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Conditions of the Ovary

5th Year Lecture UFS
by

Inge Zondagh

on 18 July 2016

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Transcript of Conditions of the Ovary

Conditions
Of The Ovary

Dr I Zondagh
INFLAMMATORY
FUNCTIONAL Benign
NON -FUNCTIONAL BENIGN
MALIGNANT
24%
6%
70%
EPITHELIAL
GERM CELL
SEX-CORD
STROMAL

BORDERLINE
METASTATIC
Most Common
> 50 years
From Epithelial Surface of the Ovary
85%
10%
5%
SEROUS
ENDOMETROID
CLEAR CELL
MUCINOUS
BRENNER
UNDIFFERENTIATED
Most Common
Subtype
40-60y
50 - 70y
40 - 80y
Endometriosis?
But Endometriosis does NOT undergo malignant transformation.
10%
30 - 50y
15%
2 or More Components
Does Not Change Mx
From Primitive Germ Cells of Embryonic Gonad
Younger ( < 35y )
Curable
High Survival
Rupture / Tortion
DYSGERMINOMA
LDH
TERATOMA
YOLK SAC
CHORIO-
CARCINOMA
B-hCG
From Connective Tissue:
Embryonal Sex Cords
Ovarian Stroma and
Mesenchyme.
Steroid-Secreting Tumours.
FIBROMA
FIBRO-
SARCOMA
SERTOLI /
LEYDIG
GRANULOSA / THECA
Low Malignant Potential:
(Neither Benign, Nor Malignant)
Epithelium is Malignant:
Does Not Invade but Implants.
Slow-growing
Rx: SURGERY
Does not respond well to Chemo
SEROUS
MUCINOUS
ENDOMETROID
Breast
GIT - Stomach / Colon
Haemopoietic
Endometrium
RISK FACTORS
FAMILY HISTORY
Age
Lifestyle
Infertility (+ Clomiphene Citrate)
Nulliparous
Early Menarche, Late Menopause
Asbestos Exposure
Smoking
Obesity
Lack of Exercise
First Degree Relative
BRCA 1 and 2
Endometriosis
PROTECTIVE FACTORS
Preventing OVULATION:
Childbearing
Breastfeeding
Early Menopause
Oral Contraceptive
SCREENING
cA-125
BRCA1
BRCA2
? Prophylactic Salpingo-OOphorectomy
PRESENTATION
Insidious Onset
Abdominal Discomfort, Distension, Bloating,
Urinary Symptoms, Dyspepsia,
Fatigue, Weight Loss, Anorexia, Depression.
Pelvic / Abdominal Mass with Pain
Abnormal Uterine Bleeding
Ascites, Pleural Effusion
ETIOLOGY
75% Stage 3 / 4

Two Hypotheses:
Incessant Ovulation
Trauma - Malignant Transformation
Familial: 5 - 10%
Breast, Colon, Ovarian CA
Hysterectomy / Tubal Occlusion
Ca-125
CA 19-9
CA-125
ALPHA-FP
OESTROGEN
TESTOSTERONE
INVESTIGATIONS
ULTRASOUND
TUMOUR MARKERS
CXR
BIOCHEMISTRY
CT Abdomen and Pelvis
ULTRASOUND
Benign
Malignant
Simple
Thin Walled
Homoechogenic
No Projections
Unilateral
Complex
Thick Walled
Solid Areas
Papillary Projections
Bilateral
Ascites
Metastases
"TUMOUR MARKERS"
BLOOD INVESTIGATIONS
Ca-125
Ca 19-9
CEA
BhCG
LDH
Alpha-FetoProtein
Estrogen
Androgens
FBC
UKE
LFT
FOLLICULAR
LUTEAL
Most Common
Upto 10cm in Diameter
Thin-Walled
Unilocular
(Estrogen - AUB)
Corpus Luteum
Less Common
Right > Left
> 3cm in Diameter (7-8cm)
Delayed Menstruation: Distinguish from Ectopic with BhCG
ENDOMETRIOMA
Endometriosis
Accumulated Menstrual Blood
Multilocular + Bilateral
Incidental when complaining of Dysmenorrhoea and Subfertility
PCOS
Follicles 2-9mm
GERM CELL
Uncommon
Mostly younger than 20y
Predominantly Solid
Immature Neural Tissue
Dedifferentiated = Worse Prognosis
Rx: Surgery + Chemo
TERATOMA
Mature Cystic
Mature Solid
Dermoid Cyst
- All 3 Germ Cell Layers
- 40% of Tumours in Children + Young Adults
Bilateral (10%)
Unilocular
< 15cm in Diameter
Rupture / Tortion
Uncommon
If predominantly solid:
Exclude Malignancy
EPITHELIAL
SEX CORD
STROMAL
Hormone Secretion
2%
Slow-Growing
20's - 30's
Hydrosalpinx
Pyosalpinx
Pseudocysts
PID
RMI =
US Score x Menopausal Score x Ca-125 in U/ml


MBcHB 5 Lecture
Related to Ovulation
Reproductive Years
Continuous Gonadotropin Stimulation
Failure to Ovulate
THECA LUTEIN
Hydatidiform Mole
Induction of Ovulation
- OHSS
Bilateral
Clear Light Yellow Fluid
> 25 cm: Hyperreactio Luteinalis
Grape-Like
MX:
Wait and See (after menses)
Provera 5mg x 5/7
NSAIDs
Do NOT Aspirate!
Complications
Persist - ? Fx: Laparoscopy
Rupture / Bleeding
Torsion
PARAOVARIAN CYSTS
Not From Ovary
Embryological Remnants: Wolffian Duct
Benign + Clear Liquid
May Reach 15 cm
Surgery
ULTRASOUND
CA-125
Ovarian Enlargement is NOT early.
ALL women: LOW PREVALENCE.
Only in HIGH RISK populations.
> 35 IU / L (+ U/S = Laparotomy)
Endometrial Ca
MMMT
Benign, Solid
Postmenopausal Women
15% - Ascites
1% - Pleural Effusion
MEIGS' Syndrome
Cystadenoma
Calcifications =
Psammoma Bodies
Carcinoma
2nd Most Common
Pseudomyxoma Peritonei
(Large Majority is Benign)
Microscopicly After Oophorectomy
Urothelial Metaplasia
tubal epithelium
endometrial epithelium
endometroid metaplasia
Precocious Puberty
Anovulation
Menstrual Irregularity
PMB
Virilisation
Gynandroblastoma
Premenarchal > 2cm
Postmenarchal > 8cm

Needs Surgical Exploration
Tendency to occur BILATERAL
Most Common Malignant GCT
Practice Fertility Sparing Surgery
Highly Sensitive to Chemo and RadioRx
Thyroid Tissue = Stroma Ovarii
Highly Malignant
Rapidly Reaches 25cm
5y Survival = 70%
Extremely Rare
Poor Prognosis
Full transcript