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Genicology Pathology > ADNEXA/OVARIES > Flashcards

ADNEXA/OVARIES Flashcards

1
Q

Diffuse disease of the female pelvic cavity

A

PID
ENDOMETRIOSIS

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2
Q

Most commonlyPID caused by
Uncommonly reason

A

Sexual disease
Genera
Chlamydia
Un. Ruptured appendix peritonitis

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3
Q

Early stage of endometriosis and PID may mimic

A

Functional bowel disease

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4
Q

Pelvic infection PID:

A

Endemetritis
Salpingitis
Hydrosalpinx
Pyosalpinx
Periovarian inflammation
Tubo ovarian complex
Tubo ovarian abscess

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5
Q

Parametritis

A

Infection found in uterine serosa and broad ligaments

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6
Q

Oophoritis

A

Ovary infection

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7
Q

Most common location

A

Oviduct
Salpingitis

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8
Q

Us in chronic Pid

A

Dilated fallopian tubes
Hydrosalpinx
Pyosalpinx
Abscess
Complex fluid intraperitoneal

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9
Q

PID clinical symptoms

A

Large palpable bilateral complex mass
Ovary separate from mass
free fluid in cul-de-sac
Doppler increase vasicularity
Infertility
Endometritis
Intensive pervic pain and tenderness described as dull aching
constant vaginal discharge
Fever
Pain in right upper abdomen
Mistral irregular bleeding
Painfull intercourse

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10
Q

Fitz-hugh- Curtis syndrome

A

Perihepatic inflammation
Along liver margin
Hypoechoic rim between liver and
Adjacent rib

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11
Q

PID lab test

A

I WBC
Caused by chlamydia
Way be asymptomatic

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12
Q

Differential consideration

A

Hematoma
Dermoid cyst
Ovarian neoplasm
Endometritis

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13
Q

Us if endometritis
Periovarian inflammation

A

Thickening or fluid endometrium
Periviovarian inflammation
Enlarged ovaries with multiple cysts
Indistinct margin

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14
Q

Us salpingitis
Clinical

A

Nodular thickening
Irregularity of tube with diverticle
Dilated tube
Tortuous

Low-grade fever
Asymptomatic
Pelvis fullness

Unilateral or bilateral

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15
Q

Us pyosalpinx or
Hydrosalpinx

A

Fluid-filled
Regular fallopian tide
With or without echo

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16
Q

Us
Tube- ovarian abscess

A

Complex mass
With septarian
Irregular margins
Internal echoes
Usually in Incul-de-sac

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17
Q

Acute salpangitis

A

The tube is enlarged
Distended with echoes pus appears
Thickwall

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18
Q

Hydrosalpinx
Reasons

A

PID
Endomeíritis
Post operative adhesions

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19
Q

Hydrosalpinx
Clinical
Us

A

A symptomatic
Pelvic fullness
Law grade fever

Wall thin ia dilatio
Multi cystic or fusi form mass
Dilated tube from fundus of uterus
Bilateral
Ampulary more dilated then interstitial
Pointed beak at swan end of tube near isthmus

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20
Q

Peritoneal psedocyst

A

With hemorrhagic mesotherial cyst appearance
Right lower pain in some patient
Fluid filled mass and separations in cul-de-sac

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21
Q

Tube-ovarian
Abscess
Complex

A

Adhesive
Edemarous
Inflamedserosa
May adhere ovary
And other peritoneal surfaces
Distort anatomy
Periovarian adhesion
Ovary cannon be separated from dilated tube
Tube - ovarian complex
Response to -o
Sono guidance for drainage

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22
Q

Peritonitis
Inflammation of peritoneum
Pelvic peritonitis

A

If infection spreads to involve bladder
Ureter
Bowel
Adnexal area

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23
Q

US in peritonitis

A

.gas forming bubbles
Located areas of fluid within pelvis
Parabolic gutters
Mesentric reflections
Evaluation space btw right kidney and liver
Left kicky spleen

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24
Q

Endemetritis division

A

Obstetric. Immediate Post partum
NONObstetric _PID or IU

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25
Q

Most common cause E of fever in Post partum

A

‘endometritis

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26
Q

Normal thickness of endemiritis
If more than

A

20mm
More than
Endometritis
hemorrhage
Retained products of pregnancy
Risk increases
Prom
Retained clot
Prolonged labor

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27
Q

Endometriosis

A

Presence of functionalendometrial tissue in abnormal locations
Anywhere
Especially more dependent Parts of pelvic
Cut de sac

