Gynecology 2.

1b

Benign Neoplasms of Oviducts and Ovaries

OUTLINE
I.

II.

Dr. Co-Hidalgo
Something AD

Oviducts
a.
b.
c.
d.
Ovaries
a.
b.
c.
d.
e.
f.
g.
h.
i.

j.

Usually located on the SEROSAL SURFACE

Usually unilateral and present as small nodules just under the tubal serosa
Do not produce pelvic symptoms or signs, and also found below the
serosa of the fundus
Do not become malignant

Leiomyoma
Angiomyoma
Paratubal Cyst
Adenofibroma
Follicular Cysts
Corpus Luteum Cysts
Theca Lutein Cysts
Benign Neoplasm of Ovaries
Benign Cystic Teratoma
Endometriosis
Ovarian Fibroma
Epithelial Cystic Tumors
Brenner Tumor
Ovarian Remnant Syndrome

LEARNING OBJECTIVES
1. To be able to finish this accursed trans in the middle of Christmas break.
REFERENCES
Unless otherwise stated, everything came from the ppt.
Recording information is italicized
th
Chapter 18, Comprehensive Gynecology (6 Edition)
* Trans Group/Editors Notes

C. PARATUBAL CYSTS
Often multiple from 0.5 to more than 20 cm in diameter
Usually an incidental finding during pelvic surgery, during routine
hysterectomy or explore laparotomy
Located within the broad ligament between the tube and the ovary
Translucent containing clear or pale yellow fluid
Small, asymptomatic, slow growing and are discovered during the third
and fourth decades of life
Thin-walled, soft and contain clear fluid. Often, there are multiple small
cysts
If you identified the ovary and it is normal and there is a cyst beside it,
can be a paratubal cyst

FALLOPIAN TUBES (OVIDUCT)

*Dra. Focused her discussion on the more common conditions of the oviduct (bold)

Leiomyomas
Adenomyotoid Tumor
Adenofibromas
Paratubal Cysts
Cystic Mesthelioma
Serous Cystadenoma

Figure 2. 2cm Non-neoplastic cyst with broad ligaments abuts the normal ovary.

CLINICAL MANIFESTATIONS
Usually asymptomatic
Dull pain is produced if symptomatic
o There are no symptoms unless they are stretched or if there is torsion
Oviduct is often stretched over a large Paratubal cyst. The oviduct should
not be removed in these cases because it will return to normal size after
excision of the cyst
They can grow rapidly during pregnancy
TORSION usually happens during pregnancy or during puerperium
Tubal torsion is usually accompanied by torsion of the ovaries. Torsion is
secondary to an ovarian mass in 50-60% of patients and common
among women of reproductive age
Acute lower abdominal and pelvic pain, sudden or gradual, 48 hours
duration is an important symptom of torsion. Pain may be located in the
iliac fossa, radiating to the thigh and flank.

A. LEIOMYOMAS
*Not discussed but part of PowerPoint.

Underreported
Tubal leiomyomas may be single or multiple and usually are discovered
in the interstitial portion of the tubes
Usually coexist with the more common uterine leiomyomas
May originate from muscle cells in the walls of the tube or blood vessels
or from smooth muscle in the broad ligament
May be subserosal, interstitial or submucosal
Present as smooth, firm, mobile, usually non-tender masses that may be
palpated during the bimanual examination
Appear as a spherical mass that protrudes from beneath the peritoneal
surface, varying from a few mm to 15 cm diameter
Majority are asymptomatic
Rarely, they may undergo acute degeneration or be associated with
unilateral tubal obstruction or torsion
Treatment if symptomatic is excision

TREATMENT

Simple excision

D. HYDATID CYSTS OF MORGAGNI

Paratubal cysts which are pedunculated and near the fimbrial end of the
fallopian tube

B. ADENOMATOID TUMORS or ANGIOMYOMA

Figure 3. Hydatid Cyst of Morgagni. Broad Ligament Cyst. This parovarian, paratubal
cyst, is thin walled and contains clear watery fluid.
Figure 1. Adenomatoid Tumor.

