Benign ovarian tumour

Benign ovarian tumour-
80%of ovarian tumour are benign.They can become secondary malignant however.
C/O-
symptoms_1 abdominal swelling upto 50 kg ovarian tomour hv been noted. 2 irregular menstrual cycle-theca granulosa cell tumour_oestrogen secretion which cause menorrhagia..
Musculizing tumour_amenorrhoe and virilization.
Brenner tumour_postmemopausal bleeding.
3 pressure symptoms-frequency of micturation,retention,pressure on rectum,dyspnoa,palpitation,bialateral pitting oedema of foot.
4 normally there is no pain but acute abdominal pain may occure if ovarian tumour undergoes torsion or rupture.
Physical sign-
inrpectiön-abdominal swelling formed by abdominal cyst.Abdominal wall moves with deep inspiration.Symmetrical position of tumour in abdomen.
Palpation-upper and lateral limit of tumour can b defind.Sooth surface. Small cyst.,tense and cystic.Large tumour is fixed. Fluid thrill can b illiciated.
Percussion-
dull over centre of tumour.Resonat over flank.
Auscultation-silent
 Bimannual examinatiön-
small tumour-uterus can b identified without difficulty.Cyst usually displace uterus to opposite side..If there is hard nodule it indicate malignancy.
D/D-
1 full bladder. 2 pregnant uterus
3 myoma 4 ascites
investigation-
1 Radiograph of abdomen and pelvis-soft tissue shadow,teeth in dermoid.
2 Diagnostic laparoscopic examination,iv pyelography excledes hydronephrosis.
3 Breast examinatiön to exclue pregnancy.
4 ultrasönograqy.
Benign cyst shows these features-unilateral,unilocular/multilocular with thin wall non-echogenic cavity,tumour marker CA 125 <35 unite/ml.
5 colour flow doppler-
neovascularization in malignant form.
6 CT MRI to identify dermoid cyst,haemorrhage cyst.
7 tissue marker CA 125 >35 unit/ml
CEA >5 mg/lit in mucinous ovarian tumour.
8 cytological study of ascitic fluid or aspirated cystic fluid.
Treatement-
laparotomy is needed.
Abdominal hysterctomy and bilateral salpingo-oophorectomy in perimenausal women.
Histological specimen may discover microscopic evidence of malignancy and thereby need of secondary surgery is avoided.
Ovarioctomy/cystectomy-
conserve healthy overy in young pt.
Clamp infudibulo pelvic ligament laterally mesovarian in middle,fallopian tuae ,overian liagment medially.
Laperoscopic cystectomy/ovariotomy_ minimal invasive surgery in vague for small cyst.
First aspirate cystic fluid,then dissect cyst wall.