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28
Q

Clinical finding endomeírisis

A

Severe diysmenorrhea
Chronic pelvic pain
Adhesion
Bleeding
Dysparenuia during sexual intercourse

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29
Q

Types of endometriosis

A

Internal and
External

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30
Q

Internal endometriosis

A

Within the uterus
Adenomyosis

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31
Q

External endometriosis

A

Outside the uterus
Pouch of Douglas
Surface of ovaries
Fallopian tube
Uterus broad ligaments
Rectovaginal septum

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32
Q

More common form of endometriosis

A

External or indirect

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33
Q

Internal or direct form of endometriosis
clinical

A

Adenomyosis
Invading the uterin body
Invading junction al zone and myometrium
Heavy menstrul bleeding and uterin e enlargement

C

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34
Q

Adenomyosis most common

A

Women had uterin surgery

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35
Q

Us endometriosis

A

Uterin bulbous
Myometrial cysts
Border between endometrium and myometrium is in distinct
BLUURED BORDER appearance more common in posterior of uterus
MRI more than US IN distinct

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36
Q

External or localized form

A

Discrete mass
Endometrioma
Or chocolate cyst
Asymptomatic
May enlarged
Surgical emergency
By rupture
Causing ovary twisted
Common site is ovaries chocolate cyst enlarge ovaries

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37
Q

External form in US

A

Rarely detected
Unless focal mass
Endometrioma present
Endometriomas may uni or bilateral ovarian mass
Ranging from anechoic
To solid depending on amount of blood
Ovaries adhere to pos uterine or in culled sac
Difficult to define
May be cystic mass be disseminated cancer or pelvic infection

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38
Q

More common form of endometriosis

A

Diffuse external endometriosis

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39
Q

Ground glass appearance

A

Endometrioma and mass in the ovaries fills with blood

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40
Q

Ovaries places

A

If uterus in the midline lateral or posterolateral
Uterus in one side of midline ipsilateral ovary superior to uterine fundus
In retroverted ovaries lateral and superior
Enlarge ed uterus ovaries more superior and laterally
Hysterectomy ovaries in midline superior to vaginal cuff
Or in high in pelvis or in curl de sac
TV if ovaries superiorly or extremely latterly can not be seen

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41
Q

Cumulus oophorus

A

As eccentrically located cyst like
1 mm internal mural protrusion
Mature follicle and ovulation

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42
Q

Crenulated
Scalloped follicles

A

Occasionally follicles decrease in size and develops a wall

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43
Q

Follicular cyst

A

Develops if fluid in non dominant follicles not reabsorbed
Like simple cyst
Dominant follicles disappear after ruptured at ovulation

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44
Q

Free fluid in the culled sac

A

Commonly seen in. Lute all phase after ovulation

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45
Q

Following ovulation in luteal phase

A

Mature corpus luteim
Develops and may be identified in US as small hypoechoic or isoechoic structure periphery within the ovary
May appear irregular with echo genie crenulated wall contain low level echoes

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46
Q

Less frequent appearance of corpus

A

RING OF FIRE
In Doppler around wall of the isoechoic corpus
That the same as ectopic pregnancy

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47
Q

Multiple small punctate
Echo genie foci commonly seen in normal ovary

A

Very small 1 2 mm
Periphery no shadowing
Multiple

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48
Q

Abnormal volum of the ovaries

A

22 ml in menstration mean 9;8 ml +- 5.8
In pst menopause more than 8 ml abnormal
If one side is twice of another

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49
Q

Majority of ovarian masses

A

Simple cysts benign
If in post menopause seen more than 5 cm with septation and solid echoes surgery recommended

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50
Q

Common cystic or complex ovarian mass

A

Follicular cyst
Capos luteum
Cystic teratoma
Para ovarian cyst
Hydrosalpinx
Endometrioma
Hemorrhagic cyst

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51
Q

Complex mass or cyst

A

Any simple cyst that hemorrhages as involuted برگشتن به حالت اولیه خودش

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52
Q

Reproductive age complex mass classic differential

A

Adnexal mass
Ectopic
Endometrioma
Endometriosis
PID
dermoid and other benign tumours
Cystadenoma
Granulosa cell Tumours or
Tubo ovarian abscess

