GYNECOLOGICAL LESIONS

WHAT IT IS CAUSE/PP CHARACTERISTICS LOCATION STATS SIGNS & SYMPTOMS MGMT AND TX DDX OTHERS
GROSS HISTO
VULVA
URETHRAL Small, fleshy mass Dec estrogen. 1-2 cm in dm Transitional and Posterior Postmeno & -Ulcerations produce spotting Initial: oral/ topical Dx: biopsy under Divided accdg to
CARUNCLE Believed to arise from single stratified squamous portion of the premenarchal -Bleeding estrogen and avoidance of local anesth appearance:
an ectropion of the Bright red epithelium with loose urethral women Variable: irritation
posterior urethral wall Soft, smooth, friable CT meatus -asymptomatic Ddx: -papillomatous
assoc w/ retraction and Sessile, maybe Submucosal layer w/ - some w/ point tendernes after If it does not regress/ 1. primary -Granulomatous
atrophy of postmeno pedunculated large dilated veins contact with undergarments or sumptomatic: cryosx, laser carcinoma of the -angiomatous
vagina. sex therapy, fuguration, urethra
Growth secondary to excision 2. prolapse of the
chronic irritation. * small, asumptomatic does urethral mucosa
not need tx. 3. malignant
lesions
*Foley catheter placed for
48-72 hours to prevent
urinary retention
CYST Median age for dx Lesions occur as
1. Bartholin duct - MC large cyst of the Non-inflamed: sterile, Fairly Non-inflamed: no tx unless is 57 y/o. carcinomas
cysts vulva clear, mucinous fluid common. large enogh to cause
Highest discomfort
incidence
among women Inflamed: oral AB &
in their 60s. drainage
3rd decade
2. Mucous gland Occlusion of the Small cysts: 0.5 to 2
cysts vestibule cm
Clear, yellow or blue
3. Wolffian duct Thin walls w/ clear, Near the Rare.
cysts or mesonephric serous fluid clitoris and
cysts lateral to
hymenal ring
4. Skene duct cysts Sec. to infection and Usu. small Ant. Wall of Rare. discomfort Excision w/ careful Urethral diverticula
scaarring of the small the vagina dissection
ducts

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 along the
distal urethra
5. epidermal/ typical epidermoid cyst 0.5- 2 cm Hair-bearing Non-inflamed: asymptomatic No tx if non-inflamed *Vulvar
epidermoid cysts develops from 1 to several areas epidermal cysts
embryonic remnants of Firm, smooth Rupture leads to do not have
an surfaced inflammation: heat applied sebaceous cells or
anatomically locally and possibly sebaceous
malformed Firm to shotty incision and drainage. material identified
pilosebaceous unit. on microscopic
Incision reveals recurrently infected or examination but
white, caseous matl, produce pain: excised when have keratin
cheese-like the acute inflammation has produced by
White, yellow, subsided. keratinocytes in
slightly pink, skin the
colored papules/ lining of the cyst
nodules wall
Nontender, slow-
growing.
Contents usu under
pressure.
6. inclusion cyst bits of epithelium are site of an Large epidermal
implanted in the skin episiotomy or cysts may be
during surgery or obstetric confused with
trauma sufficient to laceration fibromas, lipomas,
break the skin surface and hidradenomas.
NEVUS localized nest or
cluster of melanocytes

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 1. vulvar nevi one 3-10 mm Histologically the congenital asymptomatic Proper excisional biopsy all vulvar nevi ABCD:
of the most common blue to dark brown to lesions are junctional should be 3D & adequate in should be excised asymmetry,
benign neoplasms black, and some may subdivided into nevus >2 cm = width and depth. and examined border
be three major groups: 10% lifetime histologically. irregularity,
amelanotic. junctional (a risk. 5 to 10 mm margin + Color variegation,
flat, elevate or symmetric macule), dermis flat and a diameter
peduncuLated compound, and dysplastic nevi junctional nevus usually >6 mm
intradermal nevi is 15x and the dysplastic
borders are sharp, the (both papules) that of the nevus:
color even, and the general greatest potential
shape is symmetrical population. for malignant
transformation

