1. PELVIC MASS
OF
OVARIAN/ADNEXAL
ORIGIN
By Ezmeer Emiral

2. Differentials Diagnosis
 Ovarian
 Adnexal
 Uterine
 Gastrointestinal
 Bladder,Kidney,Peritoneal

3. OVARIAN
Benign Ovarian Malignant Ovarian
Neoplasm Neoplasm
Physiological Cysts

4. Physiological cyst
This groups includes follicular,corpus lteal and theca luteal cyst
Usu <5cm, have thin wall and well encapsulated
Usu unilocular & contain clear fluid
Follicular cyst
Results from unruptured Graafian follicle/failure of atresia in
non-dominant follicle
Seldom >5cm (May achieve up to 10cm)
Thin wall + well encapsulated
May resolve spontaneously
f/up every month for 3 months; US guided asp/ laparoscopy
Corpus luteum cyst – progesterone prod
 Occurs when corpus luteum cyst become ruptured or bleeding
occurs into it and subsequently fails to regress
 Size similar to follicular cyst and usually regresses with time
 Patient can present with acute abdomen if bleeding occurs and
the cyst rupture.
 Treatment:Analgelsia /surgery
 Theca luteal cyst-associated with multiple pregnancy.Most resolved
spontaneously.

5. OVARIAN TUMOURS
Benign epithelial tumours Malignant
Serous & mucinous PRIMARY:
cystadenoma  Epithelial cell
Brenner tumour  Germ cell
Endometriod cystadenoma  Sex Cord Stroma
Benign germ cell T SECONDARY:
Mature teratoma  Metastatic eg: Krukenberg
Dermoid cyst tumour
B. Sex cord stromal T.
Theca cell
Sertoli- leydig tumour
Granulosa cell

6. 40+ years

7. Epithelial Tumours
Arise from the simple cuboidal surface epithelium of the ovary
Account for 80-85% of all ovarian tumours
Classified according to the following histological subtype
o serous
o mucinous
o endometrioid
o clear cell
o Brenner
o undifferentiated.
Each subtype can be classified as benign, borderline (low malignant
potential, LMP), or malignant (invasive).
Usu found in postmenopausal women (mean presentation age is 56 years )

8. serous tumours mucinous tumours
 Benign (60%)  Benign (25%)
- unilocular  Single layer of tall, columnar
 single layer of flattened or cells
cuboidal epithelium and the  Unilateral, multilocular
absence of mitoses.  The cyst fluid is thick, yellow
 Cyst fluid is clear, thin and ,glutinous + mucin-producing
colourless. cells
 Papillae formation  Malignant
 Malignant (25%)  Solid CA in the wall
 multiloculated  Columnar cell, mitoses
 partially cystic, partially solid
tumours with friable papillae.
 Capsule smooth or irregular or
show papillary projections.

9. Papillary serous cystadenocarcinoma.
Note the many papillations on the inner
surface.
Papillary serous cystadenocarcinoma
Composed of solid tissue and has
invaded outside of the ovary, with
papillations seen over the surface.

10. Germ Cell Tumours
 Derived from primitive germ cells of the embryonic
gonad, and may undergo germinomatous or
embryonic differentiation.
 Affecting young women (peak incidence is early 20s
accounting for more than 50 % ovarian tumour of this
age group)

11. TERATOMA (dermoid cysts)
•Unilocular cyst (<15cm)
•Contain sebaceous glands, teeth, hair, nervous tissue, cartilage, bone,
resp & intestinal & thyroid tissue
•Long pedicle, heavy & easily undergo torsion
•Histologically, a variety of mature tissue elements may be found.
•Most common presentaion is acute onset of pain &sudden onset nausea
Bilateral mature cystic teratoma Opened mature cystic of ovary. A ball of
hair & mixture of tissue

12. Sex Cord Stromal Tumours
Develop from the gonadal stroma
Account for 5-10 % of all ovarian neoplasms
Subdivided into the following clinicopathological entities:
 Granulosa cell tumour
estrogen producing tumour
 Theca cell tumour
androgen producing tumour
 Sertoli-Leydig cell tumour -
 Ovarian Fibroma – Meig’s syndrome: ascites, pleural eff, fibroma – 1%

13. •Derived frm the ovarian stroma and
mostly malignant.
•Produce large amounts of estrogen.
•Accelerated skeletal growth & appearance
of sex hair
•5% (children) – precocious puberty
•60% (childbearing age) – irreg menses
•30% (post-menopausal) – PM bleeding
Granulosa cell tumour with
variegated cut surface.
Estrogen excess causes
hyperplasia of:
1. Myometrium ~
enlarged uterus
2. Endometrium ~ irreg Granulosa cell tumour has
bleeding. Occ amenorrhea nests of cells which are forming
primitive follicles.
3. Mammary gland tissue
~ enlargement, tender

15. Metastatic Tumours
Most common: from breast carcinoma
also from: colon ca
endometrial ca
Krukenberg tumour
 1° growth : stomach,
 Age 30 – 40 yrs
 Clinically silent
 Bilat, equal size, mobile, smooth & lobulated
 HPE : very cellular stroma
: signet-ring appearance + clear mucin- filled
cytoplasm

16. Krukenberg tumor of ovary
Metastatic adenocarcinoma to ovary appears as a large mass and
resembles a primary tumor:
Seen here extending out of the pelvis at autopsy is a large right ovarian
mass. Metastases are also present in the lower right portion of liver.

17. Adnexal/Tubal
 Endometrioma
 Hydrosalphinx
 Tubo-Ovarian Abcess

18. Endometrioma/ endometrioid
cyst
 Part of the condition known as endometriosis.
 Commonly seen in nulliparaous/women of
reproductive years.It may cause pelvic pain
associated with menstruation.
 ‘Chocolate cyst’, often filled with dark, reddish-
brown blood, may range in size from 0.75-8
inches
 Th cyst arise from recurrent bleeding from
endometric foci placed within substance of
ovary.

19. Hydrosalphinx
 Tubal masses that – a long-term sequale of
pelvic inflammatory disease.
 The tubes are dilated & distended with clear
fluid.
 Hydrosalpinx fluid is highly embryotoxic and is
a likely cause for the decreased fertility in
women with a hydrosalpinx. In fact,
spontaneous abortion risk is doubled.

20. Tubo-Ovarian Abcess
 Collection of pus and bacteria within the part
of the fallopian tube.
 Symptoms include lower abdominal pain,
back pain, vaginal discharge and fever.
 Treatment includes antibiotic and NSAIDS.In
severe abcess may require narcotic pain
medication and drainage of abcess/surgery.