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53
Q

Most common solid tumours of ovaries

A

Serous types
Cyst Adenoma
Cyst adeno carcinoma

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54
Q

Solid tumours

A

More complex the Tubo more more likely to be malignant
Especially with ascites

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55
Q

When solid mass found identify connections with uterus

A

To deferentiate ovarian lesion from pedunculated uterine fibroid
Color Doppler to see the vascular pedicle between uterus and mass

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56
Q

Common solid mass arising ovaries

A

Solid teratoma
Adenocarcinoma
Arrhenoblastoma
Fibroma
Dysgerminoma
Torsion

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57
Q

Doppler of the ovary

A

Suspected cystic lesion
In differentiating potential cyst from adjustment vascular iliac artery
Pulse Doppler for
Adnexal branch uterin artery
Ovarian artery
Intramural flow
To determine resistive index

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58
Q

Doppler of ovaries time

A

Normal men’s in first 10 days of cycle
To avoids confusion with normal changes in intraovarian blood flow because high diastolic flow occurs in luteal phase

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59
Q

Value for RI AND PI IN Doppler

A

RI > 0.4
PI > 1

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60
Q

Sign for malignancy

A

Intramural vessels
Low resistance flow
Absence of normal diastolic notch in DOPPLER

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61
Q

Abnormal waveform can be seen in

A

Inflammatory masses
Metabolically active masses ectopic pregnancy
corpus luteum cysts
RI is not the sensitive indicator of malignancy

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62
Q

Diastolic notch in early diastolic

A

Sign of benign disease

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63
Q

Functional ovarian cysts

A

Follicular
Corpus luteum
Hemorrhagic
Theca lutein cysts

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64
Q

Follicular cyst

A

When dominant follicles does not succeed in ovulating and remains active
Unilateral
Thin wallled translucent watery fluid 1- 8 cm
Disappear or rupture
Simple cyst

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65
Q

Corpus luteum cyst

A

From hemorrhage whitin mature corpus luteum that persisted
Filed with blood
1-10 cm
May accompany the intrauterine pregnancy
May mimic ectopic
Rupture
cyst type lesion internal echo
Increase color

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66
Q

2-hemorrhage cyst

A

Internal hemorrhage can occur in follicular cyst
Or corpus luteual cyst
Acute onset of the pelvic pain
Appearance:
Hemorrhagic cyst with Retracted blood clot showing reticular inner or cobweb or fishnet appearance
Indicating hemolysis of the blood

67
Q

Diffuse low level echoes may be seen

A

In Endometriomas
Chocolate chips and ground glass

68
Q

3- Theca lutein cyst

A

Large bilateral multiloculated cyst
With high level of bhcg
In 30% of trophoblastic molar enlarged uterus filled with grapelike clusters
Nausea vometing
In US, multilocular cyst in both ovaries

69
Q

Ovarian hyper stimulation syndrome

A

Mild
Severe
Severe pelvic pain
Ascites
Abdominal distension
Pleural effusion

Ovaries more than 10 cm
Numerous large thin walled cyst
Ovaries no more in pelvic cavity and become abdomen organ

70
Q

Polycystic ovarian syndrome

A

Include stein levanthal syndrome an endocrine disorder with chronic an ovulation
Bilaterally enlarge polycystic ovary
Clinical amenorrhea
Obesity
Hirsutism
Infertility

In US Multiple tiny cyst around periphery of ovary may be normal or enlarged ovary

Imbalance in FSH LH. Abnormal estrogen and progesterone characteristics finding in poly

Ovaries are rounded increase number of follicles

71
Q

characteristics finding in polycystic

A

Imbalance in FSH LH. Abnormal estrogen and endrogen
Elevated LH / FSH ratio

72
Q

Follow up polycystic patients

A

Unopposed esterogenic hyperplasia and endometrial carcinoma occurs in significant proportion
PCOS common cause of infertility and early pregnancy loss

73
Q

Polycystic ovation appearance

A

Enlarge ovary with string of pearls enlarged follicles prominent follicles around peripheral ovary

74
Q

Peritoneal inclusion cyst

A

When adhesion trap peritoneal fluid around ovaries
Resulting in large Adnexal mass
Pelvic pain pelvic mass

75
Q

Para ovarian cyst

A

Simple
Wolfian duct remnant
Can bleed undergo torsion
In broad ligament
Asymptomatic
Simple cyst adjuscent to ovary
May completely fill the Adnexal region

