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A - MSRA Gynaecology [8] > [45] Ovarian Cysts > Flashcards

[45] Ovarian Cysts Flashcards

1
Q

What groups can ovarian tumours be divided into?

A
  • Functional
  • Bengin
  • Malignant
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2
Q

What % of ovarian cysts are benign?

A

70%

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3
Q

What are the types of benign ovarian tumours?

A
  • Benign epithelial neoplastic cysts
  • Benign cystic teratomas
  • Benign neoplastic solid tumours
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4
Q

What % of benign ovarian tumours are benign epithelial neoplastic cysts?

A

60%

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5
Q

What are the types of benign epithelial neoplastic cysts?

A
  • Serous cystadenoma

- Mucinous cystadenoma

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6
Q

Who are serous cystadenomas most common in?

A

Women 40-50 years

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7
Q

What might happen to the size of mucinous cystadenoma?

A

They may become enormous

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8
Q

What are mucinous cystadenomas filled with?

A

Mucinous material

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9
Q

What can happen if mucinous cystademomas rupture?

A

Can cause pseudomyxoma peritonei

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10
Q

Who are mucinous cystadenomas most common in?

A

20-40 age group

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11
Q

What cells do benign cystic teratomas arise from?

A

Primitive germ cells

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12
Q

What is a benign mature teratoma also known as?

A

Dermoid cyst

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13
Q

What might a dermoid cyst contain?

A

Well-differentiated tissue, e.g. hair, teeth

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14
Q

Who are dermoid cysts most common in?

A

Young women

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15
Q

What are the types of benign neoplastic solid tumours?

A
  • Fibromas
  • Thecomas
  • Adenofibromas
  • Brenner’s tumoru
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16
Q

What is a fibroma?

A

A small, solid, benign fibrous tissue tumour

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17
Q

What are ovarian fibromas associated with?

A
  • Meigs syndrome

- Ascites

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18
Q

What are Brenner’s tumours?

A

Rare ovarian tumours displaying benign, borderline/proliferative, and malignant variants

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19
Q

What other ovarian tumours might Brenner’s tumours be associated with?

A
  • Mucinous cystadenoma

- Cystic teratoma

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20
Q

What % of women do benign ovarian cysts occur in?

A

30% with regular menses

50% with irregular menses

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21
Q

Which age group do ovarian cysts occur in?

A

Premenopausal women (uncommon in post-menopausal and pre-menarchal women)

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22
Q

What are the most common type of ovarian cysts in young women?

A

Benign neoplastic cysts of germ cell origin

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23
Q

What are the risk factors for ovarian cysts?

A
  • Obesity
  • Tamoxifen therapy
  • Early menarche
  • Infertility
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24
Q

What type of ovarian cysts might run in families?

A

Dermoid

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25
Q

How might ovarian cysts present?

A
  • Incidental finding (asymptomatic)
  • Pain
  • Dysparuenia
  • Swollen abdomen
  • Pressure effects
  • Symptoms of complications
  • Endocrine symptoms
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26
Q

Describe the pain in ovarian cysts?

A

Dull ache or pain in lower abdomen, low back pain

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27
Q

Describe the swollen abdomen in ovarian cysts?

A

Palpable mass arising out of pelvis, which is dull to percussion and does not disappear if bladder is emptied

28
Q

What might ovarian cysts put pressure on causing symptoms?

A
  • Bladder

- Venous return

29
Q

What symptoms might be caused by ovarian cysts putting pressure in the bladder?

A

Urinary frequency

30
Q

What symptoms might be caused by ovarian cysts putting pressure on venous return?

A
  • Varicose veins

- Leg oedema

31
Q

How might asymptomatic ovarian cysts be found?

A

Chance finding on bimanual examination or ultrasound

32
Q

When might ovarian cysts cause endocrine symptoms?

A

If they secrete hormones

33
Q

What endocrine symptoms might be caused by ovarian cysts secreting hormones?

A
  • Virilisation
  • Menstrual irregularities
  • Post-menopausal bleeding
34
Q

Is it common for ovarian cysts to cause endocrine synmptoms?

A

No, uncommon

35
Q

What are the differential diagnoses of ovarian cysts?

A
  • Non-neoplastic functional cysts
  • Any other cause of pelvic pain
  • Polycystic ovary syndrome
  • Endometrioma
  • Ovarian malignant tumour
  • Bowel causes
  • Other gynae causes
  • Pelvic malignancies
36
Q

What non-neoplastic functional growths are differentials for ovarian cysts?