MOST COMMON BENIGN TUMOR OF THE FALLOPIAN TUBE

MESOTHELIAL in origin though some authors say that it is an endothelial
origin in rare tumors
Small, well-circumscribed nodule, whitish (gray-white, 1-2 cm)

Group 1 | Kuh-h8tr; Vajeana; Renaughn; IKEA

E. ADENOFIBROMA
Occasionally reported but more a recent study revealed that
adenofibromas are common in the tubes
Almost exclusively located in the distal (fimbrial) portion
More solid
Page 1 of 6

GYNECOLOGY 2.1b

OVARIES
Functional Cysts, hence no treatment is needed, will resolve in 3-6
months
If you see the patient today and after 3 months, a follicular or physiologic
cyst should already disappear during this time frame.
You let the patient come back day 5 to day 7 of menses, and this should
disappear.

A. FOLLICULAR CYSTS
MOST FREQUENT CYST IN NORMAL HEALTHY OVARIES
Arise from temporary pathologic variation of a normal physiologic
process
Result from either failure of a dominant follicle to rupture (persistent
follicle) or failure of an immature follicle to undergo the normal process
of atresia (failure to resorb follicular fluid)
Lined with inner layer of granulosa cells and an outer layer of the theca
interna cells
Occurs during all stages of life: fetal to postmenopausal period
Translucent, thin walled, unilocular filled with a watery, clear to straw
colored fluid
Mostly asymptomatic, do not do anything unless it is very big but usually
it will resolve spontaneously.
Mostly diagnosed in routine gynecological exam
No solid component, just clear liquid inside
Situated in the ovarian cortex, and sometimes appear as translucent
domes on the surface of the ovary
May be found as early as 20 weeks gestation in female fetuses and
throughout a womans reproductive life. Found most commonly in young,
menstruating women.
Multiple, varies from few mm to 15 cm diameter.
Not neoplastic and are believed to be dependent on gonadotropins for
growth. They arise from a temporary variation of a normal physiologic
process
May present with signs and symptoms of ovarian enlargement, rule out
an ovarian neoplasm

May rupture during examination, because of their thin walls. May

present with tenesmus, transient pelvic tenderness, deep dyspareunia,
or no pain whatsoever

MANAGEMENT
Conservative observation is the initial management. The majority of
follicular cysts disappear spontaneously by either reabsorption of the
cyst fluid or silent rupture within 4 to 8 weeks of initial diagnosis.
Ultrasound reveals anechoic or black structure (purely fluid)
Observe for 3-6 months, then let the patient come back for ultrasound
on day 5-7 of menses and check if it is still there
Oral contraceptives may be prescribed for 4 to 6 weeks

B. CORPUS LUTEUM CYSTS

Less common than follicular cysts, but clinically more important
Mainly result from intracycstic hemorrhage
All corpora lutea are cystic with gradual reabsorption of a limited amount
of hemorrhage, which may form a cavity.
Minimum of 3 cm diameter
They may be associated with normal endocrine function or prolonged
secretion of progesterone
Menstrual pattern may be normal, delayed menstruation or amenorrhea
2-4 days post-ovulation, during the stage of vascularization, thin-walled
capillaries invade the granulosa cells from the theca interna.
Spontaneous but limited bleeding fills the central cavity of the maturing
corpus luteum with blood.
If the hemorrhage into the central cavity is brisk, intracystic pressure
increases and rupture is possible.