76
Q

Endometriosis

A

Endometrioma chocolate cyst

77
Q

Ovarian torsion

A

3% of gynaecology operative emergencies
Partial or complete rotation of ovarian pedi ul on its axis
Enlarge edematose ovary more than 4 cm
Hypoechic mass
Free fluid in pelvic
Absent of blood flow to TOR sed ovary
Result in Edelman
Loss of arterial perfusion
Infarction of the ovary
Involves ovary and fallopian tube

78
Q

Torsion of normal ovary usually in

A

In children and younger female with mobile Adnexa pre-existing ovarian cysts or mass
Or pregnancy
More often in the right side can mimic appendicitis

79
Q

Abnormal ovaries suggest malignancy defined as

A

Enlarged echogenic ovaries

80
Q

1) ovarian carcinoma

A

Absent of symptoms in early stage

Not detected until advanced
Having spread beyond capsule but still within pelvic stage ll
In to abdomen stage lll
Normal to slightly enlarge firm irregular ovaries to pelvic mass
Differentials
Endometriosis
Hemorrhagic ovarian cyst
Ovarian torsion
PID
Benign ovarian neoplasm
Increase age increase malignant
Less than 5 cm benign
More than 10 cm malignant

81
Q

Strongest risk factor for ovarian carcinoma

A

Family history of ovarian and breast cancer
Other
Nulliparity
Infertility
Uninterrupted ovulation
Late menopause

82
Q

Epithelial tumours

A

80 to 90% malignancy
65% to 75% ovarian neoplasm
Surface epithelial stromal tumours
Arise from surface epithelium cover ovary and underlying stroma

83
Q

Most common types are

A

Serous and mucinus tumours
Serous epithelial tumours are common

84
Q

Mucinous cystadenoma 20% to 25%

A

Benign ovarian
Mucinous cystadenocarcinoma 5%to 10% malignant ovarian neoplasm

85
Q

Serous cystadenoma more common in malignancy cystadeno carcinoma

A

Second most common benign tumour of the ovary after dermoid 20% to 25% of all benign ovarian tumours
Serous cyst adeno carcinoma 60 to 80% ovarian carcinoma

86
Q

Adenoma

A

Benign or low malignancy potential

87
Q

Cyst add to term

A

Lesion cystic
Malignant form adenocarcinoma
Fibroma more than 50% of tumour fibrous

88
Q

2-1 Mucinous cystadenoma

A

Type of epithelial tumour lined by Mucinous elements
20% to 25% benign ovarian neoplasm
Mucinous cystadenocarcinoma malignant

89
Q

Cystadenocarcinoma marked sign

A

Septal nodularity
Large sized and septation

90
Q

Mucynous cystadenomas

A

Benign large sized septation are characteristics in women 13 to 45
80% to 85% is benign
Very large 15-30 cm

91
Q

Sonographic findings

A

• In 75% of patients with mucinous tumors, ultrasound examination shows simple or septate thin-walled multilocular cysts
• Contain internal echoes with compartments differing in echogenicity caused by mucoid material in dependent portions

92
Q

Mucinus cyst-adenoma

A

• Unusually large (15 to 30 cm)
• Most common cystic tumor
• Usually, unilateral
• Cyst filled with sticky, gelatin-like material
• Multilocular cystic spaces
• Benign type more common than malignant
• Clinical: pressure, pain, increased abdominal girth
• Sonographic findings: simple or septate thin-walled multilocular cysts

93
Q

Mucinous cystadenocarcinoma

A

• Most frequently occurs in women 40 to 70 years old
• Accounts for 5% to 10% of all primary malignant ovarian neoplasms
• 15% to 20% bilateral when malignant

94
Q

Psedumixoma peritoneum

A

• 10% occur in menopausal women
• Can also become very large and more likely than benign form to rupture
• If tumor ruptures, associated with pseudomyxoma peritoneum
• Causes loculated ascites with mass effect

95
Q

In us mucinous

A

Sonographic findings
• Malignant cysts tend to have thick, irregular walls and septations with papillary projections and echogenic material.
•Generally, have sonographic appearance similar to serous cystadenocarcinomas

96
Q

Mucinous cystadenocarcinoma

A

• Bilateral
• May occur in menopausal women (10%)
• Large, likely to rupture-ascites
• Clinical: pelvic pressure; pain when ruptured
• Sonographic findings: ascites appears as hypochoic fluid with bright punctate echoes;
thick, irregular walls and septations

97
Q

Serous cyst adenoma

A

• Second most common benign tumor of ovary (after dermoid cyst)
• Represents 20% to 25% of all benign ovarian neoplasms
• Is usually unilateral; 20% are bilateral

98
Q

Serous cyst adenocarcinoma

A

G, H, and I are images in a single patient with a serous cystadenocarcinoma.
Extensive nodularity shows vascularity confirming the morphologic suspicion of a malignant mass.
There is high diastolic flow resulting in a low resistive index.