2. dysplastic nevi 6 to 20 mm
with one or more
atypical features such
as speckling of color,
diffuse margination,
additional red, white,
or blue hues, and
asymmetry.
3. melanoma 2nd MC malignancy 2% to 3% of Family history
arising all of the of melanoma is
in the vulva melanomas one of the
occurring in strongest risk
women factors for the
disease.
older, white,
women with a
mean age at
diagnosis
of 68 years

50% of
malignant
melanomas
arise from a

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 preexisting
nevus
HEMANGIOMA rare malformations of usually single, 1 to multiple channels frequently are asymptomatic; occasionally Asymp. hemangiomas & change in size
blood vessels rather 2 cm in diameter, flat, are predominantly discovered they hemangiomas with compression
than true neoplasms and soft, and they thin-walled initially during may become ulcerated and in children rarely require and are not
range in color from capillaries arranged childhood bleed. therapy. encapsulated
brown to red or purple randomly and
separated by thin Adults: initial treatment of
connective tissue large symptomatic
septa hemangiomas that are
bleeding or infected
may require subtotal
resection.

If ddx is questionable:
excisional biopsy

hemangioma + troublesome
bleeding=
cryosurgery, sclerotherapy,
or with the use of
lasers.

1. strawberry Congenital defects Bright red to dark red Spontaneous

hemangioma discovered in young Elevated resolution occurs
children Rarely inc in size before age 6.
after age 2
2. cavernous Usu purple and vary
hemangioma in size
larger
lesions extending
deeply into the
subcutaneous tissue
3. senile or cherry common small lesions most often less than 3
angiomas that arise mm in diameter,
multiple, and
redbrown to dark blue
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 on the labia majora,
usually in
postmenopausal women
4. angiokeratomas approximately twice 30-50 y/o Kaposi sarcoma noted for their
the and angiosarcoma rapid growth and
size of cherry tendency to bleed
angiomas, are purple during strenuous
or dark red exercise

5. pyogenic overgrowth of approximately 1 cm wide and deep excision to These lesions

grAnulomas inflamed granulation in diameter, usually a prevent recurrence grow under the
tissue. small nodule that is hormonal
slightly pedunculated influence of
and appears “pinched pregnancy, w/
in” at the base. similarities to
lesions in the
oral cavity.

They may be
mistaken
clinically for
malignant
melanomas, basal
cell carcinomas,
vulvar
condylomas, or
nevi.
FIBROMA MC benign solid a few centimeters (1- Fat or muscle cells Labia majora All age grps. Smaller fibromas: operative more frequent
tumors of the 10 cm) up to a of microscopically asymptomatic removal if the fibromas are than lipomas, the
vulva. weight more than 250 may be associated Larger: chronic symptoms or symptomatic or continue to other common
pounds with the interlacing acute pain when they grow. benign tumors of
fibroblasts. degenerate Occasionally they are mesenchymal
smaller fibromas are removed for cosmetic origin
-subcutaneous reasons
nodules they actually arise
-As they increase in from deeper
size and connective

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 weight, they become tissue=
pedunculated dermatofibromas
- firm
-grow slowly
larger tumors often - low-grade
become cystic after potential for
undergoing becoming
myxomatous malignant
degeneration

-smooth surface and a

distinct contour
- On cut surface the
tissue is gray-white.

