy with bilateral salpingo
oophorectomy.
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Thank you!