ch 9. Ovarian Cysts and Tumors

Posted: May 13, 2012 in Gynocology

The ovaries: The ovaries are two small organs located on either side of the uterus in a woman’s body.Each ovary is about the size of an almond. The ovaries make the female hormones — Progesterone and other hormone Estrogen, which trigger Menstruation. Every month, the ovaries release a tiny egg. The egg makes its way down the fallopian tube to potentially be fertilized. This cycle of egg release is called Ovulation.

Ovarian cyst : An ovarian cyst is any collection of fluid, surrounded by a very thin wall, within an ovary. Any ovarian follicle that is larger than about two centimeters is termed an ovarian cyst. An ovarian cyst can be as small as a pea, or larger than an orange.Surgery may be required to remove cysts larger than 5 centimeters in diameter.

Most ovarian cysts are functional in nature and harmless (benign).Ovarian cysts affect women of all ages.Ovarian cysts are found in nearly all premenopausal women, and some % of postmenopausal women.They occur most often, however, during a woman’s childbearing years.

Types :

Follicular cyst  or Graafian follicle cyst : This type of simple cyst can form when ovulation does not occur or when a mature follicle involutes (collapses on itself).

Features :

  1. Most common Ovarin cyst.
  2.  Forms at the time of Ovulation.
  3. Can grow to about 2.3 inches(6 cm) in diameter.
  4. The rupture of this type of cyst can create sharp severe pain called,Mittelschmerz .

    Follicular Cyst

Corpus luteum cyst: This type of functional ovarian cyst occurs after an egg has been released from a follicle. After this happens, the follicle becomes what is known as a corpus luteum. If a pregnancy doesn’t occur, the corpus luteum usually breaks down and disappears. It may, however, fill with fluid or blood and persist on the ovary.

Features :

  1. No symptoms.
  2. Forms after  Ovulation.
  3. It can  grow to almost 4 inches(10cm ) in diameter .
  4. A corpus luteum cyst rarely occurs at age 50+, because eggs are no longer being produced in menopausal women.

    Corpus luteum cyst

Dermoid Ovarian Cysts : A dermoid cyst is a cystic teratoma that contains developmentally mature skin complete with hair follicles and sweat glands, sometimes clumps of long hair, and often pockets of sebum, blood, fat, bone, nails, teeth, eyes, cartilage, and thyroid tissue.. Old textbooks showed dermoids as a tiny “humunculous,” or human being within the ovary. It is an abnormal cyst that usually affects younger women and may grow to 6 inches in diameter.

1 = Uterus,
2 = Dermoid cyst,
3 = Fallopian tube,
4 = Ovary

The twin within A dermoid cyst

Endometriomas or endometrioid cysts or Chocolate cyst of ovary: An endometrioma, endometrioid cyst, endometrial cyst, or chocolate cyst is caused by endometriosis, and formed when a tiny patch of endometrial tissue (the mucous membrane that makes up the inner layer of the uterine wall) bleeds, sloughs off, becomes transplanted, and grows and enlarges inside the

ovaries.

Endometrioma Caused by Endometriosis.

Polycystic ovarian syndrome : Polycystic is a term that simply means “many cysts.” The polycystic ovary typically contains many small – usually less than 1 centimeter – cysts (fluid-filled sacs). These cysts are usually arranged around the surface of the ovary.

Features :

  1. Forms at the time of Ovulation.
  2. Many <1 cm diameter follicular cysts.
  3. Can be found in women with high level of male hormone (testosterone).
  4. Decreased insulin activiy.

    Polycystic Ovarian Syndrome

    Mucinous Cystadenoma of Ovary:

     A cystadenoma is a type of benign tumor that develops from ovarian tissue. They may be filled with a mucous-type fluid material. Cystadenomas can become very large and may measure 12 inches or more in diameter.

    Mucinous Cystadenoma of Ovary Pic 2

    Mucinous Cystadenoma of Ovary Pic 1

Ovarian Tumors :

Ovarian Tumors is cancer that is found in the Ovaries are typically viewed as common however most are benign.Some malignant tumors cause reproductive tract cancer.

Etiology : Hereditary factors such as mutation in genes associated are BRCA1 and BRCA2  . BRCA1 has an associated risk of 45% and BRCA2 risk is 25%

Three types are recognized:

1. Epithelial Tumors – 85% – these occur in the tissue termed epithelial that cover the outer layer of the ovaries
2. Germ Cell Tumors – occur in the cells whose function is to produce eggs and is often seen in women of younger age
3. Stromal Tumors – are found in ovarian tissue referred to as connective tissue where estrogen and progesterone are produced

Staging :

  •  Stage I – Remains in one or both ovaries
  • Stage II – Extends into pelvic region
  • Stage III – Extends into pelvic region and beyond such as small bowel
  • Stage IV – Distant spread to other organs such as liver liver

Symptoms:

  1. – Abdominal pain
  2. – Back pain
  3. – Mass or nodule
  4. – Abnormal vaginal bleeding
  5. – Ascites
  6. – Urinary urgency
  7. – Decrease or loss of appetite
  8. – Indigestion
  9. – Constipation
  10. – Bloating
  11. – Weight loss

Treatment :

– Surgical removal is often necessary
– Chemotherapy

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