ONLY IF YOU ENCYST.ppt

Only If You Encyst February 2023. Peter Larsen-Disney The Ovary A Dynamic Performer And A Collage of Tissue Types Functional Ovarian Cysts The Ovary A dynamic Performer Ovarian Cysts • 10% of women in the community have an ovarian cyst • 4th most common cause of gynae.admission • 4% of al...

Only If You Encyst February 2023. Peter Larsen-Disney The Ovary A Dynamic Performer And A Collage of Tissue Types Functional Ovarian Cysts The Ovary A dynamic Performer Ovarian Cysts • 10% of women in the community have an ovarian cyst • 4th most common cause of gynae.admission • 4% of all women in U.K. will be admitted with this by age 65 years. Ovarian Cysts • Ovarian cysts may be non-neoplastic or neoplastic • 90% are benign • Of surgically managed tumour 13% in premenopausal group and 45% in postmenopausal group are malignant. Symptoms of Ovarian Cysts • Asymptomatic • Pain • Menstrual disruption Symptoms of Ovarian Cysts • Pressure When should you worry about Asymptomatic Ovarian Cysts • >8cm • >5cm • Complexity of the cyst on USS • • • • Solid Septae Bilateral Free fluid Complications of Ovarian Cysts • • • • Torsion Rupture Haemorrhage infection Case Report 1 • 22 y.o. Woman G0P0 • Seen by G.P. With vague RIF pain • USS 5cm right ovarian cyst Case Report 1 • Presented to A & E with lower abdominal pain • Tenderness and guarding lower abdo • Repeat USS No cyst some free fluid Case Report 1 Ovarian Cyst Rupture • May be traumatic or spontaneous • symptoms depend on amount and character of contents • If mild conservative management is appropriate • Sequelae include peritonitis and pseudomyxoma peritonei Case Report 2 • 29 y.o. Woman presents with acute lower right sided abdominal pain. • Minimal abdominal signs • Tender 6cm mass right adnexum Case Report 2 • USS haemorrhage into a cyst • Management determined by symptoms • Conservative versus operative. Case Report 2 Ovarian Cyst Haemorrhage • Remember bleeding can be from the cyst rather than into it and can be dramatic. • Endometriomas Case Report 3 • 72 y.o woman G3 P2 • Occasional left sided twinges • Presents with acute abdominal pain with nausea and vomiting. • Tachycardia and temperature 37.8C • Lower abdo guarding and rigidity • Leucocytosis Case Report 3 ( cont.) • Tender 10cm mass high on left side of pelvis • USS 10cm ovarian mass. No doppler flow Case Report 3 Ovarian Cyst Torsion • Usually ovarian infarction has already occurred at the time of surgery • Salpingo-oophorectomy usual surgical treatment. • ?Laparoscopic The Ovary A Collage of Tissue Types Types of Cysts (neoplasms) of the Ovary • Epithelial • Benign • Borderline • Malignant • Germ Cell • Benign • Malignant • Stromal • Benign • Malignant Case Report 4 • 19 year old female presents with two year history of “fullness” in the right side of the pelvis. • deep dysparunia, but increasing urinary frequency • Periods normal • otherwise fit and well • mass felt in right adnexum Case Report 4 • USS: complex cystic mass ? Dermoid Case 4 • Laparoscopic ovarian cystectomy • Histology: Dermoid cyst. • Uneventful recovery Case 4 • • • • • • Malignant Germ cell tumours Young Women Often rapidly growing Usually Unilateral Express tumour markers Usually cured Case 5 • • • • 18 year old female. Nulliparous presents with recent onset of amenorrhoea noted also hair recession and hirsuitism on examination: clitoromegaly and slightly tender 10cm mass in left side of the pelvis. Case 5 continued • USS complex mass in pelvis mainly solid and vascular • blood test results • Laparoscopy • / laparotomy Case 5 – Stromal Tumour • • • • Sertoli-leydig tumour on histology stage one. Granulosa cell tumour most common Hormone producing because of stromal origin • rarely bilateral • prognosis for most is very good. Epithelial Ovarian Tumours • Benign • Borderline • Malignant Epithelial Ovarian Tumours • Tumour markers • RMI = MS x USSS x CA125 • USS ORAD SCORING • MRI USS 0RAD SCORING Management of Epithelial Ovarian Tumours • Benign • Borderline Epithelial Ovarian Cancer Case 6 • Patient aged 58 y.o. G3P2 • 6/12 of vague abdominal discomfort • Recent nausea and poor appetite and 1 stone loss of weight. • Increasing malaise and tiredness • On examination Case 6 continued • CT complex ovarian masses with ascites and upper abdominal disease Case 6 continued • Surgery • Staging / Debulking. • Chemotherapy • Carboplatin +/- Taxol • Bevacizumab (Avastin) • targets a cancer cell vascular endothelial growth factor (VEGF) Screening for Ovarian Cancer • FHx of Ovarian Cancer • Life time risk • 1 first degree relative with ovary or breast Ca • 2 or more relatives • Screening is of no proven benefit so only for the really high risk and after counselling Ovarian Cancer • Insidious Disease but it is not silent • Presents late • Remissions are often possible • Cures only in early stage disease