OVARIAN MASSES 1. PHYSIOLOGICAL CYSTS • Most asymptomatic
• Commonest in young women
• Occur during normal ovarian cycle
• May occur in
– Ovulation induction – Premature females infants – Women with trophoblastic disease. a) Follicular
• Lined by granulosa cells
• Results from
– non-rupture of a dominant follicle – failure of atresia in a non-dominant follicle. – May resolve or enlarge even unto 10cm – Occasionally may continue production oestrogens o Menstrual disturbances
o Endometrial hyperplasia
b) Luteal
• Less common
• More likely to present with intraperitoneal bleeding
• Referred to as cysts if more than 3cm diameter.
2. BENIGN GERM CELL TUMOURS • Among commonest tumours (ovarian) in women less than 30yrs
• Only 2 – 3% malignant but in under 20s
o 1/3 may be malignant
• May contain all the three germ cell layers (ectoderm, mesoderm and endoderm)
• Differentiation into extraembryonic tissues – ovarian choricarcinoma or endodermal
sinus tumour • Without differentiation – dysgerminoma
a) Dermoid cyst (mature cystic teratoma) • Results from differentiation into embryonic tissues
• Accounts for around 40% of all ovarian neoplasms
• Commonest in young women, median age 30yrs.
• Bilateral in about 11% of cases
• Usually unilocular and less than 15cm diameter and with ectodermal structures
predominant. – ectodermal – lined by epithelium and has skin appendages, teeth, sebaceous material, hair and nervous tissue. – Endodermal – thyroid, bronchus, intestine, struma ovarii – tumours predominantly
thyroid tissue. 5.6% – hyperthyroid – Carcinoid – some thyroid tissue – Mesodermal – bone, cartilage and smooth muscle. • Majority asymptomatic
• Complications – acute abdomen