99
Q

Serous cyst adenoma

A

Sonographic findings
• Usually, unilocular or multilocular with thin septations
• Smaller than mucinous cysts (up to 20 cm); borders irregular with loss of capsular definition
• Multilocular cysts contain small amount of solid tissue in chambers of varying size with occasional internal septum or mural nodules

100
Q

Serous cyst adeno carcinoma

A

• External papillary mass adhesions and infection lead to bilateral involvement.
• Loss of capsular definition and tumor fixation;
calcifications
Peritoneal implants; ascites; metastases to omentum, lymph nodes, liver, and lungs
• Clinical: pelvic fullness, bloating
• Sonographic findings: cystic structure with septations and/or papillary projections; internal and external papillomas usually present

101
Q

Germ cell tumours

A

• Account for 15% to 20% of ovarian neoplasms, with approximately 95% being benign cystic teratomas
• Besides teratomas, germ cell tumors include dysgerminoma, embryonal cell carcinoma, choriocarcinoma, and transdermal sinus tumor.

102
Q

Associated with elevated AFP and hcg levels

A

• Often occur as mixed tumors with elements of two or three varieties of germ cell layers
• Associated with elevated alpha-fetoprotein
(AFP) and hCG levels

103
Q

Teratoma mature benign form

A

Teratoma: Dermoid Tumors
• Size ranges from small to 40 cm
• Unilateral, round to oval mass
• Contains fatty, sebaceous material, hair, cartilage, bone, teeth
• Clinical: asymptomatic to abdominal pain, enlargement and pressure; pedunculated; subject to torsion
• Sonographic findings: cystic/complex/solid mass; echogenic components; acoustic

104
Q

Dermoid plug

A

2) Cystic mass with very echogenic nodule along mural wall representing “dermoid plug”

105
Q

TERATOMAS IN US

A

Sonography may demonstrate one of several
patterns:
1) Completely cystic mass
2) Cystic mass with very echogenic nodule along mural wall representing “dermoid plug”
3) Fat-fluid level
4) High-amplitude echoes with shadowing (e.g., teeth or bone)
5) Complex mass with internal septations

106
Q

IMATURE TERATOMAS MALIGNANT FORM

A

• Immature teratomas uncommon; occur in girls and young women 10 to 20 years of age
• Rapidly growing, solid malignant tumors with many tiny cysts
• AFP elevated in 50% of patients
• Unilateral and small in size; may grow to larger dimension

107
Q

The tip of the ice berg sign

A

Immature teratoma because of shadowing you cannot say how deep it is the posterior margins is not appreciated

108
Q

Dermoid mesh

A

Hyper echo IVC lines corresponding hair in dermoid tumours TERATOMAS
small hyperechoic floating lines and dots

109
Q

Dermoid plug or Rokitansky nodule

A

Hyperexhoic nodule situated near the wall of the cyst with posterior shadowing

110
Q

Mobile spherules

A

Image (5).
A well-defined large complex adnexal mass lesion, with multiple large floating / mobile echogenic spherical structures (named mobile spherules) in benign cystic TERATOMAS

111
Q

Benign cystic teratoma dermoid cyst appearance

A

Image (6).
A well-defined large cystic adnexal mass lesion, with fat-fluid level (non-dependent lower density hyperechoic fat floating over dependent higher density hypochoic fluid).

112
Q
  • most common ovarian neoplasms seen in pregnancy.
A

Dysgerminoma and serous cystadenoma are two

113
Q

Dysgerminoma

A

Dysgerminoma
• Rare malignant germ cell tumor bilateral in 15% of
cases
• Mass constitutes 1% to 2% of primary ovarian

114
Q

Dysgerminoma

A

• Entirely solid ovarian mass in woman <30 years of age usually dysgerminoma

115
Q

Endodermal Sinus Tumor

A

• Endodermal sinus tumors rare rapidly growing tumors also called yolk sac tumors
• Usually occurs in women <20 years of age; is almost always unilateral
• Increased serum AFP may be seen.

