Benign Ovarian Masses

Benign Ovarian Masses

Benign ovarian masses are non-cancerous in origin.  It can be classified into Dysfunctional ovarian cysts, Benign epithelial neoplastic cyst, Solid benign tumors, and Tubo-ovarian abscess.

FUNCTIONAL OVARIAN CYSTS

Funnctional cysts are usually less than 1.5cm in diameter and mostly resolve spontaneously within 6 to 12 weeks.  These commonly occur during the childbearing years.

Follicle Cysts

These are the most common cystic structures seen in healthy and normal ovaries.  Follicle cysts arise from either nonrupture of the mature follicle or the inability of the immature follicle to undergo the normal degeneration process of degeneration. 

Corpus Luteum Cysts

Corpus luteum cysts are less common than follicular cysts.  They may bleed within the cyst cavity.  These may also rupture and cause bleeding within the abdominal cavity, particularly in patients taking anticoagulant therapy.

BENIGN EPITHELIAL NEOPLASTIC CYSTS OF THE OVARY

Epithelial cysts comprise approximately 60% of ovarian new growths.  Mucinous cysts are commonly found in women aged 30 to 50 years old.  These tumors tend to be quite big and may cause ovarian torsion, or twisting of the ovary, leading to compromise of its blood supply. 

SOLID BENIGN TUMORS OF THE OVARY

The most common benign ovarian tumor is the fibroma.  These most commonly occur in women in their postmenopausal years.  They occur on one side, are slow growing, and are at least 3cm in size.  Mature teratomas, also known as dermoid cysts, contain structures such as hair, teeth, skin, and thyroid, bronchial, and central nervous system tissues. 

TUBO-OVARIAN ABSCESS

Tubo-ovarian abscesses are initially caused by infection and inflammation of the endometrium, or the lining of the uterus, which spreads to the fallopian tubes then to the ovaries.  Clinical manifestations include lower abdominal pain, fever and chills, excessive vaginal discharge, heavy and prolonged menstrual bleeding (menorrhagia), urinary problems, and sterility.  Pelvic examination findings show tenderness upon motion of the cervix.  This is treated by a combination of intravenous antibiotics such as ampicillin, gentamycin, metronidazole, or clindamycin.  In cases where antibiotic response is inadequate, placing a drain into the abscess or surgical exploration may be performed.  In most cases, total abdominal hysterectomy and bilateral salpingo-oophorectomy (removal of the uterus and both ovaries and fallopian tubes) may be necessary.

Clinical Features

Majority of the benign tumors have no presenting symptoms.  They may occasionally cause irregularities with the menstrual cycle.  Hemorrhagic corpus luteum cysts may present with pain or signs of inflammation of the abdominal cavity (peritonitis) especially when the cyst had ruptured.  Severe pelvic pain can result from ovarian torsion especially if the tumor has grown to more than 4cm in size.

Diagnosis

Transvaginal ultrasonography is an easy and rapid method in identifying and evaluating ovarian pathology.  Tumors with radiographic characteristics of cancer, such as several locules, irregular shape, cystic and solid components, may require excision. 

Treatment

Most benign ovarian masses less than 8cm resolve spontaneously.  Serial ultrasonography is performed to documents its resolution.

Surgical resection of the cyst from the ovary via laparoscopy or laparotomy may be needed in cases where the cysts are more than 10cm in size and persist for more than 3 menstrual cycles, teratomas less than 10cm, hemorrhagic corpus luteum cysts with signs of peritonitis, and fibromas and other solid tumors. 

Surgical removal of the ovary is necessary in the following: fibromas that cannot be removed by cystectomy, cystadenomas, teratomas more than 10cm, tumors than cannot be surgically removed separately from the ovary, and tumors more than 5cm in postmenopausal women. 

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