LIPOMA 2nd most frequent type -softer and usually usually more periclitorally Unless extremely large, Excision They are slow
of benign vulvar larger than fibromas homogeneous or lipomas do not produce is usually performed to growing, and their
mesenchymal tumor -smaller than 3 cm. than fibromas. within the symptoms. establish the diagnosis, malignant
- common hamartoma -When a lipoma is Prominent areas of labia majora although smaller potential is
of fat, lipomas cut, the substance is connective tissue tumors may be followed extremely low.
of the vulva are similar soft, yellow, and occasionally conservatively
to lipomas of other lobulated. are associated with
parts of the body the mature adipose
cells of a true lipoma.
ENDOMETRIOSIS Uncommon at vulva secondary to - firm, small nodule usually found 1 in 500 most common symptoms: wide excision or laser The gross and
metaplasia, retrograde or nodules : may be at the site of women pain and introital dyspareunia. vaporization depending on microscopic
lymphatic cystic or solid and an old, with the size of the pathologic picture
spread, or potential vary from a few healed endometriosis The classic history is cyclic mass. of vulvar
implantation of millimeters to several obstetric will present discomfort and an enlargement endometriosis is
endometrial tissue centimeters in laceration, with vulvar of the mass associated with Recurrences are common similar
during operation. diameter. episiotomy lesions. menstrual periods. following inadequate to endometriosis
site, an area operative of the pelvis
- subcutaneous of removal of all the involved
lesions: blue, red, or operative area and as a result, most
purple, depending on removal of a would also
their size, activity, Bartholin recommend medical
and closeness to the duct cyst, or therapy with continuous
surface of the skin. oral contraceptives,
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 along the progestins, or GnRH
canal of agonists.
Nuck.
VAGINA
URETHRAL permanent, may be congenital or small, from 3 mm to 3 diverticulum is lined Open into the 30-60 y/o nonspecific and are identical to Classical symptoms are one should suspect often present as a
DIVERTICULUM epithelialized, saclike acquired cm in diameter. by epithelium; midportion of Peak: 4th the symptoms of a chronic in nature. urethral mass of
projection that arises however, there is a the urethra decade lower urinary tract infection. diverticulum in any the anterior
from the posterior - repetitive or chronic lack of muscle in the The most common woman with vaginal wall and
urethra infections of the saclike pocket common symptoms associated with chronic or represent
periurethral glands problem: urethral diverticula are recurrent lower approximately
1% to 3% of urinary urgency, frequency, urinary tract 84% of
women and dysuria symptoms. periurethral
masses
-/+ hematuria - Gartner duct cyst,
an ectopic ureter Occasionally,
3D: Dysuria that multiple
Dyspareunia empties into the suburethral
Dribbling urethra, and Skene diverticula occur
glands cysts in the same
woman.

INCLUSION CYST most common cystic birth trauma or 1 mm to 3 cm lined by stratified posterior or more asymptomatic. dyspareunia or pain=
structures of the gynecologic surgery Inclusion cysts squamous lateral walls common in excisional biopsy.
vagina usually result from epithelium. of the lower parous women
third of the
These cysts contain a vagina
thick, pale yellow
substance site of a
that is oily and previous
formed by episiotomy or
degenerating at the apex of
epithelial cells the vagina
following
hysterectomy
DYSONTOGENIC thin-walled, soft cysts most commonly mesonephros upper half of 1 in 200 asymptomatic, sausageshaped Small asymptomatic -A large cyst
CYSTS of single, may be (Gartner duct cyst): the vagina females tumors that are discovered Gartner duct cysts may be presenting at the
embryonic origin. multiple. cuboidal, nonciliated only incidentally during pelvic followed conservatively. introitus may be
epithelium examination. mistaken for a
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 - 1 to 5 cm in Operative excision is cystocele, anterior
diameter and paramesonephricum indicated for chronic enterocele, or
-multiple small cysts (Müllerian cyst): symptoms. obstructed
may present like a columnar, Rarely, one of these cysts aberrant ureter.
string of large, soft endocervical-like becomes infected, and if
beads. epithelium operated on during the
acute phase,
urogenital sinus marsupialization of the cyst
(vestibular cyst) is preferred.
Excision of the vaginal cyst
may be a much more
formidable operation than
anticipated. The cystic
structure may extend up
into the broad ligament and
anatomically be in
proximity to the distal
course of the ureter.
CERVIX
ENDOCERVICAL most common benign usually secondary to Cervical polyps: Focal hyperplasia and Endocervical classic symptom of an Most may be managed in endometrial - may arise from
AND CERVICAL neoplastic growths of inflammation or single polyp, but localized polyps: endocervical polyp: the office polyps, small either the
POLYPS the cervix abnormal focal multiple polyps do proliferation multiparous intermenstrual bleeding, by grasping the base of the prolapsed myomas, endocervical
responsiveness to occur occasionally. women in especially following contact polyp with an appropriately retained products canal
endo more common hormonal stimulation majority are smooth, surface epithelium of their 40s and such as coitus or a sized of conception, (endocervical
than cervical soft, reddish purple to the polyp is columnar 50s. pelvic examination clamp. The polyp is avulsed squamous polyp) or
cherry red, and or squamous with a twisting motion and papilloma, ectocervix
fragile. They readily epithelium, -/+ associated leukorrhea sent to sarcoma, and (cervical polyp)
bleed when touched. depending on the site the pathology laboratory for cervical
of origin and the Many endocervical polyps are microscopic evaluation. malignancy. base @
Endocervical polyps: degree of squamous Asymp. The polyp endocervix:
may be single or metaplasia is usually friable. If the narrow, long
multiple and are a few base is broad or bleeding pedicle and occur
millimeters to 4 cm in Six different ensues, the base during the
diameter. histologic subtypes may be treated with reproductive years
have been chemical cautery, from the
endocervical polyps: described: electrocautery, or ectocervix: short,
cherry red adenomatous cryocautery. After the broad base and
(>80%), cystic, usually occur in
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 cervical polyps: fibrous, vascular, polyp is removed, the postmenopausal
grayish white inflammatory, and endometrium should women.
fibromyomatous. be evaluated in women
difficult to palpate older than 40 who have
because of its soft presented with
consistency abnormal bleeding, to rule
out coexisting pathology, as
The stalk is composed significant endometrial
of an edematous, pathology is found in
inflamed, loose, and approximately 5% of
richly vascular asymptomatic women with
connective tissue. endocervical polyps.