116
Q

Yolk sac tumor

A

Endodermal Sinus Tumor

117
Q

Endodermal Sinus Tumor

A

• Endodermal sinus tumor has poor prognosis.
• Second most common malignant ovarian germ cell neoplasm after dysgerminoma
•Sonographic appearance similar to dysgerminoma

118
Q

•Sonographic appearance similar to dysgerminoma

A

Endodermal Sinus Tumor

119
Q

• Second most common malignant ovarian germ cell neoplasm after dysgerminoma

A

Endodermal Sinus Tumor

120
Q

• Sex cord-stromal tumors
Stromal بستر

A

• Sex cord-stromal tumors typically solid adnexal masses that arise from sex cords of embryonic gonadal and/or ovarian stroma
• Includes granulosa cell tumor, thecoma, fibroma, and Sertoli-Leydig cell tumors (androblastoma)
• Accounts for 5% to 10% of all ovarian neoplasms and 2% of all ovarian malignancies

121
Q

Fibroma and Thecoma

A

• Both fibroma and thecoma tumors arise from ovarian stroma;
are pathologically similar
• Tumors with abundance of thecal cells called thecomas, and those with abundance of fibrous tissue called fibromas
• Thecomas usually benign and unilateral, comprising 1% of all ovarian neoplasms;
70% occur in postmenopausal women
• Frequently show signs of estrogen production

122
Q

70% occur in postmenopausal women

A

Fibroma and Thecoma

123
Q

Fibroma

A

• Comprise 4% of ovarian neoplasms
• Rarely associated with estrogen production
• Clinical signs include lack of symptoms if tumor small
• If large, increasing pressure and pain apparent
• Ascites has been reported in up to 50% of patients with fibromas >5 cm in diameter

124
Q

Ascites has been reported in up to 50% of patients

A

with fibromas >5 cm in diameter

125
Q

•Meigs syndrome

A

Meigs syndrome is defined as the triad of benign ovarian tumor with ascites and
pleural effusion that resolves after resection of the tumor.

126
Q

Fibroma

A

• Associated ascites along with pleural effusion
• Referred to as Meigs syndrome; occurs in 1% to 3% of patients with fibroma
• Not specific; it can occur with other ovarian neoplasms as well
• Found in postmenopausal women

127
Q

the majority of the benign tumors seen in Meigs syndrome.

A

Ovarian fibromas constitute the majority of the benign tumors seen in Meigs syndrome.

128
Q

Granulosa Cell Tumor clinical

A

• Clinical symptoms of estrogen production may include precocious puberty or vaginal bleeding and full breasts.
• Pain, pressure, fullness may also be present.
• May twist on itself to cause torsion or rupture, leading to
Meigs syndrome
• Malignant transformation rare, but when it occurs, lesion spreads via lymphatics and bloodstream

129
Q

Granulosa Cell Tumor

A

• Feminizing neoplasm composed of cells resembling graafian follicle
• Most common hormone-active estrogenic tumor of ovary
• More common after menopause (50%)
• Also seen in reproductive ages (45%) and in adolescence (5%)

130
Q

• Most common hormone-active estrogenic tumor of ovary

A

Granulosa Cell Tumor

131
Q

• More common after menopause (50%)

A

Granulosa Cell Tumor

132
Q

Granulosa Cell Tumor

• Clinical symptoms of estrogen production may include

A

precocious puberty or vaginal bleeding and full breasts.
• Pain, pressure, fullness may also be present.
• Maystwist on itself to cause torsion or rupture, leading to
Meigs syndrome
• Malignant transformation rare, but when it occurs, lesion spreads via lymphatics and bloodstream

133
Q

Granulosa Cell Tumor in US

A

Sonographic findings
• Variable appearance
• Mass without torsion
• Similar to endometrioma or cystadenoma, with low-level homogeneous echoes
• If torsion occurs, multilocular cyst containing blood or fluid
seen
• Solid masses may have echogenicity similar to uterine fibroids.

134
Q

Metastatic Disease

A

Metastatic Disease
• Ovaries more involved with metastatic disease than any other pelvic organ
• Metastases often mimic appearance of advanced stage II to III primary ovarian cancer.
• Approximatelv 5% to 10% of ovarian nanni. metastatic in a

135
Q

• Krukenberg tumors

A

• Krukenberg tumors “drop” metastases to ovaries from GI tract, primarily from stomach, but also from biliary tract, gallbladder, pancreas.

