THE OVARY AND OVIDUCTS pdf

651

OVARY

Ovarian tumors are classified as benign (neoplastic and nonneo￾plastic), premalignant, or malignant. Benign nonneoplastic disease

of the ovary is usually of an inflammatory or infectious nature and

is discussed in Chapter 24 and Chapter 28. Table 23-1 details a clas￾sification of nonneoplastic ovarian lesions, Table 23-2 is the WHO

classification of ovarian neoplasms, and Table 23-3 gives the char￾acteristics of common ovarian neoplasms.

BENIGN OVARIAN NONNEOPLASTIC

CYSTS

The clinical assessment and therapy of benign ovarian masses have

been greatly aided by modern imaging techniques and the use of

oral contraceptives to decrease pituitary gonadotropin stimulation.

Sonographic scanning is the most frequently applied imaging tech￾nique for ovarian masses. Imaging modalities aid in the differenti￾ation of ovarian enlargements from other masses or fullness in the

pelvis, determine the structure of a tumor (solid or cystic, multi￾locular or unilocular), determine the size of a tumor (often difficult

by physical examination in obese patients), and document the

change in size of masses over time. In complex cases (e.g., cancer)

more sophisticated imaging techniques (e.g., MRI) may assist in

preoperative determinations.

Oral contraceptives administered daily for 4–8 weeks will re￾solve 80% of functional cystic ovarian masses not requiring sur￾gery. Surgery for benign lesions in the premenopausal patient is re￾moval of the lesion (cystectomy), not oophorectomy. The general

indications for operative intervention are listed in Table 23-4.

23

THE OVARY AND OVIDUCTS

CHAPTER

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TABLE 23-1

CLASSIFICATION OF OVARIAN TUMORS

Nonneoplastic lesions

Inflammatory diseases of the ovary

Adhesive disease due to subacute or chronic

infections

Endometriosis

Peritoneal inclusions

Nonneoplastic cysts

Follicle cysts

Lutein cysts (corpus luteum, theca lutein cysts)

Polycystic ovarian disease (Stein-Leventhal

syndrome)

Focal proliferation

Thecosis

Cortical granuloma

Luteoma of pregnancy

Ovarian neoplasia (mesothelial)

Mesothelial tumors (primarily epithelial)

Serous

Mucinous

Endometroid

Mesothelioid tumors

Mesotheliomas

Mesothelial tumors (primarily stromal)

Fibroadenoma

Cystadenofibroma

Brenner tumor

Granulosa-theca cell tumor

Sertoli-Leydig cell tumor

Gonadal stromal tumors

Stromal (mesenchymal) tumors

Fibroma

Fibromyoma

Gonadal stromal tumors

Sarcoma

Germ cell tumors

Dysgerminoma

Teratoma

Embryonal

Extraembryonal

Endodermal sinus

Polyvesicular vitelline (yolk sac)

Choriocarcinoma

Gonadoblastoma

Metastatic tumors and secondary malignant tumors

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FOLLICLE CYST

Follicle cysts are normal, transient, and often multiple, physiologic

structures resulting from faulty resorption of the fluid from incom￾pletely developed follicles. They occur most frequently in young,

menstruating women and are the most common cysts found in nor￾mal ovaries. Their diameter may be microscopic to 8 cm (2 cm av￾erage). Grossly, they are translucent, thin walled, and filled with

clear to slightly yellow fluid. Histologically, the wall of the cyst is

formed by closely packed, round granulosa cells overlying a deeper

layer of spindle-shaped theca cells.

Follicle cysts are usually asymptomatic and disappear sponta￾neously in 60 days. If symptoms occur, they usually involve an

abnormally long or short intermenstrual interval. Intraperitoneal

bleeding and torsion are rare complications. Any cyst that contin￾ues to enlarge or persist
60 d warrants further investigation. The

usual investigation for cysts 4 cm is initial ultrasound examina￾tion, reexamination in 6 weeks and again in 8 weeks if the cyst per￾sists. In follicle cysts 4 cm or if a small cyst is persistent, oral

contraceptives for 4–8 weeks should cause resolution of the cyst.

CORPUS LUTEUM CYST

After ovulation, the granulosa cells become luteinized to form a

corpus luteum. If blood leaks into the cavity during this process

(which involves marked vascularization), a corpus hemorrhagicum

is formed. Resolution involves resorption of the blood, and a corpus

luteum cyst remains. A corpus luteum is termed a corpus luteum

CHAPTER 23

THE OVARY AND OVIDUCTS 653

TABLE 23-2

WORLD HEALTH ORGANIZATION CLASSIFICATION

OF OVARIAN NEOPLASMS

Common epithelial tumors

Sex cord stromal tumors

Lipid (lipoid) cell tumors

Germ cell tumors

Gonadoblastoma

Soft-tissue tumors (not specific to ovary)

Unclassified tumors

Secondary (metastatic) tumors

Tumorlike conditions (not true neoplasm)