1. Benign Tumors of Ovaries
Management
Mehtab Sami
Final Year MBBS

2. Management
Asymptomatic Patients
Patients less than 35 years
More likely to be benign.
Treat conservatively
Criteria for observtion:
 Patient under 35
 Unilateral tumor
 Unilocular cyst
 No solid component
 Tumor size less than 10cm
 Ascites absent
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3. Cyst under 3cm:no management
 Cyst 4-10cm:USG every 8 weeks
 If cyst fails to reduce in size or if initial
size>10cm:Laparoscopy or
Laparotomy
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4. Patients aged 35-45 years:
 Treated on individual basis.
 Benign cyst<5cm,and wish for uterus
conservation: conservative mgt.
 Larger cyst+completed family: surgery
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5. Patients above 45 years:
 Early recourse to surgery is beneficial.
 Criteria for conservative mgt:
 Simple unilateral cyst<3cm
 CA 125 levels < 35µ/ml
 Normal vascular resistance pattern
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6. Symptomatic Patients
 Emergency laparotomy or laparoscopy
irrespective of size of tumor or age of
patient.
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7. Treatment
Therapeutic ultrasound guided cyst
aspiration
 Laparoscopy
 Laparotomy
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8. Therapeutic ultrasound guided
cyst aspiration
Has a high recurrence rate
Candidate:
 Young woman
 Unilateral
 Unilocular
 Anechoic
 Thin walled cyst
 Less than 10cm in dia
 Contraindications:
 Solid tumor
 Symptomatic patient
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9. Laparoscopy
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Indications:
 Doubt about the nature of lesion
 Cyst suitable for lap surgery(simple
ovarian cyst without solid
component,benign cystic teratoma)
 Patients < 35 years
Procedures:
 Aspiration and fenestration
 Cystectomy
 Oophorectomy
 Salpingo-oophorectomy

10. 
Disadvantages:
 Spillage of cyst contents
 Incomplete excision of cyst wall
 Unexpected dx of malignancy
 Inadequate tm of malignancy
discovered by chance at laparoscopy
 High recurrence rate

11. Laparotomy
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Indications:
Persistent cyst
 Symptomatic tumor
 Solid tumor
 Tumor with solid component
 In case of laparoscopic complication
 Suspected malignancy
 Acute abdomen:emergency laparotomy
 Procedures:
 Cystectomy
 Unilateral salpingo-oophorectomy
 TAH+BSO
 Omentectomy
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12. Pregnant female
Asymptomatic ovarian cyst:
 Managed conservatively
 Should NOT be removed in 1st trimester
 Simple cysts<10cm:conservative
mgt+regular USG
 Must be observed carefully during
puerperium as dermoid cysts can
undergo torsion.
 If cyst persists 6 weeks post
partum:surgery.
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13. Symptomatic ovarian cyst:
 Sugery is the treatment of choice
regardless of size of cyst or duration
of gestation.
 Suspected malignancy: Caesarian
hysterectomy, BSO and omentectomy.
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