ovarian%20mass
OVARIAN MASS
Ovarian cysts are typically noted after clinical screening, or as a result of exam for a suspected pelvic mass, or an incidental finding in investigations done for other reasons.
Most ovarian masses manifest with few or mild nonspecific symptoms.
Ovarian masses in women of reproductive age are mostly benign but the risk of malignancy increases with age.
Ovarian cysts in the prepubertal patients especially after the first week of life are abnormal and likely to be neoplastic. In adolescent patients, majority of ovarian masses are functional cysts.

Surgical Intervention

  • Rapid onset of acute pain may occur with adnexal torsion which must be treated surgically; risk factor is an ovarian mass >5 cm
  • Cyst rupture can result in a small amount of intraperitoneal bleeding or hemorrhage which can manifest as generalized abdominal pain
  • If there are findings suggestive of hemoperitoneum, surgical intervention by laparoscopy or laparotomy is required
  • Aspiration of ovarian cysts is done only for symptom control of advanced malignancy in patients who cannot undergo surgery
    • Cystic aspiration is associated with high recurrence rate
  • Pregnant women with ovarian cysts may undergo surgery if there is a suspicion for malignancy, if an acute complication is present (eg torsion), or if the size is likely to cause problems
  • Histopathological assessment of ovarian cysts following surgery is warranted
    • Avoid spilling the cyst contents as preoperative and intraoperative evaluation cannot exclude malignancy

Laparoscopy

  •  Suitable for patients with RMI of <200
  • Advantages of laparoscopic approach include:
    • Magnified view of the pelvic and abdominal anatomy
    • Precise diagnosis and treatment of the disease of adjacent vital organs, blood vessels, nerve structures
    • Minimized bleeding from small vessels, no large abdominal incision, shorter operative time, less adhesion formation, early ambulation, faster recovery, less cost

Laparotomy

  • May be appropriate for large masses with solid components
  • Explorative laparotomy is warranted if malignant ovarian cyst is suspected and may include staging and lymph node status assessment
  • A full-staging laparotomy will be required if there is suspicion of malignancy in the ovarian cysts as shown by patient’s clinical evaluation, CT findings, RMI score >200, or laparoscopic findings
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