🔹 The ovary is made up of :
-Epithelial cells derived from celomic
epithelium.
-Oocytes which have differentiated from the
primitive germ cells
🔹
-Medullary elements (mesenchimal).
Ovarian enlargement is of two forms:
Non neoplastic (functional cysts).
True neoplasia.
Etiology and epidemiology:
🔹 ▪️
▪️Benign ovarian cysts are common ( 90% ).
🔹 Is most common in the wealthy nations.
Epithelial ovarian carcinomas accounts for 85% of all ovarian
frequently asymptomatic and often resolve
🔹
malignancies.
▪️
spontaneously
1🔹NON NEOPLASTIC OVARIAN TUMOURS:
The main objectives of management are to exclude
Frequently associated with nulliparity, an early menarche,
malignancy and to avoid cyst complication, without
🔹
and a late age at menopause.
🔹 Infertility and prolonged induction of ovulation. ALMOST ALL ARE CYSTIC
impairing future fertility in younger women.
🔹
🔹
Genetic factors (familial ovarian cancer 5-10%).
🔹In the prepuberty and post menopausal AGE group
Personal history of breast or colon cancer. 1)Functional ovarian cyst Management:
🔹 Age over 60 years.
High-fat diets, and exposure to talcum powder-( no
(Follicular cyst,Corpus luteum cysts,Theca lutein cysts)
🔹
2)Endometroitic cyst (chocolate cyst) → surgical treatment.
🔹Oral contraceptive, and Ovaricectomy are protective.
evidence).
3)Inflamatory cyst (T.B. or pyogenic)
In the reproductive age group, the management
depend on the SIZE of the cyst:
-If less than 8 cm → Observation and follow up.
4)Pregnancy lutoma solid tumour mainly regress after birth.
Suspicion of malignant changes -If more than 8 cm → Surgical treatment.
-Bilateral
-Solid
-Fixation 🔹
For the follow up:
Pelvic examination or ultrasound after the menses
-Ascites.
🔹
monthly for 3-4 months.
🔹
-Rapid growth of the tumor Use of contraceptive pills for 3 months.
Abnormal vaginal bleeding. If the cyst is persist or increases in size → Surgical
-Symptoms:involve of the lower bowel Abdominal pain or tt.
tenderness.
-Age (Before and after reproductive age).
🔹
Symptoms:
🔹
A. Serous cystadenoma:
🔹 Most common between 30-40 y
🔹
🔹
Are usually asymptomatic (Late diagnosis)
Abdominal mass.
benign tumors 🔹 Bilateral in 30% of cases.
Became malignant in about 30% of cases
🔹
🔹
Compression of the bladder or rectum.
Pain ( Malignant or complicated tumors)
🔹
Has size of 10-15 cm
Treatment is surgical.
🔹
🔹
Menstrual abnormalities are rare.
Edema of the legs or varicosities. LESIONS OF THE
🔹 Anorexia associated with cacuexia.
Feminization ( Sexual precocity, or post menopausal OVARY 🔹
B) Mucinous cystadenoma:
🔹 Most frequently between 30-50 years.
bleeding).
Malignant tumors
🔹 Constitute about 30% of all ovarian tumor.
Usually unilateral with the majority being 15-20 cm
OVARIAN PAPILLARY CYSTADENOCARCINOMA
solid tissue has invaded outside of the ovary, with
🔹
These tumors rarely become malignant
🔹 They are completely cystic and multilocular.
Psuedomyxoma pertonei is a complication that may result
papillations seen over the surface. if the content of a mucinous cyst are spilled in to the
These neoplasms characteristically spread by "seeding"
along peritoneal surfaces. 🔹
peritoneal cavity by rupture.
Treatment is surgical.
🔹
C) Dermoid Cyst (Teratoma):
🔹 It is derived from primordial germ cells.
Relatively common, and contains elements of all
CANCER OVARY three layers of the early embryo (contain hair, teeth,
🔹
This is the cut surface of a large (about 15 cm diameter) sebaceous glands).
mostly "solid" ovarian carcinoma indicating that it is high Bilateral in 12%, size between 5-10 cm, often pedunculated.
grade or poorly differentiated. 20% of all ovarian tumors, most frequently between 20-40
🔹
The yellowish areas indicate necrosis. years.
🔹 The tumors are almost benign.
Rapid growth during pregnancy,
2🔹 TRUE OVARIAN
treated by excision of the cyst.
NEOPLASIA
TREATMENT by fatema okoff -These may classified to:- DIAGNOSIS
🔹
Three forms of treatment: 1)CELOMIC EPITHELIUMTUMOURS Clinical symptoms
🔹
(Benign,borderline or malignant)(SEROUS and Are usually asymptomatic (Late diagnosis)
🔹
1) Surgery: Indicated in all stages of the diseases MUCINOUS cystadenoma). Abdominal mass.