Group 1 | Kuh-h8tr; Vajeana; Renaughn; IKEA

If cystic central cavity persists, blood is replaced by clear fluid, and the
result is a hormonally inactive corpus albicans cyst

CLINICAL MANIFESTATIONS
Asymptomatic to severe abdominal pain because of intraperitoneal
bleeding associated with rupture
Most ruptures occur on cycles day 20-26
Can produce hemorrhage and some are explored due to pain
Produce dull, unilateral, lower abdominal and pelvic pain
Enlarged ovary is moderately tender on pelvic examination
Depending on the amount of progesterone secretion associated with
cysts, the menstrual bleeding may be normal or delayed several days to
weeks with subsequent menorrhagia.
Classic triad of delay in a normal period followed by spotting; unilateral
pelvic pain; and a small, tender, adnexal mass (similar to ectopic
pregnancy)

DIAGNOSIS
Vaginal ultrasound is useful for diagnosis. Shows an anechoic mass.

DIFFERENTIAL DIAGNOSES
Ectopic Pregnancy - differentiate with serum or urinary HCG
Ruptured Endometrioma
Adnexal Torsion

TREATMENT
Observation for mild pain or minimal peritoneal fluid will resolve
Cystectomy is the operative treatment of choice since it is conservative

Figure 4. Corpus Luteum Cyst on Ultrasound (left). Hemorrhagic corpus luteum with
an outer yellow rim and central hemorrhage (right).

C. THECA LUTEIN CYSTS

Almost always bilateral secondary to hundreds of thin-walled lobules
or cysts, producing a honeycombed appearance
Produce moderate to massive enlargement of the ovaries
Vary in size from 1 cm to 10cm or more in diameter
Arise from other prolonged or excessive stimulation of the ovaries by
endogenous or exogenous gonadotropins or increased ovarian
sensitivity to gonadotropins
LEAST COMMON OF THE PHYSIOLOGIC OVARIAN CYSTS
Produces an enlarged ovary, larger than corpus, usually seen in
hydatiform mole
50% molar pregnancies and 10% choriocarcinomas have associated
bilateral theca lutein cysts. HCG from trophoblast produces luteinization
of the cells in immature, mature, and atretic follicles
External surface of the ovary appears lobulated
Small cysts contain a clear to straw-colored or hemorrhagic fluid

CLINICAL MANIFESTATIONS
of women with smaller cysts are asymptomatic
Generally only the larger cysts produce vague symptoms, such as a
sense of pressure in the pelvis
Ascites and increasing abdominal girth have been reported with
hyperstimulation from exogenous gonadotropins.
Majority

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GYNECOLOGY 2.1b

DIAGNOSIS
Palpation followed by transvaginal ultrasound for confirmation
Presence of theca lutein cysts is established by palpation and confirmed
by ultrasound

TREATMENT
Conservative because they usually regress spontaneously
Bleeding is difficult to control in these cases because of the thin walls
that constitute the cysts. No attempts should be made to drain or
puncture them.

Figure 5. Bilateral Theca Lutein Cysts. Note its lobulated appearance

RELATED CONDITIONS TO THECA LUTEIN CYSTS

1. HYPERREACTIO LUTEINALIS
Ovarian enlargement secondary to the development of multiple
luteinized follicular cyst

2. LUTEOMA OF PREGNANCY
Rare, specific, benign hyperplastic reaction of ovarian theca lutein cells
Asymptomatic
Discovered during caesarian section or postpartum ligation
NOT A TRUE NEOPLASM
Regress spontaneously following completion of pregnancy
Nodules do NOT arise from the corpus luteum of pregnancy
50% are multiple, and 30% have bilateral nodules
Incidental findings during surgery of solid, fleshy often hemorrhagic
nodules
Masculinization of the mother in 30% and sometimes the female fetus

Figure 6. Luteoma of pregnancy with numerous solid brown nodules.

Figure 7. 3cm Luteoma with multiple reddish nodules.

D. BENIGN CYSTIC TERATOMA

Dermoid Cyst, Mature teratoma
Teratoma literally means monstrous growth.
Teratomas of the ovary may be benign or malignant. Although dermoid is
a misnomer, it is the most common term used to describe the benign
cystic tumor, composed of mature cells, whereas the malignant variety
is composed of immature cells (immature teratoma).

