Benign Ovarian Epithelial Tumors

Benign forms of tumors make up 60-70%, and 33% of them are tumor-like processes. In benign tumors, the epithelium grows without signs of atypia and destruction of the basement membrane. 

Serous tumors (cystadenomas)

Serous tumors (cystadenomas) are the most common neoplasms of the ovaries. They are found in almost all age groups (with the exception of childhood), most often in 40-50 years. There are various sizes, single or multi-chamber, single or double-sided with a smooth inner and outer surface, with a light serous content. The walls of the cavities are formed by connective tissue lined with various types of epithelial cells. They are localized more often at the border of the ovary with mesovarium or under the ovarian cortex closer to its lateral edges. Tumor elastic consistency; can have a leg and twist with the development of the phenomena of “acute abdomen”. With a large tumor, an increase in the abdomen, the appearance of pulling pains in the lower abdomen and lumbar region are noted.

Mucinous benign tumors

Mucinous benign tumors are usually unilateral, dense, tuberous, irregular in shape, multi-chamber; can reach large sizes. The contents of the tumor cavity are viscous, viscous, cloudy or hemorrhagic. The capsule consists of dense connective tissue; the epithelium lining the cavity and producing mucin is similar to the epithelium of the cervical canal or resembles the epithelium of the mucous membrane of the colon. The average age of patients is 50 years old, often tumors can occur in women under 30 years of age. Complaints mainly about pain and a feeling of heaviness in the lower abdomen. With a large tumor, an increase in the abdomen is noted. Having a long leg and a large weight, tumors are usually mobile and more often than serous, they cause the torsion of the tumor legs. May be combined with uterine myoma and adenomyosis.

Endometrioid benign tumors

Endometrioid benign tumors are rare, more often they are bilateral with a dense thick wall covered with adhesions; often multi-chamber, filled with tarry contents. Tumors can be located intraligamentally and are fixed by commissures. The inner surface of the capsule is lined with high prismatic epithelium of the tubal-uterine type. Under the basement membrane are cells resembling the stroma of the endometrium in the proliferation phase.
Observed more often at the age of 30-50 years. The clinical course is slow. Compared with serous tumors, endometrioid ones have greater hormonal activity, combined with uterine myoma, adenomyosis, endometrial hyperplasia, mastopathy and cancer of the uterus.

Brenner’s Tumor

It is rare, accounting for 1-2% of all ovarian tumors, mainly in postmenopausal women. The tumor is usually benign; in some cases, it may be with signs of hormonal activity. Often there are symptoms associated with increased activity of estrogens, rarely – androgens. The leading symptoms are the presence of a tumor and spotting from the genital tract. It is found mainly in older women (average age 63 years).
The tumor is more often unilateral (left-sided), ranging in size from a few millimeters to 15-20 cm; oval or round, tuberous, very dense, has a capsule. In the section, the tumor is whitish, only a benign variant consisting of 2 components – epithelial nests and cell stroma has structural specificity. Diagnosis is mainly histological. Brenner’s tumor is often combined with a mucinous or granulosa cell tumor of the same ovary, teratoma, uterine myoma, and endometrial cancer.

Benign tumor treatment

If a mass formation is found in the pelvis, it is necessary to exclude frequently occurring diseases that are not related to neoplasia, namely: diverticulitis, ectopic pregnancy, ovarian cyst, uterine fibroids and endometriosis. Ultrasound tomography using transabdominal and transvaginal sensors allows us to evaluate not only the condition of the ovaries, but also the structure of the tumor formation coming from the ovary (cyst, solid formation).
All benign neoplasms are subject to surgical treatment, with the exception of tumor-like formations in the form of functional (retention) cysts. This is due to the fact that without surgery it is impossible to completely exclude the malignant process, and it is also impossible to predict the “behavior” of a benign tumor in the subsequent period. In connection with the introduction of new minimally invasive methods of treating benign ovarian tumors in women of any age, video surgery is in first place. In young patients, when a benign tumor is removed, it is necessary to strive to maintain unchanged ovarian tissue (cyst enucleation). In older women, in addition to adnexectomy, it may be necessary to expand the scope of the operation until hysterectomy is performed (with concomitant genital pathology). When a benign cystic or solid ovarian tumor is removed by laparoscopic access, in order to exclude tumor dissemination (in case of possible malignancy), it is necessary to strive to preserve the tumor capsule, avoiding its contents entering the abdominal cavity. Mandatory is an urgent histological examination of all suspicious papillary growths in the cyst. Laparoscopic access for benign ovarian tumors should be performed by highly qualified gynecologists who, in addition to good knowledge of the technique of endovideo surgery, could perform an adequate operation from laparotomic access, and if a malignant process is detected in the ovaries, it is necessary to correctly assess the degree of spread of the disease. This is very important for choosing a further treatment plan.

Borderline tumors (low grade)

Borderline tumors (of low malignancy) among ovarian cancers are about 10%, the average age of women is about 40 years, which is 20 years younger than patients with ovarian cancer. These tumors proceed relatively favorably, limiting only to the ovary. However, in 10% it is possible to identify peritoneal implants. Basically, borderline tumors of serous and mucinous histological types.

Serous borderline tumors

Serous borderline tumors account for 9.8% of patients with ovarian epithelial tumors. The presence of papillary growths, which are found not only on the inner, but also on the outer surface of the tumor capsule, is typical for this type of tumor, often multi-chamber. When the papillae grows through the cystoma wall, implantation along the peritoneum is possible. These tumors are more likely to occur between the ages of 30-50 years, but sometimes in women younger than 30 years.
The earliest symptom of the disease is lower abdominal pain, which occurs earlier than with other forms of ovarian tumors. There may be complaints about an increase in the abdomen, a feeling of heaviness and pressure in its lower parts, dysuric phenomena. Perhaps a violation of the menstrual and reproductive functions. In 38-75% of patients, the tumors are bilateral.

Mucinous borderline ovarian neoplasms

Mucinous borderline ovarian neoplasms account for 14% of all mucinous tumors. Basically, they are one-sided, with a dense capsule, can reach large sizes, are more common at the age of 50-70 years. Often combined with thyroid pathology (thyrotoxicosis, thyroid cancer). Along with highly differentiated structures, they contain elements with severe epithelial dysplasia and small foci of invasive cancer. Tumor cells produce mucus of a heterogeneous composition. The clinical course of these tumors is more favorable than serous analogues. The cause of death in them can be two factors – a complication of the course of the disease with pseudomyxoma of the peritoneum or a generalization of the process by type of cancer. The source of generalization is small foci of invasive cancer missed during the initial diagnosis, in the presence of foci of malignancy, regardless of their size and stage of the disease; the generalization process is unpredictable and may occur in the coming years after surgery.
The mechanical entry of mucus into the abdominal cavity is not equivalent to the pseudomyxomy of the peritoneum. Its development is not always associated with the degree of malignancy of tumor cells. There have been cases of the development of pseudomyxoma with absolutely benign mucinous cysts and its absence in patients with mucinous ovarian cancer, although the latter very often show a defect in the tumor wall.

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