NABOTHIAN retention cysts of produced by the -may be translucent or Rarely, a woman with several asymptomatic, and no
CYSTS endocervical columnar spontaneous healing opaque whitish or large nabothian treatment is necessary.
cells occurring where a process yellow in color cysts may develop gross
tunnel or cleft has been of the cervix. -microscopic to enlargement of the cervix.
covered by squamous The area of the macroscopic size,
metaplasia. These cysts transformation zone of with the majority
are so common that the cervix between 3 mm and 3
they are considered a is in an almost constant cm in diameter.
normal feature of the process of repair, and
adult cervix. squamous metaplasia
and inflammation may
block the cleft of a
gland orifice.
The endocervical
columnar cells
continue to secrete, and
thus
a mucous retention cyst
is formed
CERVICAL smooth, firm masses Grossly and many hyalinized, Because of 3% to 8% of small and asymptomatic Management is similar to The diagnosis of a A cervical myoma
MYOMA that are similar to histologically, thick-walled blood the relative myomas are that of uterine myomas. cervical myoma is is
myomas of the fundus cervical myomas are vessels that paucity of categorized as
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 identical to and are postulated to be smooth cervical Symptoms depend on the drxn Treatment of cervical by inspection and usually a solitary
indistinguishable the source of the muscle fibers myomas. in w/c the enlaring myoma myomas that grow laterally palpation growth in contrast
from myomas of the neoplastic smooth in the expands & produces may become a challenge if to uterine
corpus of the uterus. muscle cervical symptoms secondary to myomectomy is the myomas, which
tumor (vascular stroma, the mechanical pressure on operation in general, are
leiomyoma) majority of adjacent organs. of choice, because of both a multiple.
myomas that complex blood supply and
appear to be -dysuria involvement with the distal
cervical Urgency or ureteral obstrxn course of the ureter.
actually arise Dyspareunia, obstrxn of cervix Cervical myomas may
from be treated by radiologic
the isthmus catheter embolization.
of the uterus Prolapsed uterine
myomas are discussed later
in this chapter
UTERUS
ENDOMETRIAL localized overgrowths Unknown -soft, pliable, and may 3 comp. of polyps: the fundus of occur in all Asymp. The optimal management A well-defined, Polypoid
POLYPS of endometrial be single or multiple. 1. endometrial glands the uterus. age groups - of endometrial polyps is uniformly hyperplasia is a
glands and stroma that Because -few millimeters to 2. endometrial peak incidence Symptomatic: wide range of removal hyperechoic mass benign condition
project beyond the polyps are often several centimeters in Stroma between the abnormal bleeding patterns by hysteroscopy with D&C that is less than 2 in which
surface of the associated with diameter, and it is 3.central vascular ages of 40 cm in diameter, numerous small
endometrium endometrial possible for a single channels and 49. MC bleeding patterns: identified by polyps are
hyperplasia, unopposed large polyp to fill the menorrhagia, premenstrual and vaginal ultrasound discovered
estrogen has been endometrial cavity - 2 of 3 polyps postmenstrual staining, and within the throughout the
implicated as a -may have a broad consist of an scanty postmenstrual spotting endometrial cavity, endometrial
possible etiology. base (sessile) or be immature is usually a benign cavity.
attached by a slender endometrium that endometrial polyp
pedicle does not respond to - Sometimes large
(pedunculated) cyclic changes in - submucous endometrial
circulating leiomyomas, polyps may
-Polyps are succulent progesterone. This adenomyomas, contribute to
and velvety, with a immature retained products infertility.
large central vascular endometrium differs of conception,
core. The color is from surrounding endometrial -Malignancy in an
usually gray or tan but endometrium and hyperplasia, endometrial polyp
may occasionally be often appears as a carcinoma, and is related to
red or brown. “Swiss uterine sarcomas patient’s