Dermoid

is a term that emphasizes the preponderance of ectodermal

tissue with some mesodermal and rare endodermal derivatives
st
Believed to arise from a single germ cell after the 1 meiotic division.
They develop from totipotential stem cells and are neoplastic sequelae
from a transformed germ cell.
Account for more than 90% of germ cell tumors of the ovary
Certain elements from all three germ cell layers
May contain a malignant component usually in >40 years old: found in
1% of cases and usually a squamous carcinoma
Occurs from infancy to postmenopausal years
MOST COMMON OVARIAN NEOPLASMS
MOST COMMON OVARIAN NEOPLASM IN PREPUBERTAL AND
TEENAGERS
Bilaterality is 10 to 15%
Grow from few mm to 25cm in diameter
Doughy consistency upon palpation and usually unilocular
50-60% are asymptomatic, but others may present with pain and
sensation of pelvic pressure
Torsion most frequent complication of a dermoid.
Associated medical conditions are thyrotoxicosis, carcinoid syndrome,
autoimmune hemolytic anemia
DIAGNOSIS
is often established when a semisolid mass is palpated anterior
to the broad ligament
50% have pelvic calcifications on radiographic exam
Ultrasound - These characteristics include a dense echogenic area within
a larger cystic area, a cyst filled with bands of mixed echoes, and an
echoic dense cyst
Diagnosis

TREATMENT
Cystectomy for young patients, pre-menopausal, especially the
nulligravid (remove the cyst and retain ovarian tissue)
Salphingo-oophorectomy for older patient with a complete family
(remove the fallopian tubes and ovaries)

NOTABLE SH*T
1. TUBERCLE OF ROKITANSKY
Protrusion or Mamilla in the cyst wall containing mostly solid elements.
Most solid elements arise and are contained in a protrusion or nipple
(mamilla) in the cyst wall, termed the prominence or tubercle of
Rokitansky.
May be visualized by ultrasound as an echodense region.
If malignancy occurs, it is most always found in this nest of cells.
The wall of the cyst will often contain granulation tissue, giant cells, and
pseudoxanthoma cells
2. STRUMA OVARII ()
A teratoma in which the thyroid tissue has overgrown other elements and
is the predominant tissue.
Usually unilateral and measure less than 10 cm in diameter.
Less than 5% develop thyrotoxicosis, which may be secondary to the
production of increased thyroid hormone by either the ovarian or the
thyroid gland.

Group 1 | Kuh-h8tr; Vajeana; Renaughn; IKEA

Figure 8. Mature cystic teratoma (dermoid cyst) filled with hair

and keratinous debris with one solid nodular area (Rokitansky
protuberance).
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GYNECOLOGY 2.1b
E. ENDOMETRIOSIS
Patches of normal endometrium located outside of the uterus
MOST COMMON LOCATIONS for these implants are on the
o Ovary
o Anterior and posterior cul-de-sac
o Posterior broad ligament
o Uterosacral ligament
o Uterus
o Fallopian tube
o Sigmoid Colon
o Appendix
o Round ligament
Size varies from small superficial, blue-black implants that are 1 to 5 mm
diameter to large, monoculated hemorrhagic cysts 5 to 10 cm
Endometriomas are areas of ovarian endometriosis that become cystic
Ovarian surface is often pucked, irregular and scarred

