Benign Tumors & Anatomy of Female Reproductive System

Benign Tumors of the Female Genital Tract

• Presentation by Dr. Alamin Babeker Mohamed, assistant professor of obstetrics & gynecology
• Objectives:
  • Describe benign tumors of the genital tract
  • Identify clinical presentation and management

Anatomy of the Female Reproductive System

• Shows the uterus, ovaries, fallopian tubes, endometrium, cervix, and vagina.
• Labels key components for understanding location.
• Diagrams illustrate the relative positioning.

Benign Ovarian Cysts

• Images of a woman's reproductive organs depict ovarian cysts.
• Labels show follicular cyst and its location.

Clinical Presentation

• Possible symptoms in patients with benign tumors of female reproductive organs include a pelvic/abdominal mass.
• Pelvic/abdominal pain may occur due to pressure on the bladder or bowels, or possibly from torsion.
• Benign tumors can be found incidentally during diagnostic imaging (ultrasound) or surgery.
• Differential diagnoses include pregnancy, appendicitis, and tubo-ovarian abscess.
  • Other possible diagnoses include uterine or ovarian tumors, fallopian tube tumors, bowel tumors and urinary bladder tumors.

Causes of Benign Ovarian Cysts

• Functional cysts:

  • Follicular cyst
  • Corpus luteal cyst
  • Theca luteal cyst

• Inflammatory cysts:

  • Tubo-ovarian abscess
  • Endometrioma

• Germ cell cysts:

  • Benign teratoma

• Epithelial cysts:

  • Serous cystadenoma
  • Mucinous cystadenoma
  • Brenner tumor

• Sex cord stromal cysts:

  • Fibroma
  • Thecoma

Investigations

• Common diagnostic tests for a variety of female reproductive organ conditions:
  • Complete blood count (CBC)
    • White blood cell count (WBC)
    • C-reactive protein (CRP)
  • Ultrasound (transvaginal or abdominal)
  • Computed tomography (CT) scan of the pelvis
  • Magnetic resonance imaging (MRI)
  • Human chorionic gonadotropin (hCG): used to rule out pregnancy.
  • Tumor markers (CA 125, CAE, CA-19, AFP, beta-hCG, Inhibin): used to evaluate possible tumor presence

Functional Cysts

• Follicular ovulatory cyst average size: 2.5 cm.
• Can enlarge to 3-10 cm.
• Corpus luteal cysts are postovulatory.
• Theca luteal cysts may be associated with pregnancy.
• Management includes monitoring with ultrasound and analgesia.
• Rare cases may require surgical or laparoscopic cystectomy.

Inflammatory Ovarian Cyst

• Usually associated with pelvic inflammatory disease (PID).
• Potential involvement of ovaries, fallopian tubes, or even the bowel.
• Characterized by symptoms and signs of PID and inflammatory markers.
• Treatment typically involves analgesia and antibiotics.
• Surgical excision may be required in some cases.

Benign Germ Cell Tumor

• Dermoid cyst (mature teratoma) is a common benign germ cell tumor.
• Primarily affects young females.
• 10% of cases are bilateral.
• Contains tissues like teeth, hair, and fat.
• Malignant transformation is rare.
• MRI is the diagnostic technique of choice.
• Management often involves cystectomy, possibly with ovariectomy (removal of the ovary).

Benign Epithelial Ovarian Tumors in Females

• Peri-menopausal women commonly develop benign epithelial ovarian tumors.
• Serous cystadenoma are typically unilateral and unilocular.
• Mucinous cystadenomas are typically multilocular.
• Brenner tumors are small and may secrete estrogen.

Sex Cord Stromal Ovarian Tumors

• Commonly found in postmenopausal women.
• Ovarian fibromas are benign, solid tumors.
• Meigs' syndrome is characterised by a combination of ovarian fibroma, pleural effusion, and ascites.
• Thecoma is an estrogen-secreting tumor, and postmenopausal bleeding suggests this type of tumor as a potential cause.
• Patients with thecoma have a possible risk of endometrial cancer.

Benign Tumors of the Uterus

• Uterine fibroids (leiomyomas)
• Endometrial and cervical polyps

Uterine Fibroids

• Benign, firm, whorled tumors of uterine smooth muscle.
• Typically estrogen-dependent, with rapid growth potential, possible during pregnancy's second trimester.
• Potential complications include red degeneration, hyaline change, cystic formation, calcification, necrosis, and inflammation.
• Malignant transformation (sarcoma) is infrequent (1 in 200 cases).
• Clinical presentations:
  • Menorrhagia (heavy menstrual bleeding) can lead to anemia, if caused by submucous fibroids
  • Pain, if caused by intramural or submucous fibroids.
  • Subfertility from obstructions of the endometrial cavity and/or fallopian tubes.

Types of Fibroids

• Intramural fibroids: located within the uterine wall.
• Subserosal fibroids: located beneath the outer layer of the uterus.
• Submucosal fibroids: located beneath the inner lining of the uterus.

Investigation & Management of Fibroids

• Investigation Includes hemoglobin level, and ultrasound of fibroid site, size, and urinary system.
• Management:
  • Conservative (medical): treatments such as tranexamic acid, mefenamic acid, combined oral contraceptive pills, and gonadotropin releasing hormone agonists.
  • Surgical: procedures like myomectomy (fibroid removal) and hysterectomy (removal of uterus), or uterine artery embolization (UAE).

Endometrial Polyps

• Outgrowths of the uterine lining.
• Can be pedunculated or sessile (attached directly).
• May be multiple or single.
• Treatment involves removal if symptoms persist for three months or more.
• Considered insignificant in those under 40 years.
• Diagnosis typically via ultrasound or hysteroscopy.
• Biopsy may be needed in perimenopausal women to rule out simple or atypical hyperplasia.

Cervical Benign Tumors: Cervical Polyps

• Asymptomatic or present with postcoital bleeding (PCB).
• May cause intermenstrual bleeding (IMB).
• Diagnosis via pelvic examination and speculum.
• Management usually involves polypectomy, surgically removing the polyp.

Nabothian Follicles

• Mucus-filled cysts on the cervix.
• Typically not significant.
• Rarely require treatment, though large ones might require drainage.

Vulval Benign Tumors: Bartholin's Cyst

• Cysts in the Bartholin's gland area.
• Common findings with inclusion cysts.

General

• A question-and-answer section follows the presentation.
• Presenter expresses gratitude to the audience.