Benign tumors of the ovaries

Benign tumors of the ovaries are primarily functional cysts and tumors; most have an asymptomatic course.

Functional cysts develop from the graafial follicles (follicular cysts) or from the yellow body (yellow body cysts). Most functional cysts are smaller than 1.5 cm in diameter; few exceed 8 cm, very rarely reach a size of 15 cm. Functional cysts usually resolve spontaneously from several days to weeks. In the cysts of the yellow body, hemorrhages may occur, which, by stretching the capsule of the ovary, can lead to rupture of the ovary.

Benign tumors of the ovaries usually grow slowly and are rarely malignant. The most frequent benign tumors of the ovaries are benign teratomas. These tumors are also called dermoid cysts, because they originate from all three layers of embryonic sheets and consist mainly of ectodermal tissue. Fibroma, the most common solid benign ovarian tumor, is characterized by slow growth and sizes less than 7 cm in diameter. Cystadenomas can be serous or mucinous.

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Symptoms of benign ovarian tumors

Most functional cysts and benign tumors have an asymptomatic course. Hemorrhagic cysts of the yellow body can cause pain or signs of peritonitis. Sometimes there is very severe pain in the abdomen when twisting the appendages of the uterus or ovarian cysts larger than 4 cm. Tumors are often detected by chance, but they can also be suspected if there are symptoms. It is necessary to perform a pregnancy test to rule out an ectopic pregnancy.

Types of benign ovarian tumors

The most common are epithelial tumors, dermoid cysts (mature teratomas), ovarian fibroids. Benign tumors of the ovaries (other than hormone-producing), regardless of the structure in their clinical manifestations, have much in common. In the early stages of the disease, as a rule, is asymptomatic.

Epithelial tumors of the ovaries

These tumors account for 75% of all ovarian neoplasms. Cyloepithelial and pseudomucinous cystadenomas of the ovaries develop from the Müllerian epithelium.

[3], [4], [5]

Cyloepithelial tumors (serous)

There are two types of serous cystadene: smooth-walled and papillary. The inner surface of smooth-walled serous tumors is lined with a ciliated epithelium. This cystadenoma is a thin-walled globular or ovoid form with a smooth shiny surface, multi-chambered or more often monocamous. The tumor rarely reaches a very large size, contains a clear clear liquid.

Papillary tumors are divided according to the morphological structure into coarse-papillary papillary cystadenomas, superficial papillomas, adenofibromas. There are differentiating tumors, when the papillae are located only on the outer surface of the capsule; inverting - only on the inner surface of the capsule; mixed - when the papillae are located both on the inner and outer surface of the tumor capsule, while the tumor looks like a "cauliflower".

Peculiarities of the clinical course of papillary cystaden: bilateral ovarian lesions, intraligamentary location of tumors, ascites, proliferation of papillae along the surface of the tumor and peritoneum, adhesion process in the abdominal cavity, frequent menstrual dysfunction and decreased reproductive function. The disease is more severe if there is an eversion form and a two-way process. In these tumors, malignant transformation occurs much more often than in others.

[6], [7], [8], [9], [10], [11]

Pseudomucinous cystomas

The tumor has an ovoid or spherical shape, often with an uneven lobate (due to the bulging individual chambers) the outer surface. The tumor capsule is smooth, shiny, silvery-white or bluish. Depending on the nature of the contents (admixture of blood, cholesterol, etc.) and the thickness of the walls, the tumor can have a variety of colors - from greenish-yellow to brown. In most cases, the tumor reaches a considerable size. Smooth-walled mucinous cysts rarely affect both ovaries, they have a well-defined stem. Interconnected tumor location is rare. The joints with neighboring organs are not large. Torsion of the stem of smooth-walled mucinous cystadenoma occurs in 20% of cases. Ascites in benign mucinous tumors are observed in 10% of patients.

Papillary mucinous tumors of the ovaries, in contrast to papillary serous, always have a well-pronounced stem. These cystadenomas are often associated with ascites, and they are also marked by a pronounced tendency to proliferation.