CAUSE
The specific cause of endometriosis is not known
Several theories can, in part, explain the existence of endometriosis
1. IMPLANTATION THEORY
o During menses, some reflux of menstrual products back through the
fallopian tubes occurs.
o Viable endometrium can land on a favorable site and, if tolerated by
the patients immune system, can establish enough of a blood supply
to live and respond to the cyclic ovarian hormones
2. COELOMIC METAPLASIA THEORY
o The peritoneal cavity contains some cells that have retained their
undifferentiated nature and, given the proper stimulus, may grow
and differentiate into endometrial cells.
INCIDENCE
Exact incidence of endometriosis in the general population is not known.
Endometriosis is found in
o 6% to 43% of women undergoing sterilization
o 12% to 32% of women undergoing laparoscopy for pelvic pain
o 21% to 48% of women undergoing laparoscopy for infertility
o 50% of teenagers undergoing laparoscopy for chronic pelvic pain and
dysmenorrheal
Usually associated with endometriosis in other areas of the pelvic cavity

CLINICAL PRESENTATION
are asymptomatic, but most common symptoms are pelvic pain,
dyspareunia and infertility
About half of the women who are demonstrated to have endometriosis
have no symptoms at all
Classically, women with symptomatic endometriosis present with a
chronic steadily worsening pelvic pain. It is worse with menses and
sometimes worse with ovulation. It may be focal or diffuse but its
location is usually constant.
A second classical symptom is painful intercourse on deep penetration.
Less common is painful bowel movements. If Implants are located on
the rectosigmoid or close to it (uterosacral ligaments), then she may
experience pain while actually passing her stool.

On

pelvic exam, ovaries are often tender and immobile, secondary to

associated inflammation and adhesions

Most

CLASSICAL PHYSICAL FINDINGS

Unusual tenderness and thickness (a dough-like consistency) in the
adnexal areas.
Tender nodules along the uterosacral ligament, usually appreciated best
on combined recto-vaginal bimanual exam.
Tender nodules at the junction of the bladder and the uterus.
Tender nodules over the uterine corpus.
Many women (particularly those with asymptomatic endometriosis) have
no positive physical findings.

Group 1 | Kuh-h8tr; Vajeana; Renaughn; IKEA

DIAGNOSTIC FINDINGS
There are no laboratory tests that are specific for endometriosis. ultrasound must be done
o Medium level echoes are noted on ultrasound
o Always document if viable or normal tissue was noted on ultrasound
to guide surgeons in performing invasive procedures
Some women with endometriosis have a persistent complex or solid
adnexal mass on ultrasound, CT or MRI.
o These endometriomas can assume a passable resemblance to
almost any adnexal neoplasm.
o This means that the differential diagnosis for virtually any adnexal
mass would include endometriosis.
Most women with endometriosis will have an elevated serum CA-125,
however this is not specific.
o This chemical is released any time when there is peritoneal irritation
from any source
DIAGNOSIS
Clinical diagnosis is through HISTORY of the classical description
Surgical diagnosis is made by visualizing typical endometriosis implants in
the typical places endometriosis tends to flow in.
o LAPAROSCOPY method of choice for direct visualization
Histologic diagnosis
NATURAL HISTORY
Untreated
Endometriosis can worsen
Regress or stay the same
More often is progressive
Pregnancy and breast-feeding SUPPRESS endometriosis.
Birth control pills, even if taken cyclically, usually SUPPRESS
endometriosis, particularly if the endometriosis is minimal (mild or
moderate).
At menopause, endometriosis usually REGRESSES.
ENDOMETRIOSIS AND INFERTILITY
Probably between 25% and 50% of infertile women will have at least
some degree of endometriosis present
PRINCIPLES OF MANAGEMENT
There is no single best management for all women with endometriosis
Treatment must be individualized.
There are PRIMARY FACTORS to be considered namely:
o The need for preserving childbearing capacity
o The severity of her symptoms
o Presence or absence of infertility as a clinical concern for her.
o Age
For example:
A 35 year old woman with severe symptoms and no desire for any further
childbearing might be best managed by a hysterectomy.
The same woman at age 50 might prefer to go with medical therapy until
menopause, when the symptoms will go away.
The same woman at age 40, but with mild symptoms might do well on birth
control pills.
ALWAYS INFORM PATIENTS OF RISKS AND BENEFITS OF PROCEDURES.

