Vaginal Polyp• This is a rare tumor which can be seen in
infants or in adults. The origin from the vaginal
mucosa has to be demonstrated
to differentiate from much more
common urethral caruncles, cervical and
uterus polyps.
Vaginal fibroma
• Fibroma of the vagina is a very rare tumor. It may be pedunculated and
appear at the introitus.
Clinically it is a firm benign noninfiltrating
growth.
Benign cervical lesions• Cervical erosion
• Leukoplakia (without atypia)
• Polyps• Endometriosis• Ectropion, scars• Exo-,
endocervicites
Algorithm for investigation
• Speculum exam• Pap smear,
bacterioscopy• Visual inspection after
application acetic solution
• Colposcopy• Biopsy
• A true ulcer with loss of epithelial covering is seen in the anterior lip of cervix
Cervical erosion
• Laparoscopic view of a uterus with a pedunculated posterior myoma
• A fibroid in this location should not affect chances for pregnancy or miscarriage
• However, if it were pushing into the cavity of the uterus, it might cause problems
Protruded myoma
Treatment of women with uterine leiomyomas must be individualized, based on:Symptoms, Size and Rate of growth of the uterus, and The woman’s desire for fertility.
Hysterectomy Myomectomy >40 years complete her family large subserous-submucous and complicated large +ve complications (pressure Symptoms)
<40 years anxious to have children solitary-few-welldefined subserous (pedunclated) small to moderate no
Patient Age. Parity.
Fibroid
No
Type
Size Associated
Indications for surgical treatment
- a rapidly growing myoma - persistent abnormal
bleeding- Symptomatic myoma:
pain or pressure- Myoma sizes more
than 12 week of gestation
Operations: myomectomy or hysterectomy
Treatment of women with uterine leiomyomas must be individualized, based on:
1.Symptoms, 2.Size and 3.Rate of growth of the uterus, and 4.The woman’s desire for fertility.
Conservative treatment
• Gonadotropin-Releasing Hormone Agonists - should be restricted to a 3- to 6-month interval, following which regrowth of fibroids usually occurs within 12 weeks.
• estrogen–progestin combinations
• Gestagens (depot medroxy-progesterone acetate (Depo-Provera), IUD - MIRENA
• Danazol has been associated with a reduction in volume of the fibroid in the order of 20% to 25%.
Ovarian cysts
Chocolate cyst
Dermoid Thin membrane, small sizes, conservative or surgery, rare complications
Conservative or Surgery: oophorectomy, ovarian resection
Ovarian cystomasSerous Cystadenoma
Bilateral cystadenoma
Papillary cystadenoma
Thick membrane, large sizes, surgery, most often complications
Torsion of the ovarian pedicle
Anatomical pedicle:•Ovarian lig•ov. Suspensory lig.•mesosalpinx
mesosalpinx
Surgical pedicle:•Ovarian lig•ov. Suspensory lig.•Mesosalpinx•Fallopian tube
Surgery - salpingooophorectomy