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 cheese” cystic age and is most
hyperplasia during all often of a low
phases of the stage and grade.
menstrual
cycle

-1/3 consist of
functional endometria
that will undergo
cyclic histologic
changes.
LEIOMYOMA/ Myomas/ fibroids/ familial tendency -may be single but corpus of the The lifetime In general, a third of myomas Although myomas do not - growth of
MYOMA fibromyomas most often are uterus prevalence of will become symptomatic have a true capsule, this myomas is
hypoxia is multiple leiomyomas is causing abnormal and pseudocapsule is a valuable dependent
-are benign tumors of implicated in early -vary greatly in size fallopian tube greater than excessive surgical plane during a on gonadal
muscle cellular events that lead from microscopic to or the round 80% among uterine bleeding, pelvic pain, myomectomy. steroids, and there
cell origin. to the myometrial multinodular uterine ligament, and African- pelvic pressure, bowel and are increased
smooth muscle cell to tumors that may approximatel American bladder -Symptomatic uterine numbers of
MC benign neoplasms transform into weigh more than 50 y 5% of women and dysfunction, infertility, leiomyomas : primary steroid receptors
of the leiomyoma pounds and literally uterine approaches recurrent miscarriage, and indication for 30% of all in myomas
uterus. fill the patient’s myomas 70% abdominal hysterectomies compared with
abdomen originate among white protrusion. normal
from the women myometrium.
Small myomas are cervix. prone to grow and become They are
round, firm, solid Rarely, highest symptomatic in nulliparous diagnosed only
tumors. With myomas will prevalence: women after menarche
continued growth, the arise in the 5th decade and tend to
myometrium at retroperitone -submucosal tumors: - regress
the edge of the tumor um and Risk factors abnormal vaginal bleeding after menopause
is compressed and produce -increasing -distortion
forms a symptoms age of the uterine cavity -infertility - broad ligament
pseudocapsule. secondary to - early or miscarriage. myoma: Growth
“mass menarche of a myoma
3 TYPES: intramural, effects” on -low parity in a lateral
subserous, and adjacent -tamoxifen use direction from the
submucous, with organs -obesity uterus. difficult to
special nomenclature -African- differentiate on
American pelvic
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 for broad ligament women( examination from
and parasitic myomas. highest a solid ovarian
incidence) tumor
1. submucosal tumor -familial
-5% to 10% of tendency Only 25% of
myomas tumors extend
-most troublesome Smoking: beyond the broad
clinically decreased ligament –
-associated with incidence of intraligamentary
abnormal vaginal myomata myoma
bleeding or distortion
of the uterine cavity Parasitic myoma
that may produce -outgrow its
infertility or abortion uterine blood
-enlarges and supply
becomes -obtain a
pedunculated.uterus secondary blood
will try to expel it  supply from
prolapse another organ,
such as the
2. Subserosal myomas omentum
-knobby contour
during pelvic
examination.
-Further growth may
lead to a pedunculated
myoma wandering
into the peritoneal
cavity