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GYNECOLOGY 2.1b
MEDICAL MANAGEMENT
1. BIRTH CONTROL PILLS
For mild or moderate endometriosis.
Reduce the heaviness of the menstrual flow and its duration
Provide a powerful decidualizing effect on the implants by virtue of
their strong progestin. This discourages further growth of pre-existing
implants.
When taken continuously, stops the episodic hormonal withdrawal
bleed that occurs both with normal endometrium and with endometrial
implants.
It usually takes 3-6 months of continuous OCPs or oral contraceptive
pills, and up to 12 months to achieve maximum benefit.
OCPs are relatively inexpensive, making this treatment choice very
affordable for most patients.
2. GnRH AGONISTS
a. Luprolide
b. Goserelin
Numerous drawbacks include temporary menopausal side effects
Moderately expensive; may be as expensive as surgery
Consider the patients age. If she is an elderly female who is a good
surgical candidate, opt for surgery over medical management
Given for about 6 months
3. DANAZOL
This is a cousin of testosterone and has both direct and indirect effects
on endometriosis
Directly inhibits endometriotic implant growth through its powerful
decidualization properties
Suppresses the secretion of pituitary gonadotropins, resulting in
inhibition of ovarian function and lower estrogen levels.
Blocks steroidogenic enzymes.
DRAWBACKS:
o High cost
o Significant side-effects (weight gain, masculinizing side-effects and
depression)
o It is normally taken for about a year before stopping it.

Fibromas are connective-tissue tumors that arise from the ovarian

cortical stroma (undifferentiated ovarian stroma)
If the stroma is estrogenic or leutenized, the tumors are actually
THECOMAS.
Incidence of ascites is directly proportional to the size of the tumor
Pelvic pressure and abdominal enlargement may develop
Smaller tumors are asymptomatic since they do not elaborate hormones
MEIGS SYNDROME- Association of ovarian fibroma, ascites and
hydrothorax
MANAGEMENT
Surgery: the approach and extent depend on the age of the patient
Simple Excision brings about resolution of symptoms
Bilateral salpingo-oophorectomy and total abdominal hysterectomy done
since the condition is common among post-menopausal women

*The following topics were only graced with a cursory discussion by the lecturer

G. EPITHELIAL CYSTIC TUMORS

Epithelial cystic tumors account for about 60% of all true ovarian
neoplasms.
Serous Cystadenoma and Mucinous Cystadenoma
1. SEROUS CYSTADENOMA
Typically unilocular but sometimes multilocular with papillary
components (*that is, its walls are not smooth)

2. MUCINOUS CYSTADENOMA
Account for approximately 10-15% of all epithelial ovarian neoplasms.
70% are benign and found in women 30-50 years old
Smooth walled compared to serous variety, they rarely are associated
with true papillae.
Often multilocular
Mucinous tumors consist of epithelial cells filled with mucin. These cells
resemble cells of the endocervix or may mimic intestinal cells, which can
pose a problem in the differential diagnosis of tumors that appear to
originate from the ovary or intestine

4. PROGESTINs
Progestins seem to be about as effective in treating endometriosis as
OCPs
Somewhat less well tolerated
Weight gain and breakthrough bleeding are the biggest problems
It is not particularly expensive, and is a reasonable choice for someone
wishing to avoid surgery and OCPs, but intolerant of Danazol or
Luprolide
Figure 9. Multi-loculated mucinous cystadenoma

SURGICAL MANAGEMENT
Conservative surgical management:
o Removal of endometriosis and retain normal tissue as much as
possible to preserve child bearing capacity
Definitive Surgical management
o Hysterectomy with or without removal of the tubes, ovaries and
other sites of endometriosis.
o Hysterectomy with bilateral salpingo-oophorectomy.
o Hard to perform surgery due to possible puncturing of chocolate
cysts or adherence to rectum