136
Q

Sonographic findings
• Metastatic disease to ovaries

A

Sonographic findings
• Metastatic disease to ovaries frequently bilateral and often associated with ascites
• Metastases usually completely solid or solid with “moth-eaten” cystic pattern that occurs when nectotic

137
Q

moth-eaten” cystic pattern

A

Metastases usually completely solid or solid with “moth-eaten” cystic pattern that occurs when nectotic
بید گاز زده

138
Q

• Lymphoma

A

‏nvolving ovary usually diffuse and disseminated and frequently bilateral
‏• Sonographically, mass appears as solid hypochoic tumor similar to lymphoma elsewhere body.

139
Q

Carcinoma of the Fallopian Tube

A

• Least common (<1%) of all gynecologic malignancies
• Adenocarcinoma most common histological finding
• Occurs most frequently in postmenopausal women with pain, vaginal bleeding, pelvic mass
• Usually involves distal end; may involve entire length of tube

140
Q

• Least common (<1%) of all gynecologic malignancies

A

Carcinoma of the Fallopian Tube

141
Q

Carcinoma of the Fallopian Tube most in

A

• Occurs most frequently in postmenopausal women with pain, vaginal bleeding, pelvic mass

142
Q

Carcinoma of the Fallopian Tube in US

A

Sonographic findings
• Appears as sausage-shaped, complex mass, with cystic and solid components often with papillary projections
• Clinical and sonographic findings similar to those of ovarian carcinoma

143
Q

• Appears as sausage-shaped, complex mass, with cystic and solid components often with papillary projections

A

Carcinoma of the Fallopian Tube in US

144
Q

• The differential considerations of a solid-appearing adnexal mass include

A

pedunculated fibroid, dermoid, fibroma, the-coma, granulosa cell tumor, Brenner tumor ( a solid abnormal growth on the ovary most benign most often in women after menopause), and metastasis.
Tubo-ovarian abscess, ovarian torsion, hemorrhagic cysts, and ectopic pregnancy also may appear solid.
• Pulsed Doppler interrogation of the adnexal branch of the uterine artery, the ovarian artery, or intratumoral flow is performed to determine the resistive index or pulsatility index.

145
Q

Theca-lutein cysts

A

are the largest of the functional cysts and appear as very large, bilateral, multiloculated cystic masses. They are associated with high levels of human chorionic gonadotropin and are seen most frequently in association with gestational trophoblastic disease.

146
Q

Omental cysts tend to be higher in the abdomen, and urachal cysts are midline in the anterior abdominal wall above the bladder

A

Omental cysts

147
Q

Germ cell tumors include

A

teratomas, dysgerminoma, embryonal cell carcinoma ( type of testicular cancer) ( , choriocarcinoma, and transdermal sinus tumor.

148
Q

Common Cystic or Homogenous
Ovarian Masses

A

• Follicular cyst
• Corpus luteum cyst of pregnancy
• Cystic teratoma
• Paraovarian cyst
• Hydrosalpinx
• Endometrioma (low-level echoes)
• Hemorrhagic cyst
• Cystadenoma
• Dermoid cyst
• Tubo-ovarian abscess
• Ectopic pregnancy
• Granulosa cell tumor

149
Q

Ovarian Remnant Syndrome

A

Ovarian Remnant Syndrome. Infrequently, a cystic mass may be seen in a patient who has a history of bilateral oopho-rectomy. This usually results in a technically difficult surgery (because of adhesions), in which a small amount of residual ovarian tissue has been unintentionally left behind. The residual ovarian tissue can become functional and produce cysts with a thin rim of ovarian tissue in the wall.

150
Q

Fluid Collections in Adhesions

A

. Fluid collections in adhesions can create cystic structures of odd shapes throughout the abdomen. Omental cysts tend to be higher in the abdo-men, and urachal cysts are midline in the anterior abdominal wall peritoneum above the bladder. Any tumor may have cystic elements, and the sonographer should demonstrate if the tumor is a simple cyst or a complex mass.

151
Q

benign Cysts in Fetuses and Adolescents.

A

Small simple cysts (1 to 7 mm) normally occur in fetuses and newborn girls because of stimulation by maternal hormones. In pre-menarchal girls, small follicles (less than 9 mm) are common.
Larger cysts also are seen in otherwise healthy premenarchal gis. These may be followed closely if they are regressing, as jong as the child’s growth and development appear normal.
Occasionally, ovarian cysts produce symptoms of precocious puberty in young girls. These may arise spontaneously or in association with other hormonal derangements.