ADENOMYOSIS/ derived from aberrant associated with diffuse involvement -benign endometrial -found in up to Classic symptoms Hysterectomy :definitive Retrospective dx do not usually
ENDOMETRIOSIS glands of the basalis -increased parity of both anterior and glands, and stroma 60% of -secondary dysmenorrhea and treatment Transvaginal undergo the
INTERNA layer of the -uterine surgeries posterior walls of the are within the hysterectomy menorrhagia ultrasonography traditional
endometrium -traumas uterus- most common myometrium specimens in -dysmenorrhea becomes -For the woman in her late -sensitivity proliferative and
- posterior wall > -standard criterion women in the increasingly more severe as 40s, the ovaries are often between 53% and secretory changes
anterior wall used in diagnosis : late the disease progresses. removed as a risk-reducing 89% that are associated
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 -direct extension from - disruption of the finding of reproductive -pelvic examination: uterus is measure against ovarian -a specificity of with cyclic
the endometrial lining barrier between the endometrial glands years diffusely enlarged (2-3X carcinoma. 50% to 89% ovarian hormone
endometrium and focal area or and stroma more than LARGER) production
-hyperplasia and myometrium as an adenomyoma one low-powered - >50 %: -no satisfactory proven MRI
hypertrophy of initiating step. - asymmetrical uterus field (2.5 mm) from asymptomatic -uterus is globular and tender medical treatment for -more sensitive,
individual muscle - pseudocapsule the basalis layer of immediately before and during adenomyosis ranging between
fibers leading to the endometrium menstruation 88% and 93%
globular enlargement of -GnRH agonists, cyclic -higher specificity
the uterus hormones, or prostaglandin (66% to 91%)
synthetase inhibitors

OVIDUCT
ADENOMATOID The most prevalent - small, graywhite, - composed of small - tubal serosa (-)pelvic symptoms or signs
TUMORS benign tumor of the circumscribed tubules lined by a low - also found
oviduct nodules, 1 to 2 cm in cuboidal or flat below the
diameter epithelium. serosa of the
- unilateral and fundus of the
present as small - thin- walled uterus and
nodules just under the channels of the broad
tubal serosa mesothelial origin ligament

PARATUBAL often multiple and 3rd and 4th majority :small, asymptomatic, simple excision frequently
CYSTS may vary from 0.5 cm decades of life and slow growing incidental
to more than 20 cm in discoveries during
diameter symptomatic: produce a dull gynecologic
pain operations for
- are thin-walled and other
smooth and contain abnormalities
clear fluid.

1. Hydatid cysts of pedunculated near the

Morgagni fimbrial end
of the oviduct

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 OVARY
FUNCTIONAL
CYST
1. Follicular cyst - most frequent cystic - from either the - multiple - the ovarian majority are asymptomatic and - initial management Thin: may rupture - dependent on
structures in normal dominant mature - few millimeters to as cortex are discovered during :conservative observation. during examination gonadotropins for
ovaries follicle’s failing to large as 15 cm in ultrasound imaging of the growth
rupture (persistent diameter pelvis or a routine pelvic - majority disappear CA-125
A minimum diameter to follicle) - translucent, thin- examination spontaneously by either - Postmeno: helpful
be considered as a cyst: or an immature walled, filled with a . reabsorption of the cyst in evaluating the
2.5- 3 cm follicle’s failing to watery, clear to straw- - tenesmus, a transient pelvic fluid or silent rupture adenexal mass
undergo the normal colored fluid tenderness, deep dyspareunia, within 4 to 8 weeks of
-not neoplastic process of atresia - sometimes appear as or no pain whatsoever initial diagnosis. - premenopausal
translucent domes on women: rarely
the surface of the - Persistence:  operative helpful unless the
ovary intervention to mass is extremely
differentiate a physiologic suggestive of
cyst from a true neoplasm malignancy
of the ovary