Hormone-producing tumors of the ovaries

Hormonal-active tumors of the ovaries (5% of all tumors) are called neoplasms originating from the hormonal-active structures of the "female" and "male" parts of the gonad, secreting respectively the estrogens or androgens. Distinguish between feminizing and virilizing tumors of the ovaries.

Feminizing tumors:

• Granuletscheletochnye tumors - develop from granulosa cells of atreducing follicles. Their frequency is 2-3% of the number of benign tumors. About 30% of granulosa cell tumors do not have hormonal activity, in 10% of tumors malignant transformation is possible. Most often occur in postmenopause, less than 5% of tumors are detected in childhood.

Histologically, micro-, macrofollicular, trabecular and sarcomatous types of granulosa cell tumors are isolated, the latter being malignant.

• Teka-cell tumors - are formed from ovarian cells, their frequency is about 1% among all tumors. Tumors are found more often in the age of postmenopause. They are small in size. Tumors of solid structure, dense, on a cut of bright yellow color. They are not inclined to malignancy.

Features of the clinical manifestation of feminized ovarian tumors:

• in childhood, symptoms of premature puberty;
• in the reproductive age - a violation of menstrual function according to the type of acyclic uterine bleeding, infertility;
• in the period of menopause - the disappearance of phenomena of age-related atrophy of external and internal genitalia, uterine bleeding, increased content of estrogen hormones in the blood.

Feminizing tumors are characterized by slow growth.

Virilizing tumors:

• Androblastoma - occurs more often in women 20-40 years; its frequency is 0.2% among all tumors. The tumor is formed from the male part of the gonad and consists of the cells of Leydig and Sertoli.
• Arenoblastoma - a tumor from the dystopic tissue of the adrenal cortex; its frequency is 1.5-2%. Malignant growth is noted in 20-25% of cases. Tumor occurs more often in young women - up to 30 years; Has a dense capsule, small size, often repeats the shape of the ovary.
• Lipoid cell - consists of lipoid-containing cells, with proper cell types of the adrenal cortex, and cells resembling Leydig cells. Tumor occurs most rarely among virilizing neoplasms and, mainly, in the climacteric period and postmenopause.

Symptoms of virilizing tumors:

With the emergence of a virilizing tumor, a woman initially develops defeminization (amenorrhea, atrophy of the mammary glands, a decrease in the libido), and then - masculinization (growth of mustaches and beards, alopecia, decrease in the tone of the voice).

Stromatogenic, or connective tissue, tumors

The incidence of these tumors among all ovarian tumors is 2.5%.

Ovarian fibroid refers to tumors of the stroma of the genital tract, to the group of tecom fibro. Arises from connective tissue. The tumor has a round or ovoid form, often repeating the shape of the ovary. Consistency is dense. It occurs mainly in old age, it grows slowly.

Clinically characteristic of the Meigs triad:

1. swelling of the ovary;
2. ascites;
3. hydrothorax.

Brenner's tumor is a rare occurrence. It consists of epithelial elements, arranged in the form of inclusions of various forms among the connective tissue of the ovary.

Teratoid, or germinogenic, ovarian tumors

Of benign tumors of this group (10%), a mature teratoma (dermoid) is more common, which has an ectodermal origin, highly differentiated. The tumor can be of various sizes, has a dense smooth capsule, contents in the form of fat, hair, teeth, etc.

Other tumors of this group (teratoblastoma and dysgerminoma) belong to malignant tumors.

Treatment of benign ovarian tumors

Most ovarian cysts smaller than 8 cm dissolve without treatment; a series of ultrasonographic studies is needed to confirm the resorption of the cysts.

Cyst removal (ovarian cystectomy) is performed in the presence of cysts larger than 8 cm, which persist for more than three menstrual cycles. The hemorrhagic cysts of the yellow body are removed in the presence of peritonitis. Cystectomy can be performed by laparoscopy or laparotomy. In cystic teratomas, cystectomy is necessary. Such benign ovarian tumors as: fibroma, cystic adenoma, cystic teratomas larger than 10 cm in size and cysts that can not be surgically removed separately from the ovary are indications for ovarian excision.