152
Q

Other epithelial tumors

A

Less common varieties of epithelial tumors are endometrioid, clear cell, Brenner (transitional cell), and undifferentiated carci-noma. Endometrioid tumors are nearly all malignant and are the second most common epithelial malignancy. Approximately 25% to 30% are bilateral and occur most frequently postmeno-pausal; peak age ranges from 50 to 60 years. Clear cell tumors are considered to be of müllerian duct origin and a variant of the endometrioid carcinoma. Clear cell tumors are nearly always malignant and are bilateral about 20% of the time. Peak age ranges from 50 to 70 years. Transitional cell tumor, also known as Brenner tumor, is uncommon. The Brenner tumor is found in 1.5% to 2.5% of patients; peak age ranges from 40 to 70 years. It is nearly always benign and 6% to 7% are bilateral; 30% are associated with cystic neoplasms in the ipsilateral ovary.
• Sonographic Findings. These types of epithelial tumors cannot be distinguished sonographically; however, they are more frequently found unilaterally. They are usually small and present as a nonspecific, complex, predominantly cystic mass. Occasionally the tumor may contain hemorrhage or necrosis. The Brenner tumors are hypochoic, solid masses that may contain calcifications in the outer wall. They are composed of dense fibrous stroma and appear similar to ovarian fibromas and thecomas.

153
Q

Epithelial tumors

A

Serous and mucinous
Serous cystadenoma
Serous cystadenocarcinoma
Mucinous cystadenocarcinoma
Mucinous cystadenocarcinoma
Other epithelial tumors

154
Q

Germ cell tumors

A

Teratoma
Immature and mature teratoma
Dysgerminoma
Endodermis sinus tumor

155
Q

Stromal tumors

A

Fibroma
Thecoma
Granulosa
Sertoli leydig cell tumors
Arrhenoblastoma

156
Q

Sertoli-Leydig Cell Tumor

A

Sertoli-Leydig cell tumors (also called androblastomas) are rare. They generally occur in women under 30 years and constitute less than 0.5% of ovarian neoplasms. Almost all are unilateral, and malignancy occurs in 10% to 20% of these tumors. Clinically, symptoms of virilization occur in about 30% of patients. Occasionally, these tumors may be associated with estrogen production.
Sonographic Findings. Sonographically, the tumor usually appears as a solid hypochoic mass.

157
Q

Arrhenoblastoma

A

Arrhenoblastoma
Arrhenoblastoma is a masculinizing ovarian tumor that occurs in females 15 to 65 years of age, with a peak incidence at 25 to 45 years. Clinical features are the same as for other pelvic masses, with the addition of amenorrhea and infertility. This mass may undergo malignant transformation in 22% of patients.
• Sonographic Findings. The tumor is a solid mass with cystic components; it is lobulated and well encapsulated. In

158
Q

Cyst Adenoma

A
  1. All of the following are solid tumors except:
    A. Thecoma
    B. Fibroma
    C. Brenner’s tumor
    D. Cystadenoma
    E. Teratoma
159
Q

B. Cystic and ovarian in origin

A

Most adnexal masses are:
A. Cystic, ovarian in origin, and malignant
B. Cystic and ovarian in origin
C. Ovarian in origin and malignant
D. Cystic and malignant
E. None of the above

160
Q

Granulosa cell tumors may be discovered in patients

A

Benign and estrogenic.
Granulosa cell tumors may be discovered in patients of all ages, including children.
Smatiy are seen in posimenopausal parients. They are usually benign but do on malignant potential. These estrogenic hmors secrete estrogen, causing pander female characteristics thai present as precocious puberty in children and seas veginal bleding and breast dysplasia in ihe posimenopausal patient.
18. E. Leiomyoma.

161
Q

€ 458. A 52-year-old female presents as postmenopausal for 5 years, G-4-PA. Her uterus is enlarged upon palpation and is irregular in contour. You suspect:
A. Endomet: ial cancer
B. Adenomyosis
C. Endometriosis
D. Hydatidiform mole
E. Leiomyoma

A

E

162
Q

Arrhenoblastoma

A
  1. B. Arrhenoblastoma.
    Arrhenoblaslomas are androgenic tumors that secrete lestosterone, causing secondary male characteristics. Female patients present with a masculine stature and male hair growth patterns on the face, abdomen, and upper thighs. After removal, female characteristics should return.
163
Q

Sex cord germ cell stromal tumors

A

• Includes granulosa cell tumor, thecoma, fibroma, and Sertoli-Leydig cell tumors (androblastoma)

Genicology Pathology (3 decks)

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