- cyst should be removed if

there is any suspicion of
malignancy

Surgical if:
- CA-125 is abnormal (>35)

- or if the cyst is persistent

or large (>10 cm)

2. Corpus Luteum Halban’s classic triad may be associated with Grossly: smooth Produce dull, unilateral, lower Oral contraceptives: used to
Cysts 1. delay in a normal either normal surface, purplish red abdominal and pelvic pain. suppress ovulation and
period/spotting endocrine function or to brown avoid recurrent hemorrhage
2. unilateral pelvic pain prolonged secretion of Cut Section enlarged ovary is moderately
3. small, tender, progesterone - the convoluted tender on pelvic examination Cystectomy
adnexal mass lining is yellowish menstrual bleeding may be - Operative treatment of
orange normal or delayed several days choice, with preservation of
to weeks with subsequent
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 - the center contains menorrhagia: Depending on the remaining portion of the
an organizing blood the amount of progesterone ovary
clot secretion associated with cysts

may cause intraperitoneal

bleeding
often follows coitus, exercise,
trauma, or a pelvic
examination.

Bleeding: 20 and 26 of the

cycle

3. Theca Lutein Cysts -least common of the - prolonged or - external surface of Lining: composed of 50% of molar Conservative - presence of theca
three types of excessive stimulation the ovary appears theca lutein cells pregnancies lutein cysts
physiologic ovarian of the ovaries by lobulated. (paralutein cells), and 10%of 1. palpation
cysts endogenous or - small cysts contain a believed to originate choriocarcino 2. confirmed by
exogenous clear to straw-colored from ovarian mas : (+) ultrasound
- almost always gonadotropins or hemorrhagic fl uid connective tissue bilateral theca examination
bilateral lutein cysts
- increased ovarian - luteinization of
- produce moderate to sensitivity to granulosa cells
massive enlargement of gonadotropins
the ovaries
Hyperreactio
luteinalis(Development
of multiple luteinized
follicular cysts) 
ovarian enlargement

BENIGN
NEOPLASMS
1. BENIGN CYSTIC -aka dermoid cyst, - unilocular contain elements - account for - 50% to 60% asymptomatic Operative treatment: lap diagnosis often - chromosomal
TERATOMA mature teratoma - The walls of the cyst from all three germ more than cystectomy established: makeup of 46,XX
are a smooth, shiny, cell layers 90% of germ Presenting symptoms : pain with preservation of as semisolid mass is - tubercle of
- cystic structures opaque white color cell tumors of and the sensation of pelvic much normal tissue as palpated anterior to Rokitansky:
Cut Section: the ovary. pressure possible the broad ligament protrusion or
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 Teratoma A.K.A. - thick sebaceous composed of mature Complications nipple (mamilla)
“monstrous growth.” fluid pours from the cells - 20% to 25% - torsion during pregnancy: Approximately in the cyst
cyst, often with of all ovarian - rupture - removal in the second 50% of dermoids
-may be benign or tangled masses of hair malignant variety is neoplasms - Infection trimester have pelvic Three medical
malignant and firm areas of composed of - Hemorrhage calcifications on diseases also may
cartilage and teeth immature cells - 33% of all - malignant degeneration. Dermoids have a higher radiographic be associated with
- Among the most (immature teratoma) benign tumors incidence of torsion and examination dermoid cysts:
common ovarian potential for rupture during 1. thyrotoxicosis
neoplasms preponderance of - most pregnancy. ultrasound picture 2. carcinoid
ectodermal tissue common syndrome
with some ovarian 1. Dense echogenic 3. autoimmune
mesodermal and rare neoplasm in area within a larger hemolytic anemia
endodermal prepubertal cystic area
derivatives females and 2. a cyst filled *Struma Ovarii –
teenagers with bands of contains thyroid
mixed echoes tissues; 2-3% of
- 25 -50 years 3. an echoic dense teratomas
– 50% cyst

