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Approach To Patient With Ovarian Cysts: Done By: Yahyia Al-Abri 90440
Approach To Patient With Ovarian Cysts: Done By: Yahyia Al-Abri 90440
cysts
Done by: Yahyia Al-Abri
90440
Outline
• Definition of ovarian cyst
• Case scenario
• How to approach
– History, physical examination , investigation,
management.
• Functional ovarian cyst
• Benign ovarian neoplasm
• Mixed ovarian neoplasm
• Ovarian cancer
ovarian cyst
• An ovarian cyst is a sac filled with liquid or
semiliquid material that arises in an ovary.
• These cysts can develop in females at any stage of
life, from the neonatal period to postmenopausal
• Most ovarian cysts, occur during infancy and
adolescence, which are hormonally active periods
of development.
• Most are functional in nature and resolve without
treatment.
Case
• 19 years old Omani lady, Unmarried,
Presented to the A&E with history of
Abdominal left iliac fossa pain started 15
minutes prior coming to the hospital.
History Examination
Management Investigation
History
• Most patients with ovarian cysts are
asymptomatic
• Pain or discomfort may occur in the lower
abdomen
sudden, unilateral, sharp pelvic pain Cyst rupture
• Complex cysts
– Multilocular ,thickening of the wall, projections
into the lumen or on the surface,
Radiology
• CT scanning
– more sensitive but less specific than
ultrasonography in detecting ovarian cysts.
– best in imaging hemorrhagic ovarian cysts or
hemoperitoneum due to cyst rupture
– to distinguish other intra-abdominal causes
• CT scanning should be avoided in pregnancy,
– MRI
Procedure
• Diagnostic laparoscopy
– To inspect a suggestive adnexal cystic mass.
– advantage of decreased morbidity, improved
postoperative recovery.
Our case
• Labs done in the A&E:
- Hb 11.6 WCC 8.7
- U&E Normal
- Tumor markers normal
• U/S pelvis done:
– The right ovary is normal in size and appearance.
hyperechoic lesion about 5 cm on left ovary that is
new from old scan that can be hemorrhagic
complex cyst & can not rue out/in torsion
Calculation of the Risk Of Malignancy
Index (RMI)
• Surgical care
– laparoscopy or laparotomy, depending on clinical
presentation, amount of blood in the abdomen,
patient stability.
Our case
PLAN:
• consent taken for :
– Emergency laparoscopy ovarain cystectomy ,+/-
salpingectomy +/- salpingo oopherectomy
– risk of converted to laparotomy ,risk of veesels ,bowel
,bladder injuries ,risk of thrombosis , risk of infection all
explined to the pateint ,pateint`s father and mother
• Cross match, NPO
• Shift direct from A&E to the OT
Our case
Laproscopic findings:
– Left ovarian cystectomy
– Post-op Diagnosis: hemorrhagic cyst with clots, No ovarian
torsion
– Findings: Normal R ovary , pelvis, uterus and upper abdomen
• Day 1 Post op:
She is complaining of mild pain at surgical site.
- Mobilizing.
- Voided well.
- To be discharged with encouraging oral hydration and
analgesia.
- Appointment for tracing histopathology after 6 wks
- Earlier to A&E if any complains as explained.
What are the differential diagnosis of ovarian mass?
Pathogenesis Specific type
Functional Follicular cysts
Lutein cyst
Polycystic ovaries
Inflammatory Salpingo-oophoritis
Pyogenic oophoritis-puerperal,
abortal, or related to an intrauterine
device
Granulomatous oophoritis
Metaplastic Endometriomas
Neoplastic Premenarchal years-10% are
malignant
Menestruating years-15% are
malignant
Postmenopausal years-50% are
malignant
follicular cysts
Divided by cell
type of origin
A. Fitz-Hugh-Curtis syndrome
B. Lung cancer
C. Meig's syndrome
D. Leriche's syndrome
F. Liver failure
Germ cell tumors
• Occur at any age.
• Make up about 60% of ovarian neoplasms occurring in
infants and children.
• Most common benign cystic teratoma (dermoid cyst).
• 10-15% are bilateral.
• Slow growing tumor.
• Diagnosed b/w 25-50 yrs of age.
• <10 cm in diameter.
Teratomas
Dermoid cysts (teratomas) are one of the
most common types of cysts , half are
diagnosed in women between 25 and 50 years
A. Follicular cyst
B. Teratoma (dermoid cyst)
C. Endometrioma
D. Ovarian adenocarcinoma
E. Ovarian fibroma
Ovarian cancer
• It is the leading cause of death from gynecologic cancer
because it is difficult to detect before it disseminates.