Benign Lesions of Ovaries- Types, Risk Factors, and Management

What Are Benign Lesions of Ovaries?

Benign lesions or growths of ovaries usually include cysts and tumors. A non-cancerous (benign) ovarian tumor does not spread to other regions of the body (the spread of cancer to other cells of the body is called metastasis). Therefore, non-cancerous lesions are rarely life-threatening.

What Are the Symptoms That Indicate Benign Lesions of Ovaries?

The majority of functioning cysts and non-cancerous ovarian tumors are asymptomatic.

Symptoms that may appear include,

• Abdominal pain due to an increase in the size of the cyst or tumor.

• Unexplained and unusual vaginal bleeding.

• Pain during sexual intercourse.

• Pelvic pain.

• Fluid accumulation in the abdomen (ascites).

What Are the Various Benign Lesions of Ovaries?

The most commonly occurring benign lesions of ovaries are as follows-

• Dysfunctional Ovarian Cysts-

  • Follicular Cyst- The most common cystic formations detected in healthy ovaries are ovarian follicle cysts. These cysts are not cancerous and result from transitory pathologic abnormalities of a normal physiologic mechanism. Solitary follicular cysts are frequent and can arise at any age, from fetal to postmenopausal. Cysts smaller than 2.5 cm are usually categorized as follicles and are not of any clinical significance.

  • Corpus Luteum Cysts- Follicular cysts are more prevalent than corpus luteum cysts. Intracystic hemorrhage is the most common cause, and they appear in the second half of the menstrual cycle. They are hormonally inactive, but they tend to rupture when there is intraperitoneal hemorrhage, especially in individuals taking anticoagulants.

  • Treatment: In most cases, no treatment is necessary, and many cysts cure on their own within six weeks to twelve weeks. Surgical intervention may be required to address these cystic tumors in rare cases (like torsion, rupture, and hemorrhage).

• Benign Epithelial Neoplastic Ovarian Cysts-

  • Serous tumors- These cysts are characterized by a growth of epithelium similar to that which lines the fallopian tubes. They are usually observed in women in their fourth and fifth decade of life, and in 15 % to 20 % of cases, they are bilateral. Some benign lesions like mucinous cystadenomas might be unilocular or multilocular, with a smooth lining surface and a thin, transparent yellow fluid.

  • Mucinous epithelial tumors- Mucinous cysts have smooth walls and are rarely linked with true papillae compared to serous cysts. The mucus-containing loculi appear blue through the tight capsules, and the tumors are usually multilocular. These tumors can develop to be quite large, up to 30 cm in diameter, and patients frequently report ovarian torsion. Mucinous tumors are most prevalent in people in their third to fifth decades of life, and they are only very rarely bilateral. The larger varieties are linked to a higher chance of rupture.

  • Treatment: Simple unilateral oophorectomy via laparoscopy or laparotomy is sufficient for women of reproductive age, assuming the contralateral ovary is grossly normal.

• Benign Solid Ovarian Tumors- Ovarian solid epithelial tumors are usually malignant. The most common types of epithelial tumors are serous, mucinous, and endometrioid, with clear cell tumors, Brenner tumors, and undifferentiated ovarian carcinomas being rarer.

  • Brenner tumors are transitional cell tumors that can be benign, intermediate, or malignant. These tumors are usually small, firm, and solid, with a good-to-excellent prognosis when restricted to the ovary, depending on the malignancy status.

  • Fibromas and thecomas are two common benign solid tumors. The most prevalent benign ovarian neoplasm is fibromas. These tumors most typically affect postmenopausal women. They are usually unilateral and at least 3 cm in diameter. Fibromas emerge from the ovarian cortical stroma and are connective-tissue tumors. The tumors are thecomas if the stroma is estrogenic or luteinized.

  • Tumors composed of differentiated tissue from all three germ layers are solid, mature teratomas. More recognizable organic features, such as thyroid, bronchial, and central nervous system tissue, are likely to be found in benign teratomas (also known as mature teratomas or dermoid cysts).

