BENIGN TUMOURS,CYSTS&MALFORMATIONS OF THE GENITAL TRACT
WAQAR SAEED
09-122
MALFORMATIONS OF THE GENITAL TRACT
I. THE MALFORMATIONS
1.Faliure of Recanalization:
- Imperforate hymen or
transverse septum
- Cruciate Incision in the hymen
2.Failure of Ducts to form or fuse:
FAILURE OF DUCTS TO FUSE
BENIGN CYSTS OF VULVA
- Bartholin cysts
- Skene Gland cysts
- Mucus inclusion cysts
with or without vulval discomfort
BARTHOLIN CYSTS
MARSUPIALIZATION OF CYST
II. VULVAL CANCERS
•VULVAL TUMORS:
- Similar to those that arise in skin
- Vulval varicosities
VAGINAL CANCER
VAGINAL TUMORS: ( Rare)
- Cysts
- Gartner Duct Cyst
- Urethral Diverticulum
- Myoma
THE TUMORS…
CERVICAL TUMORS:
Cervical Polyp:
- Most common
- Columnar to squamous
metaplasia
- May ulcerate
- Intermittent/postcoital bleed
- Remove by twisting pedicle
THE TUMORS….Cervical Tumors:
Genital Papillomata
Fibroids
THE TUMORS…
UTERINE TUMORS:
1.)Endometrial Polyps
- Associated with endometrial
hyperplasia
- Abnormal uterine bleeding
- Detected by curettage or by
hysteroscopy.
THE TUMORS…
2.) Uterine Fibroids:
Gen. Considerations:
- Most common tumor of the GT
- Smooth muscle fibers interspersed
with connective tissue
- More common in nulliparous women
- Etiology unclear
- Post Menopausal Atrophy
- Types
Symptoms:
- Depend on size and position of fibroid
- Mostly asymptomatic
- Abnormal uterine bleeding
- Pelvic pressure and discomfort
Diagnosis:
- On PA
- Pelvic U/S
Management:
i) Observe
ii) Myomectomy
iii) Hysterectomy
iv) GnRH analogues
Effect of:
i) Pregnancy on Fibroid:
“ Red Degeneration”
ii) Fibroid on Pregnancy:
- Spontaneous Miscarriage
- Large tumor malpresentation of
fetus
- Can Obstruct Labour
- Bladder/Bowel Symptoms
- PPH
Manage Fibroid in Pregnancy:
- * AVOID Myomectomy
- If labour obstructed go for CS
BENIGN OVARIAN CYSTS &TUMORS
-Ovary consists of:
- Coelomic Epithelium
- Oocytes
- Mesenchymal elements that form
medulla
BENIGN OVARIAN CYSTS &TUMOURS
CLASSIFICATION:
TUMOR Cell Origin Type Incidence
Functional Cysts Normal Follicle Cystic 24
Serous Cystadenoma
Coelomic Epitelium
Cystic 20
Mucinous CYstadenoma
Coelomic Epithelium
Cystic 20
Teratoma (Dermoid Cyst)
Oogonia Cystic 15
Endometrioma Ectopic Endometrium
Cystic 10
Fibroma Mesenchyme Solid 5
BENIGN OVARIAN CYSTS &TUMOURS
1.) FUNCTIONAL CYST:
- Enlargement of unruptured Graffian
follicle
- Unilat. < 5cm
- May secrete estrogen resulting in
menorrhagia
- TVS for diagnosis
Rx:
- Observe ( 2-3 months)
- Aspirate under U/S & laproscopic guidance
- If Blood stained aspirate Laprotomy
- Multilocular cyst Surgical removal
BENIGN OVARIAN CYSTS &TUMOURS
2.) Mucinous Cystadenoma:
- B/w age 35-55
- Usually unilat.
- Lined by Columnar cells
- Psuedomyxoma peritonei
3.) Serous Cystadenoma:
- Age b/w 35-55
- Cuboidal Lining
- 1/3 may have malignant change
BENIGN OVARIAN CYSTS &TUMOURS
4.) Endometrioma:
- Chocolate Cyst
- Rx as Endometriosis
5.) Benign Teratoma:
( Dermoid Cyst)
- Age 20-40
- Epithelial,Endothelial, Mesothelial
elements
BENIGN OVARIAN CYSTS &TUMOURS
6.) Connective Tissue Neoplasm:
- Fibromas
- 10% Bilateral
- Meig’s Symdrome??
- Diagnosis by TVS
BENIGN OVARIAN CYSTS &TUMOURS
Management:
- Surgical
- Young Cystectomy
- BSO TAH