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6. REPRODUCTIVE > 4. Ovary/Adnexa > Flashcards

4. Ovary/Adnexa Flashcards

1
Q

Few general tips

A
  1. Never biopsy or recommend biopsy of an ovary
  2. If you can’t find the ovary on CT, follow the gonadal vein
  3. Hemorrhage in a cystic mass = benign
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2
Q

Normal ovarian size =

A

15 ml

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3
Q

Post menopausal ovary should NOT be larger than

A

6 cc

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4
Q

What phase?

A

Follicular phase

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5
Q
A

Corpus luteum

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6
Q

Follicles seen during the early menstrual cycle are typically small = ___ mm in diamater

A

< 5 mm

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7
Q

The LH surge causes the dominant follicle to

A

Rupture, releasing the egg

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8
Q

After the egg is relaesed, what happens to the follice?

A

Regrss in size, forming a Corpeus Luteum

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9
Q

Premenopausal ovarian cyst.

< 1 cm =
1-2 cm =
> 3 cm =

A

< 1 cm = Follicle
1-2 cm = Dominant follicle
> 3 cm. = Cyst

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10
Q
A

Cumulus Oophorus

It is a collection of cells in a mature dominant follicle that protrudes into the follicular cavity

signals imminent ovulation

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11
Q

this is a type of functional cyst (more on that below), related to overstimulation from b-HCG

A

Theca Lutein Cysts

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12
Q
A

Theca Lutein cysts

see are large cysts (~ 2-3 cm) and the ovary has a typical multilocular cystic “spoke- wheel” appearance.

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13
Q

Multifetal pregnancy + Gestational Trophoblastic Disease (moles) + Ovaryian Hyperstiumlation Syndrome =

A

Theca Lutein Cysts

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14
Q

Theca lutein cysts + Ascites + Pleural effusion + pericardial effusion + risk for ovarian torsion and hypovolemic shock

A

Ovarian Hyperstimulation Syndrome

complication associated with fertility therapy (occurs in like 5%)

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15
Q

Cyst that is in the adnexa but not within the ovary. Instead these things are located adjacent to the ovary or tube. If the cyst is simple (not septated or nodular) and clearly not ovarian they will not need followup — is doesn’t matter how big it is, as they have incredibly low rate o f malignancy.

A

Paraovarian (Paratubal Cyst)

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16
Q

maximum ovarian volume in a post menopausal woman

A

6 ml

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17
Q

Unlike premenopausal ovaries, post menopausal ovaries should show these feature on PET

A

should NOT be hot on PET.

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18
Q

Incidental Simple Appearing Ovarian Cyst -Shown on CT-

PreMenopausal: < 3 cm =
PreMenopausal: > 3 cm =

PostMenopausal: < 1cm =
PostMenopausal: > 1cm =

A

PreMenopausal: < 3 cm = Call it Normal Follicle PreMenopausal: > 3 cm = Get an US
PostMenopausal: < 1cm = Call it Normal Cyst PostMenopausal: > 1cm = Get an US

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19
Q

Incidental Simple Appearing Ovarian Cyst -Shown on US-

PreMenopausal: < 7 cm =
PreMenopausal: > 7 cm =

PostMenopausal: < 5 cm =
PostMenopausal: > 5 cm =

A

PreMenopausal: < 7 cm = No Follow Up
PreMenopausal: > 7 cm = Follow Up (3 months)

PostMenopausal: < 5 cm = No Follow Up
PostMenopausal: > 5 cm = Follow Up (3 months)

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20
Q

The Sinister Six of Ovarian MAsses

A

Physiologic and functioning follicles
Corpora lutea
Hemorrhagic cysts
Endometriomas
Benign cystic teratomas (dermoids)
Polycystic ovaries

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21
Q

These cysts are benign and usually 25 mm or less in diameter. They will usually change / disappear in 6 weeks. =

If it persists? =

A

Functioning Ovarian Cysts

Non functioning if it persists (Not under hormonal control)

22
Q

Simple cysts > 7 cm =

A

MRI

+ risk of torsion

23
Q

Corpus Luteum VS Ectopic Pregnancy

moves WITH the ovary =

Move SEPARATE from the ovary =

A

Corpus luteum = Moves with the ovary

Ectopic pregnancy = Moves separate from the ovary

24
Q

Triad:
Infertility + Dysmenorrhea + Dyspareunia (painful sex)

A

Endometrioma

25
Q
A

Endometrioma

ounded mass with homogeneous low level internal echoes and increased through transmission (seen in 95% of cases).

+/- Fluid-fluid levels and internal septations

Looks like hemorrhagic cysts sometimes

26
Q

the more unusual or varied the echogenicity and the more ovoid or irregular the shape, the more likelv the mass is

A

and endometrioma

27
Q

What is the most sensitive imaging feature on MRI for the diagnosis of malignancy in an endometrioma ?

A

An enhancing mural nodule

28
Q

complications of endometriosis

A

Bowel obstruction
infertility

= Due to a fibortic reaction associated with the implant.

29
Q

The most common location for solid endometriosis

A

uterosacral ligaments

30
Q

Other locations of endometriosis

A

CS scars

31
Q
A

Endometrioma

“Dropped implants”

32
Q

Do Endometriomas Ever Become Cancer?

A

About 1% - usually Clear Cell

33
Q

Malignancy is very rare in endometriomas smaller than 6 cm. They usually have to be bigger than

A

> 9 cm

69?? nyaha

34
Q

Risk factors for endometrioma turning into cancer =

A

a. > 45 y.o.
b. Bigger than 6-9 cm.

35
Q

a solid nodule with blood flow in an endometrioma of a pregnant girl

A

“decidualized endometrioma. ”

36
Q
A

Endometrioma

“Shading” - T2 shortening (getting dark) of a lesion that is T1 bright

Bright T1
Dark T2 (iron)
No fat supression (not a teratoma)

37
Q

sometimes a ruptured follicle bleeds internally and re- expands. The result =

A

homogenous mass with enhanced through transmission (tumor won’t do that) with a very similar look to an endometrioma

38
Q
A

Hemorrhagic cyst

“Fishnet appearance”

39
Q

Endometrioma vs Hemorrhagic Cyst

A

Hemorrhagic cyst with go away in 1-2 menstrual cycles (so repeat 6-12 weeks)

40
Q

Hemorrhagic cyst + post menopausal ladies =

A

follow-up 6-12 weeks

41
Q

Hemorrhagic cyst + Very old ladies =

A

Consider cancer till proven otherwise

42
Q

most common ovarian neoplasm in patients younger than 20

A

Dermoid

43
Q
A

Dermoid

“Tip of the iceberg sign”

absorption of most of the US beam at the top of the mass

cystic mass, with a hyperechoic solid mural nodule

44
Q
A

Dermoid

Rokitansky nodule or dermoid plug

45
Q

Cystic mass + Nodule + bright T1/T2 + Fat suppression

A

Dermoid

46
Q

Do Dermoids Ever Become Cancer?

A

1% - Squamous cell

47
Q

Gross Fat containing ovarian mass on CT =

A

Dermoid

48
Q

Hair within a cyst =

A

“Dot-dash” pattern

49
Q

Overweight girl + infertility + acne + Pencil mustache

A

Polycystic ovarian Syndrome

50
Q

imaging criteria of PCO

A

10 or more peripheral simple cysts ( < 5mm)
“string of pearls”
Enlarged ovaries (>10 cc)

6. REPRODUCTIVE (17 decks)

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