  • Treatment- For women of reproductive age, simple excision of solid tumors is sufficient treatment. The treatment of benign cystic teratomas of the ovaries with laparoscopic surgery is also advised (laparoscopic ovarian cystectomy). The contralateral ovary is preserved in this treatment in premenopausal women, and every attempt is made to remove only the dermoid cyst itself, leaving both ovaries in place.

• Tubo-ovarian Abscesses- Patients with pelvic inflammatory disease (PID) and those with limited or no access to normal gynecologic treatment are at risk for tubo-ovarian abscesses (TOAs).

  • Laboratory findings may show leukocytosis, high erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) levels, and positive findings on endometrial biopsy or gonorrheal or chlamydial culture.

  • Frequent TOA symptoms include dyspareunia and rectal discomfort, partial intestinal obstruction, dysuria, urine frequency, and sterility. Fever with signs of pelvic peritonitis might occur on rare occasions.

  • The findings of a pelvic examination are typical. The uterus is inverted, and cervical motion causes discomfort. Enlarged masses adhering to the cul-de-sac may be felt laterally in the uterus. Soft cystic regions in the adnexa may be indurated. Bilateral tumors are common, and all pelvic structures are immobile.

  • Transvaginal scanning is the most effective way to assess a TOA. When the inflammation spreads to the ovary, the ovarian contour loses shape, and the periovarian tissue thickens.

  • Treatment: Every effort is made to treat the local infection with intravenous (IV) antibiotics before surgery. Ampicillin, gentamicin, and clindamycin or metronidazole are regularly used as triple antibiotics. Placing a drain or drains into the abscesses may benefit individuals who do not respond to antibiotic therapy. Only severe sepsis requires immediate abdominal exploration. Less invasive surgery, such as unilateral or bilateral salpingectomy, may be considered in rare circumstances, especially in young women desiring fertility. These women frequently need in vitro fertilization (IVF) to get pregnant.

• Endometriosis- In women of childbearing age, endometriosis is the most usually diagnosed disease. Endometriosis is described as the presence of endometrial tissue outside of the myometrium in an ectopic site. Endometriosis is most commonly diagnosed between the ages of 25 and 29. The most prevalent endometriosis symptoms are pelvic pain, secondary dysmenorrhea, dyspareunia, and infertility. Endometriosis can cause gastrointestinal and urinary tract discomfort. Patients with severe illness have bilateral endometrial cysts called endometriomas.

  • Treatment: Laparoscopic excision, fulguration, or laser treatment of implants remains the most effective therapy for this condition when compared to medicinal (hormonal) management or simple palliative treatment. It is critical to send excisional biopsies for pathology. Laparoscopic uterosacral nerve ablation (LUNA) is a treatment performed by some gynecologic surgeons. Normal pelvic anatomy is restored, obvious endometriotic alterations are removed, and pelvic pain is eliminated.

• Polycystic Ovary Syndrome (PCOS)- The ovaries are frequently bilaterally enlarged, contain numerous follicles, and have enhanced stromal echogenicity in females with polycystic ovarian syndrome (PCOS). It is linked to hyperandrogenic, insulin resistance, and a higher chance of developing metabolic syndrome.

  • Treatment: Many women experience infertility as a result of anovulation or oligo-ovulation. Fortunately, most women with PCOS respond well to oral ovulation induction drugs (Clomiphene Citrate) with or without progestin-controlled menses. In addition, oral hypoglycemics may be used in conjunction with Clomiphene citrate to achieve pregnancy if it fails to achieve ovulation.

What Are the Various Risk Factors for Developing Benign Lesions of Ovaries?

The exact cause of benign ovarian tumors is unknown. According to certain researches, some risk factors are linked to the development of ovarian tumors-

• Family history.

• Infertility.

• Obesity.

Conclusion:

Ovarian cysts are common and benign in most cases (non-cancerous). They come in various sizes and might appear in the ovary at multiple locations. Tumors usually are discovered during a routine pelvic exam or Pap test, and symptoms are uncommon. Surgical excision of the tumor and any surrounding tissue or the afflicted ovary are usually required. After treatment, fertility is usually preserved.