F. OVARIAN FIBROMA
MOST COMMON BENIGN SOLID OVARIAN NEOPLASMS
Occurs most commonly in postmenopausal women.
Unilateral and often at least 3cm in size
Low malignant potential and extremely slow growing tumors

Group 1 | Kuh-h8tr; Vajeana; Renaughn; IKEA

H. BRENNER TUMOR/TRANSITIONAL CELL TUMOR

small, smooth, solid, fibroepithelial ovarian tumors that are
generally asymptomatic.
Relatively rare and most common in the fourth to sixth decades of life
Small, firm, and gray white solid, slow growing, with occasional
yellow tinge with small cystic spaces
1 to 2% chance of malignant transformation
Found incidentally at pathologic evaluation, often in conjunction with a
serous or mucinous cystadeoma or dermoid cyst
Two Principal components are solid masses or nests of epithelial cells
and a surrounding fibrous stroma
30% discovered as small, solid tumors in association with a concurrent
serous cystic neoplasia, such as serous or mucinous cystadenomas of the
ipsilateral ovary.
Rare,

Page 5 of 6

GYNECOLOGY 2.1b
Presently,

most authorities accept the theory that most of these tumors

result from metaplasia of coelomic epithelium into uroepithelium.
(*hence, the name transitional cell tumor)

Postmenopausal

bleeding is sometimes seen, as endometrial hyperplasia

is a coexisting abnormality in 10-16% cases
MANAGEMENT
scan demonstrates a finding of extensive amorphous calcification
within the solid components of the ovarian mass
Surgery simple excision or ablation; depends on patients age

CT

J. OVARIAN REMNANT SYNDROME

Chronic pelvic pain secondary to small area of functioning ovarian tissue
after intended removal of both ovaries
Most women who develop this had endometriosis or chronic pelvic
inflammatory disease and extensive pelvic adhesions discovered during
previous surgical procedures
Another risk factors is laparoscopic oophorectomy
50% present with chronic pelvic pain is cyclic, exacerbated following
coitus
50% present with pelvic masses that are small, 3 cm, most commonly
located in the retroperitoneal space immediately adjacent to either
ureter

Diagnosed

Figure 10. Brenner Tumor

MANAGEMENT
through palpation during pelvic exam, vaginal ultrasound or

MRI
Surgical removal of remaining ovarian tissue via laparoscopy or
laparotomy with wide excision of the mass using meticulous techniques
to protect integrity of ureter
Edited by: bkcm

I tend to have too much vodka sometimes, and I

eat too much processed food but I think the most
unhealthful habit I have is comparing myself to
others.
-notRenan
Figure 11. Benign Brenner tumor. A cyst in the Brenner tumor is lined by an inner layer
of endocervical-type mucinous cells and an outer layer of stratified transitional cells, a
few of which have grooved nuclei.

INCIDENCES OF OVARIAN NEOPLASMS

Table 1. Incidences of Ovarian Neoplasms
Cystic Teratoma
58%

Serous Cystadenoma

25%

Mucinous Cystadenoma

12%

Benign Stroma

4%

Brenner tumor

1%

I. POLYCYSTIC OVARIAN SYNDROME (PCOS)

The diagnosis of PCOS has been simplified from the previously tedious
method.
Currently, 2 of 3 criteria are required for diagnosis
1. Polycystic ovaries (multiple small cysts, often around the periphery of
the ovary, the classic string of pearls appearance)
2. Signs of androgen excess (acne, hirsutism, temporal balding, male
pattern hair loss, clitoromegaly, etc)
3. Menstrual irregularities (oligomenorrhea or polymenorrhea).
Note that a diagnosis of PCOS does not require multiple ovarian
cysts or polycystic ovaries.

Figure 12. PCOS on UTZ. Note the multiple unechoic areas indicating the presence of
cysts
Group 1 | Kuh-h8tr; Vajeana; Renaughn; IKEA

Page 6 of 6