🔹Total abdominal hysterectomy with bilateral salpingo-oopharectomy and omentectomy. 2)MESENCHIMAL ELEMENTS (fibroma, lymphoma) Compression of the bladder or rectum. Edema of the
🔹
3)SEX CORD TUMOURS legs or varicosities.
🔹De-bulking: The resection of as much as possible of the tumor to reduces its size. -Granulosa and Theca tumors.
🔹 Anorexia associated with cacuexia.
🔹
-Medullary male directed cells (Androblastoma ) Pain ( complicated tumors)
🔹 A second – look operation sometimes is indicated 6 month after chemotherapy
treatment for new staging, and excision residual tumor.
4)GERM CELL TUMOURS
-The primitive oocyte ( TERATOMA).
-Rests of oogenia (Dysgerminomas).
🔹 Menstrual abnormalities.
Feminization ( Sexual precocity, or post menopausal
bleeding).
2) Chemotherapy: Para clinical diagnosis:
Combination of drugs are used including: Pregnancy test.
( Cysplatin, Adriamycine, Cyclophosphamide, 5,Fluracil, Vincristine) Ultrasound.
can be used before or after surgery or alone as in stage 1V. Laparoscopy.X-Ray.C.T scan. IVP.
Barium enema.
3) Radiotherapy Laparotomy.
Is now almost never used in the routine management of ovarian carcinoma.
🔹
Tumor markers in blood:
🔹 CA 125 in Epithelial neoplasias
🔹
🔹
Alfa – feto – proteins in Yolk sac tumors
HCG (in Choriocacinoma
🔹
🔹
CEA (Carcino-Emberionic Antigens) in Yolk sac tumors
LDH (lactic acid dehydrogenase) in Dysgermeioma
🔹 Estradiol in Granulose or Theca cell tumors
Testestron in Sertoli – Lydge cell tumor
🔹
DIFFERENTIAI DIAGNOSIS
Small Ovarian Tumors
1- Pyo-or hydrosalpings
2- Broad ligament cyst.
3- Retroverted pregnant uterus.
4- Uterine myoma. 🔹
Complications:
🔹 Axial Torsion.
5- Ectopic pregnancy
6- Pelvic kidney 🔹
🔹
Hemorrhage(intra cystic)
Rupture.
🔹
7-Distended bladder.
Big ovarian tumors 🔹
🔹
Infection
Malignant changes
1) Pregnancy.
2) Obesity.
3) Ascites.
🔹 Pseudomyxoma peritonei
Incarceration
4) Full urinary bladder.
5) Cystic degeneration of myoma.
6) Cancer rectum.
-Epithelial cells derived from celomic
epithelium.
-Oocytes which have differentiated from the
primitive germ cells
🔹
-Medullary elements (mesenchimal).
Ovarian enlargement is of two forms:
Non neoplastic (functional cysts).
True neoplasia.
Etiology and epidemiology:
🔹 ▪️
▪️Benign ovarian cysts are common ( 90% ).
🔹 Is most common in the wealthy nations.
Epithelial ovarian carcinomas accounts for 85% of all ovarian
frequently asymptomatic and often resolve
🔹
malignancies.
▪️
spontaneously
1🔹NON NEOPLASTIC OVARIAN TUMOURS:
The main objectives of management are to exclude
Frequently associated with nulliparity, an early menarche,
malignancy and to avoid cyst complication, without
🔹
and a late age at menopause.
🔹 Infertility and prolonged induction of ovulation. ALMOST ALL ARE CYSTIC
impairing future fertility in younger women.
🔹
🔹
Genetic factors (familial ovarian cancer 5-10%).
🔹In the prepuberty and post menopausal AGE group
Personal history of breast or colon cancer. 1)Functional ovarian cyst Management:
🔹 Age over 60 years.
High-fat diets, and exposure to talcum powder-( no
(Follicular cyst,Corpus luteum cysts,Theca lutein cysts)
🔹
2)Endometroitic cyst (chocolate cyst) → surgical treatment.
🔹Oral contraceptive, and Ovaricectomy are protective.
evidence).
3)Inflamatory cyst (T.B. or pyogenic)
In the reproductive age group, the management
depend on the SIZE of the cyst:
-If less than 8 cm → Observation and follow up.
4)Pregnancy lutoma solid tumour mainly regress after birth.
Suspicion of malignant changes -If more than 8 cm → Surgical treatment.
-Bilateral
-Solid
-Fixation 🔹
For the follow up:
Pelvic examination or ultrasound after the menses
-Ascites.
🔹
monthly for 3-4 months.
🔹
-Rapid growth of the tumor Use of contraceptive pills for 3 months.
Abnormal vaginal bleeding. If the cyst is persist or increases in size → Surgical
-Symptoms:involve of the lower bowel Abdominal pain or tt.
tenderness.
-Age (Before and after reproductive age).
🔹
Symptoms:
🔹
A. Serous cystadenoma:
🔹 Most common between 30-40 y
🔹
🔹
Are usually asymptomatic (Late diagnosis)
Abdominal mass.
benign tumors 🔹 Bilateral in 30% of cases.