Bilaterality:
10% to 15%

2. FIBROMA most common benign, - vary in size from composed of approximately incidence of associated ascites Simple Excision Always Meigs’ syndrome
solid neoplasms of the small nodules to huge connective tissue 5% of benign is directly proportional to the differentiate with - 2% of ovarian
ovary pelvic tumors (spindle- shaped ovarian size of the tumor ovarian carcinoma fibroma
weighing 50 pounds. mature fibroblasts), neoplasms - ovarian fibroma,
Low malignant stromal cells, and approximately Pelvic symptoms ascites, and
potential: <1 % - heavy, solid, well varying amounts of 20% of all 1. pressure and abdominal hydrothorax
encapsulated, collagen interposed solid tumors enlargement - ascites and the
- extremely slow- grayish white between the cells of the ovary 2. there is no change in the hydrothorax
growing tumors Cut surface : pattern of menstrual flow resolve after
Homogeneous white 90% - removal of the
or yellowish white unilateral ovarian tumor
solid tissue with a
trabeculated or Average age –
whorled appearance 48 y/o

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 3. One of the most Vary from small (few Endometrial glands Most are asymptomatic UTZ: Thick walled
ENDOMETRIOMAS common causes of mm) to 5-10 cms in Endometrial stroma cyst with relatively
ovarian enlargement dm Hemosiderin – laden Symptoms: homogenous
large phagocytic cells 1. Pelvic pain echopattern
Cut section: 2. Dyspareunia
-Thick walled 3. infertility
- Chocolate – like
fluid Pelvic exam:
(Chocolate cyst) Ovaries are tender and
immobile

4. TRANSITIONAL Small, smooth, solid, Estrogen- producing  <5 cm in dm Nest of epithelial Benign, Asymptomatic UTZ: Extensvie
CELL / BRENNER fibroepithelial tumors endometrial cells surrounded by proliferative(l amorphous
TUMOR hyperplasia, Smooth, firm, gray – fibrous stroma ow Malignant 85-95 % unilateral calcifications
Classified as epithelial postmenopausal white solid tumors potential, within the solid
tumor bleeding which resemble Coffee- bean Malignant) – components of the
fibroma appearing nucleus in 2% of ovarian mass
1-2% malignant the epithelial cells tumors
transformation Occasionally –
yellowish tinge with - 40-60 y/0
small cystic spaces
-30% - with
concurrent
serous or
mucinous
tumor

5. Benign firm tumors that Adenofibroma: Gray Fibrous and epithelial Usually occur Bilateral – 20-25% TAHBSO
ADENOFIBROMA arise form the surface or white tumors with component in
AND of the ovary cystic spaces postmenopaus
CYSTADENOFIBR 1-15 cm in dm Mostly serous al
OMA epithelial component

Preponderance of
connective tissue
(25%)

BAYATING, LK
GYNE 2017
 True cystic gland
spaces lined by
cuboidal epithelium
with abundant fibrous
connective tissue
surrounding the the
cytic spaces

6. OVARIAN/ Important cause of INITIALLY: Acute, severe, unilateral, lower Salpingoophorectomy DDx:
ADNEXAL acute lower abdominal 1. Venous and abdominal and pelvic pain 1. Ruptured
TORSION and pelvic pain lymphatic obstruction Cystectomy corpus luteum
2. Cyanotic and Nausea and vomiting cyst
Occurs commonly in edematous ovary **Pulmonary embolism – 2. Adnexal abscess
patients in mid – 20s 3. Unilateral extremely Fever 0.2% risk
tender adnexal mass
Common with masses Leukocytosis
8-12 cms PROGRESSIVE
TORSION:
Right >left 1. Interruption of major
arterial blood supply
2. Hypoxia, adnexal
necrosis
3. Low grade fever,
leukocytosis

BAYATING, LK
GYNE 2017