Adnexal Masses

Question 1

What level of CA-125 is suspicious for malignancy?

Answer 1

Premenopausal - >200 U/mL

Postmonopausal - >35 U/mL

Question 2

A round homogenous cyst containing low-level echoes, with “ground glass” appearance describes what type of adnexal mass

Answer 2

Endometrioma

Question 3

Corpus luteum cyst on US is described as…?

Answer 3

Diffusely thick-walled, with peripheral vascularity (“ring of fire”), usually 2-10cm, possibly crenulated contour

Question 4

An adnexal cyst with “lace-like” or reticular echoes +/- fluid levels, and no internal blood flow describes what type of mass?

Answer 4

Hemorrhagic cyst

Question 5

Describe a teratoma as seen on US

Answer 5

hypoechoic attenuating components with multiple small homogeneous interfaces. Often with punctate calcifications and Rokitanski nodules.

Question 6

A tubular-shaped sonolucent cyst, often “C” or “S”-shaped, may show a cogwheel appearance in cross section, describes what type of adnexal mass?

Answer 6

Hydrosalpinx

Question 7

Most common form of epithelial ovarian malignancy?

Answer 7

Serous (70% of epthelial malignancies) Often with elevated CA125

Question 8

Endometriosis is associated with what two types of malignancy

Answer 8

Endometrioid (10-40% associated with endometriosis) and Clear Cell tumors

Question 9

Women with Granulosa Cell tumors often present with what symptom, and why?

Answer 9

Postmenopausal bleeding due to estrogen secretion and thickened EMS

Question 10

Endodermal sinus / Yolk Sac Tumors often have what elevated tumor marker?

Answer 10

Alpha fetoprotein (AFP)

Question 11

What is considered typically the most hormonally active sex-cord stromal tumor?

Answer 11

Thecoma (androgen secreting)