Became malignant in about 30% of cases
🔹
🔹
Compression of the bladder or rectum.
Pain ( Malignant or complicated tumors)
🔹
Has size of 10-15 cm
Treatment is surgical.
🔹
🔹
Menstrual abnormalities are rare.
Edema of the legs or varicosities. LESIONS OF THE
🔹 Anorexia associated with cacuexia.
Feminization ( Sexual precocity, or post menopausal OVARY 🔹
B) Mucinous cystadenoma:
🔹 Most frequently between 30-50 years.
bleeding).
Malignant tumors
🔹 Constitute about 30% of all ovarian tumor.
Usually unilateral with the majority being 15-20 cm
OVARIAN PAPILLARY CYSTADENOCARCINOMA
solid tissue has invaded outside of the ovary, with
🔹
These tumors rarely become malignant
🔹 They are completely cystic and multilocular.
Psuedomyxoma pertonei is a complication that may result
papillations seen over the surface. if the content of a mucinous cyst are spilled in to the
These neoplasms characteristically spread by "seeding"
along peritoneal surfaces. 🔹
peritoneal cavity by rupture.
Treatment is surgical.
🔹
C) Dermoid Cyst (Teratoma):
🔹 It is derived from primordial germ cells.
Relatively common, and contains elements of all
CANCER OVARY three layers of the early embryo (contain hair, teeth,
🔹
This is the cut surface of a large (about 15 cm diameter) sebaceous glands).
mostly "solid" ovarian carcinoma indicating that it is high Bilateral in 12%, size between 5-10 cm, often pedunculated.
grade or poorly differentiated. 20% of all ovarian tumors, most frequently between 20-40
🔹
The yellowish areas indicate necrosis. years.
🔹 The tumors are almost benign.
Rapid growth during pregnancy,
2🔹 TRUE OVARIAN
treated by excision of the cyst.
NEOPLASIA
TREATMENT by fatema okoff -These may classified to:- DIAGNOSIS
🔹
Three forms of treatment: 1)CELOMIC EPITHELIUMTUMOURS Clinical symptoms
🔹
(Benign,borderline or malignant)(SEROUS and Are usually asymptomatic (Late diagnosis)
🔹
1) Surgery: Indicated in all stages of the diseases MUCINOUS cystadenoma). Abdominal mass.
🔹Total abdominal hysterectomy with bilateral salpingo-oopharectomy and omentectomy. 2)MESENCHIMAL ELEMENTS (fibroma, lymphoma) Compression of the bladder or rectum. Edema of the
🔹
3)SEX CORD TUMOURS legs or varicosities.
🔹De-bulking: The resection of as much as possible of the tumor to reduces its size. -Granulosa and Theca tumors.
🔹 Anorexia associated with cacuexia.
🔹
-Medullary male directed cells (Androblastoma ) Pain ( complicated tumors)
🔹 A second – look operation sometimes is indicated 6 month after chemotherapy
treatment for new staging, and excision residual tumor.
4)GERM CELL TUMOURS
-The primitive oocyte ( TERATOMA).
-Rests of oogenia (Dysgerminomas).
🔹 Menstrual abnormalities.
Feminization ( Sexual precocity, or post menopausal
bleeding).
2) Chemotherapy: Para clinical diagnosis:
Combination of drugs are used including: Pregnancy test.
( Cysplatin, Adriamycine, Cyclophosphamide, 5,Fluracil, Vincristine) Ultrasound.
can be used before or after surgery or alone as in stage 1V. Laparoscopy.X-Ray.C.T scan. IVP.
Barium enema.
3) Radiotherapy Laparotomy.
Is now almost never used in the routine management of ovarian carcinoma.
🔹
Tumor markers in blood:
🔹 CA 125 in Epithelial neoplasias
🔹
🔹
Alfa – feto – proteins in Yolk sac tumors
HCG (in Choriocacinoma
🔹
🔹
CEA (Carcino-Emberionic Antigens) in Yolk sac tumors
LDH (lactic acid dehydrogenase) in Dysgermeioma
🔹 Estradiol in Granulose or Theca cell tumors
Testestron in Sertoli – Lydge cell tumor
🔹
DIFFERENTIAI DIAGNOSIS
Small Ovarian Tumors
1- Pyo-or hydrosalpings
2- Broad ligament cyst.
3- Retroverted pregnant uterus.
4- Uterine myoma. 🔹
Complications:
🔹 Axial Torsion.
5- Ectopic pregnancy
6- Pelvic kidney 🔹
🔹
Hemorrhage(intra cystic)
Rupture.
🔹
7-Distended bladder.
Big ovarian tumors 🔹
🔹
Infection
Malignant changes
1) Pregnancy.
2) Obesity.
3) Ascites.
🔹 Pseudomyxoma peritonei
Incarceration
4) Full urinary bladder.
5) Cystic degeneration of myoma.
6) Cancer rectum.
