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Thursday, September 26, 2013

Ovarian Cystadenoma

Posted by Chantel Martiromo,  Article By Kyle J. Norton  

Ovarian Cystadenoma is a types of cystic adenoma originated from the glandular cells and defined as a condition of development of benign cyst which can grows to 12 inches in diameter and is filled with a mucous-type fluid material from the tissues of ovary.

Types of ovarian cystadenoma
1. Serous cystadenomas
Serous cystadenomas, accounted for about 30% of ovarian tumors, also known as serous cystadenoma, is a very common type of benign ovarian tumor filled with a thin, watery liquid. In rare case, it can become cancerous, according to a study of Molecular genetic analysis of ovarian serous cystadenomas, by Eric J Cheng, Robert J Kurman, Menglin Wang, Robert Oldt III, Brant G Wang, David M Berman and Ie-Ming Shih, researchers found that In fact, only 14% of serous cystadenomas are clonal, suggesting that serous cystadenomas develop as a hyperplastic expansion of ovarian surface epithelial inclusions. We speculate that a small proportion of these cystadenomas become clonal and that mutations of KRAS or BARF in some of these clonal cystadenomas lead to the development of serous borderline tumors, which are the precursors of low-grade serous carcinoma. These findings have important implications for understanding the pathogenesis of ovarian serous carcinoma, and for the screening and treatment of ovarian cancer.
2. Ovarian mucinous cystadenomas
Mucinous cystadenomas found in middle aged women in 75% of patients, are filled with a sticky thick liquid. They can grow to the size of between 6 and 12 inches in diameter. In some cases, it can grow more than 25 cm in diameter with hugh masses. In a study of A massive ovarian mucinous cystadenoma: a case report Remah M Kamel , researcher concluded that Management of ovarian cysts depends on the patient's age, the size of the cyst and its histo-pathological nature. Conservative surgery as ovarian cystectomy and salpingo-oophorectomy is adequate for benign lesions. In our patient, left salpingo-oophorectomy was performed as there was no ovarian tissue left and the tube was unhealthy. After surgery, the patient should be followed-up carefully as some tumors recur. Although the tumour was removed completely and intact with the affected ovary, our patient was given appointments to be reviewed every 3 months for a year.

Symptoms
1. Lower abdominal pain
2. Irregular menstrual periods
3. Abdomen pressure
5. Painful sexual intercourse
6. Pain during urination or bowel movements
7. Nausea and vomiting
12. Dizziness
13. Fatigue and tiredness
14. Etc.

Diagnosis and tests
1. Endo-vaginal ultrasound:
If you doctor suspects that you may have develop ovarian cysts, he or she may order an Ultrasound to exam your pelvic organs. Ovarian Cystadenoma can be diagnosed based on the appearance on the ultrasound.

2. CT scanning
If your ultrasound image has found ovarian Cystadenoma, your doctor may want to confirm the abnormalities by ordering the CT scan. A CT scan generates a large series of two-dimensional X-ray images taken around a single axis of rotation, to create a three-dimensional picture of the inside of the body in details.The pictures are viewed by your doctor to see the extent of the cystic abnormalities.

3. Biopsy
With a woman abdomen filled with a gas, your doctor makes small incision and a laparoscope passes into your abdomen. By examining your abdomen through the laparoscope, he or she can view the cysts and removes a sample to view under microscope to determine whether the tumor is benign or malignant.

4. MRI (magnetic resonance imaging)
MRI (magnetic resonance imaging is one of many advanced technology used to visualize internal structures cross sectional imaging of your body used effectively in providing the better details of the cysts and surrounding areas.
According to the study of Developing an MR Imaging Strategy for Diagnosis of Ovarian Masses, by Izumi Imaoka, MD, Akihiko Wada, MD, Yasushi Kaji, MD, Takafumi Hayashi, MD, Michiharu Hayashi, MD, Michimasa Matsuo, MD and Kazuro Sugimura, MD., researchers concluded that MR imaging is a useful modality for differentiating benign and malignant ovarian tumors, and a specific diagnosis can be made for certain pathologic entities. Morphologic appearance, signal intensity characteristics, and adequate use of intravenous contrast material provide information for arriving at the correct diagnosis.

Treatments
Since most of ovarian Cystadenoma are harmless they do not pose a threat to most women's health. Most doctors suggest to use ultrasonic observation or endovaginal ultrasound to monitor the growth frequently, unless there is necessary then surgery may be required to remove them depending to the concern of fertility of the patient and the size of cysradenoma
A. Oral Contraceptives
1. In some cases, if the size of the ovarian cysadenoma is small and surgery is not possible for what ever reasons, oral contraceptive pill may be beneficial, by
a. Reducing the period pain by creating a continual pregnancy like state
b. inhibiting the over production of prostaglandins which cause the muscles spam contraction of ovarian muscles resulting of less menstrual cramps and pain.
c. Reducing the risk of ovarian Cystadenom to become cancerous and stopping or reducing of period blood flow.
g. Shrinking ovarian Cystadenoma
Reducing substance to activate the menstrual cycle because of pregnancy like state.
e. Etc.

2. Risks and side effects
a. Growth of fibroids
Growth of fibroid is caused high level of estrogen and progesterone. The intake of the pill increase the level of both hormones resulting in increase the risk of growth of fibroid.
b. Recurrent of menstrual symptoms
Some women stop taking the pill may see all the menstrual symptoms coming back.
c. Blood clots
Estrogen in the pill may cause blood clots in the small vessels in the leg and the lung.
d. Stroke and heart diseases
Study shows that women who have higher natural estrogen levels may have a higher risk of stroke and heart diseases.
e. Depression and mood swing
At the beginning, it may cause abnormal fluctuations in estrogen and progesterone elevate both physical and psychological stress, eventually resulting in both depression and mood swing
f. Bleeding and spotting
Bleeding and spotting is normal for the first six months for women who begin with any oral contraceptive combination pill treatment.
g. Lost interest in sex
Some women may experience lower sexual desire
h. Nutritional deficiency
Oral contraceptive pill causes vitamin and mineral imbalances or deficiencies.
i. Etc.

B. Surgery
The aim of the surgery is to cure , if the size of cystadenoma is small and the women are healthy in most cases, it can be removed without causing serious side effects. If the size of cystadenom is too large, removing the ovary may be necessary.
1. Oophorectomy
a. Also known as ovariotomy, oophorectomy is a medical procedure to have one ovary removed, depending to the size of the cystadenoma. After oophorectomy, the woman will continue to have menstrual cycle and can become pregnant and follow up management may be necessary.
b. Unilateral oophorectomy is performed in the hospital with general anesthesia, In the surgery, a laparoscopic, thin tube containing a tiny lens and light that inserts through a small incision in the navel with a camera on the other end to allow your doctor to see the abdominal cavity on a video monitor. After the ovary is detached, it is removed though a small incision at the top of the vagina.
b.1. Vertical incisions
Vertical incisions give the doctor better view of of the abdominal cavity but it will leave some notable scar. After the incision the ovary is removed
b.2. Horizontal incision
If the ovary is removed by horizontal incisions it will leave a less notable scar.
c. Risk and side effects
Surgical and anesthetic risks

2. Cystectomy
a. If the ovarian Cystadenom is small in size, risk of becoming cancerous is low, fertility is a concern and surgery is necessary, cystectomy with a laparoscopic, may be a good choice as it is an effective treatment of non cancerous ovarian Cystadenom by removing only the Cystectomy in the pelvic region.
b. Risk and side effects
Surgical and anesthetic risks

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