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GYNECOLOGICAL ONCOLOGY . . . CONT.

Notes

c l a s s i c a l l y a s s o c i a t e d w i t h h y d a t i d i f o r m o r i n v a s i v e m o l e c a n a l s o o c c u r w i t h p o l y c y s t i c o v a r i e s , d i a b e t e s , e r y t h r o b l a s t o s i s , m u l t i p l e p r e g n a n c y , l a r g e f e t u s , a n d o v u l a t i o n i n d u c t i o n w i t h g o n a d o t r o p i n s o r c l o m i p h e n e t r e a t m e n t

  • conservative

endometriomacyst will regress as ßhCG level falls

  • see Endometriosis section

Germ-Cell Tumours c y s t i c t e r a t o m a ( d e r m o i d c y s t ) ( s e e C o l o u r A t l a s D 3 ) s i n g l e m o s t c o m m o n b e n i g n o v a r i a n n e o p l a s m e l e m e n t s o f a l l t i s s u e s r e p r e s e n t e d i n a w e l l - d i f f e r e n t i a t e d f o r m m o s t c o m m o n l y c o n t a i n s d e r m a l a p p e n d a g e s ( i . e . s w e a t a n d s e b a c e o u s g l a n d s , h a i r f o l l i c l e s a n d t e e t h ) 2 0 % o c c u r o u t s i d e t h e r e p r o d u c t i v e y e a r s 2 0 % b i l a t e r a l 5 - 1 0 c m u s u a l l y ( s e l d o m l a r g e r t h a n 2 0 c m ) s m o o t h - w a l l e d , m o b i l e , o f t e n u n i l o c u l a r o f t e n a n t e r i o r t o b r o a d l i g a m e n t m a y r u p t u r e o r t w i s t a n d i n f a r c t m a y c a u s e p e l v i c d i s c o m f o r t / p r e s s u r e i f l a r g e e n o u g h d i a g n o s i s u l t r a s o u n d m a y s h o w c a l c i f i c a t i o n t r e a t m e n t • cystectomy

Epithelial Ovarian Tumours increasing frequency after age 20-25 believed to be derived from the mesothelial cells lining the peritoneal cavity most common group of benign ovarian tumours types • serous • serous cystadenomas are common • often multilocular

• mucinoulisning similar to fallopian tube epithelium • less common • often multilocular • may grow to reach enormous size • cytologically resembles the endocervical epithelium • endometrioid • cytologically resembles the endometrium • occasionally, tumours made up of ciliated endosalpingial tissue • does not demonstrate the invasive characteristics of endometriosis • rare • Brenner tumour • solid neoplasm with large fibrotic component • usually benign • associated with mucinous epithelial elements in 1/3 of cases treatment • cyst aspiration • cystectomy • unilateral salpingo-oophorectomy

Sex Cord-Stromal Ovarian Tumours fibromas • non-functioning, does not secrete steroids • firm, smooth, rounded tumour with interlacing fibrocytes • occasionally associated with ascites • transudation of ascitic fluid into right pleural cavity via lymphatics —> Meig syndrome • ascites + right hydrothorax in association with an ovarian fibroma • treatment is surgical resection of tumour granulosa-theca cell tumours • occur in any age group • estrogen-producing —> feminizing effects • precocious puberty • menorrhagia • post-menopausal bleeding

Gynecology 46

MCCQE 2000 Review Notes and Lecture Series

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