A
  • Follicle cyst
  • Corpus luteum cyst
  • Theca lutein cyst
37
Q

What are the bowel differentials for ovarian cysts?

A
  • Colonic tumour
  • Appendicitis/appendix mass
  • Diverticulitis
38
Q

What are the other gynaecological differentials for ovarian cysts?

A
  • Pelvic inflammatory disease
  • Tubo-ovarian abscess
  • Uterine tumour, e.g. fibroid
  • Para-ovarian cyst
  • Ectopic pregnancy
39
Q

What pelvic malignancies are differentials for ovarian cysts?

A
  • Retroperitoneal tumours
  • Small intestine tumours
  • Mesothelial tumours
40
Q

What cysts is it important that a correct diagnosis is made?

A

Some adnexal cysts, including;

  • Endometrioma
  • Mature cystic teratoma
  • Paraovarian cysts
41
Q

Why is important that some adnexal cysts are diagnosed correctly?

A

As they may affect patients’ fertility, and may be associated with significant pelvic disease or put the patient at risk of ovarian torsion

42
Q

What investigations may be done in ovarian cysts?

A
  • Pregnancy test
  • FBC
  • Urinalysis
  • Ultrasound
  • CT or MRI scan
  • Diagnostic laparoscopy
  • Fine needle aspiration and cytology
  • CA125
43
Q

What might be indicated on FBC in suspected ovarian cyst?

A
  • Infection

- Haemorrhage

44
Q

When should urinalysis be done in suspected ovarian cyst?

A

If there are urinary symptoms

45
Q

When should urinalysis be done in suspected ovarian cyst?

A

If there are urinary symptoms

46
Q

What is the role of ultrasound in ovarian cysts?

A

A pelvic ultrasound is the single most effective way of evaluating an ovarian mass

47
Q

What type of ultrasound is preferable in ovarian cysts?

A

Transvaginal

48
Q

What is the role of biopsy in ovarian cysts?

A

May be used to confirm the impression that a cyst is benign

49
Q

When does CA125 not need to be done in ovarian cysts?

A

In premenopausal women who have had an ultrasound diagnosis of simple ovarian cyst

50
Q

Why should CA125 not be done in pre-menopausal women with an ultrasound diagnosis of ovarian cysts?

A

Unreliable in differentiating benign from malignant masses in premenopausal women due to increased rate of false positives and reduced specificity

51
Q

What other conditions can result in raised CA125 levels?

A
  • Diverticulitis
  • Endometriosis
  • Liver cirrhosis
  • Uterine fibroids
  • Menstruation
  • Pregnancy
  • Benign ovarian neoplasms
  • Other malignancies
52
Q

What other malignancies is CA125 raised in?

A
  • Pancreatic
  • Bladder
  • Breast
  • Liver
  • Lung
53
Q

What is the main of use of CA125?

A

Assessing response over time to treatment for malignancy

54
Q

What are the management options for ovarian cysts?

A
  • Expectant management

- Surgery

55
Q

When do women with ovarian cysts not require follow up?

A

Small (less than 50mm diameter) simple ovarian cysts

56
Q

Why do women with small simple ovarian cysts not require follow up?

A

As these cysts are very likely to be physiological and almost always resolve within 3 menstrual cycles

57
Q

What follow up should be given to women with simple ovarian cysts of 50-70mm diameter?

A

Yearly ultrasound follow-up

58
Q

What should be done in women with simple ovarian cysts of over 70mm diameter?

A

Consider for either further imaging (MRI) or surgical intervention

59
Q

When are ovarian cysts unlikely to be functional, and may need surgical management?

A

Those that persist or increase in size

60
Q

Is the oral contraceptive recommended for use in ovarian cysts?

61
Q

When is surgery used for ovarian cyst?

A

If conservative measures fail or criteria for surgery are met

62
Q

What is good about surgery for ovarian cysts?

A

It is generally very effective and provides cure with minimal effect on reproductive capacity

63
Q

What are the options for surgical management of ovarian cysts?

A
  • Cystectomy

- Oophrectomy

64
Q

When might cystectomy be preferred to oophorectomy?

A

In children and younger women wishing to preserve maximum fertility

65
Q

What are the complications of ovarian cysts?

A
  • Torsion
  • Haemorrhage
  • Rupture
  • Infertility
66
Q

dont forget to finish the complications

A - MSRA Gynaecology [8] (52 decks)

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