Tumor Jinak Ginekologi - 4
Tumor Jinak Ginekologi - 4
Tumor Jinak Ginekologi - 4
Vulva
Epidermoid and sebaceous cysts can be difficult
to differentiate.
Management involves excision of the cyst.
Cysts may also arise from the duct of the
Bartholins gland that lies in subcutaneus tissue
below the lower third of the labium majorum.
Incision and marsupialization of the abscess and
antibiotic therapy give excellent results.
The pus from the abscess should be sent for
culture in media suitable for the detection of
gonococcal infection.
Vulva
Epidermoid cyst
Vulva
Sebaceous cyst
Vulva
Bartholins cyst
Vulva
Bartholins cyst
Vulva
Condyloma acuminata
Vulva
Condyloma acuminata
Vagina
Vagina
Condyloma acuminata (warts)
Physiological cysts
Follicular cyst:
The commonest benign ovarian tumor and is
Physiological cysts
Follicular cyst:
Physiological cysts
Follicular cyst:
Physiological cysts
Follicular cyst:
Physiological cysts
Luteal cyst:
Less common than follicular cysts
More likely to present with
intraperitoneal bleeding
They may also rupture, usually happens
on days 20-26 of the cycle.
Corpora lutea are not called luteal cysts
unless they are more than 3 cm in
diameter.
Fibroma:
These unusual tumors are most frequent around
50 years of age.
Symptoms
Presentation of benign ovarian tumours:
Asymptomatic (found incidentally)
Pain (torsion, rupture, hemorrhage or infection)
Abdominal swelling
Pressure effects (GI or urinary symptoms)
Menstrual disturbances (may be coincidence)
Hormonal effects (androgen >> hirsutism & acne)
Abnormal cervical smear
Torsion
Abdominal swelling
Differential diagnosis
Pain: Ectopic pregnancy
Spontaneous abortion
PID
Appendicitis
Meckels diverticulum
Diverticulitis
Abdominal Swelling:
Pregnant uterus
Fibroid uterus
Full bladder
Distended bowel
Ovarian malignancy
Colorectal carcinoma
Investigation
Gynecological history
General history and examination
Abdominal examination
Bimanual examination
Ultrasound
Ultrasound-guided diagnostic ovarian cyst aspiration
Radiological investigation
Blood test and serum markers
Management
The management will depend upon the severity
of the symptoms, the age of the patient and
therefore the risk of malignancy and her
desire for further children.
Benign
uterus and cervix tumors
Endometrium
Endometrial polyps
These typically occur in women aged over
40 years.
Endometrium
Endometrial polyps
Myometrium
Uterine fibroids
A fibroid is a benign tumour of uterine smooth muscle,
termed a leiomyoma.
dependent
Uterine fibroids
Uterine fibroids
Uterine fibroids
Clinical features
Risk factors:
Nulliparity
Obesity
A positive family history
African racial origin
Uterine fibroids
Clinical features (cont)
Common presenting complaints are menstrual disturbance
and pressure symptoms, especially urinary frequency
Menorrhagia submucous fibroids distorting the
endometrial cavity and increasing the surface area are truly
causal.
Subfertility mechanical distortion or
occlusion of the fallopian tubes
submucous fibroids may prevent
implantation of a fertilized ovum.
Abdominal exam. might indicate the presence of a firm
mass arising from the pelvis.
Uterine fibroids
Differential Diagnosis
Pregnancy
Ovarian tumor
Leiomyosarcomas
Uterine fibroids
Investigation
A Hb concentration will help to indicate
anemia if there is clinically significant
menorrhagia.
USG is useful to distinguish a uterine
from an ovarian mass.
Uterine fibroids
Treatment
Concervative management is appropriate
where asymptomatic fibroids are detected
incidentally.
Repeat clinical exam. or ultrasound after a 612 month interval.
Ovarian suppression using a GnRH agonist
A bulky fibroid uterus causes pressure
symptoms, the options are myomectomy with
uterine conservation, or hysterectomy.
Adenomyosis
Condition in which functioning endometrial
tissue has penetrated the myometrium by
direct spread from the uterine lining.
Adenomyosis
Management
Symptoms and enlargement
Negative
No treatment
Positive
Hysterectomy