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Obstetrics + Gynaecology > Benign ovarian cysts + PCOS > Flashcards

Benign ovarian cysts + PCOS Flashcards

1
Q

Broad causes of ovarian masses

A

functional:
- follicular cyst
- corpus luteum cyst
- theca lutein

inflammatory:
- tubo-ovarian abscess

neoplastic:
- benign
- borderline
- malignant

others:
- endometrioma
- enlarged polycystic ovary
- parovarian cyst

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2
Q

When are ovarian masses highly suspicious?

A

pre-pubertal
post-menopausal

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3
Q

What is the most common cause of an ovarian mass in a woman of reproductive age?

A

functional cysts

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4
Q

What is a functional cyst?

A

cysts that happen in the normal functioning of the ovary eg. due to ovulation

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5
Q

Name some functional ovarian cysts

A

follicular cysts
corpus luteum cysts
theca lutein cysts
luteomas of pregnancy

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6
Q

What is the most common functional cyst?

A

follicular cyst
(cystic follicle >3cm)

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7
Q

Rare complications of functional cysts

A

haemorrhage
rupture
torsion

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8
Q

What is a key risk of a corpus luteal cyst?

A

more likely to rupture and haemorrhage causing haemodynamic instability
needs surgery

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9
Q

Describe theca lutein cysts

A

OHSS (ovarian hyperstimulation syndrome)

enlarged ovaries with multiple luteinised cysts or corpora lutea with ascites

risk of torsion
associated with assisted reproduction

conservative management unless torsion

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10
Q

Describe endometriomas

A

pseudocyst that happens due to invagination of ovarian cortex sealed off by adhesions

ground glass on USS due to presence of old blood

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11
Q

Endometrioma presentation

A

pelvic pain
dysmenorrhoea
infertility

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12
Q

Name some benign ovarian tumours

A

serous cystadenoma
mucinous cystadenoma
dermoid
fibroma
thecoma
brenner tumour

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13
Q

Describe serous cystadenoma

A

> 40 years
mostly unilocular, serous fluid

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14
Q

Describe mucinous cystadenoma

A

can grow very large
multilocular
risk of rupture + torsion

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15
Q

Describe dermoid tumour of ovary

A

most common <40y
totipotent cells –>all 3 germ layers

can involve bone, teeth, hair, sebaceous material

acoustic shadowing on USS

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16
Q

Describe ovarian fibroma

A

most common benign solid neoplasm
firm, resembles fibroid
associated with Meigs syndrome

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17
Q

Meig’s syndrome features

A

benign ovarian tumour (fibroma)
ascites
pleural effusion

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18
Q

Describe ovarian thecoma

A

solid fibromatous, yellow to orange
may be hormonally active –> oestrogen/androgenic effects
usually unilateral

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19
Q

Describe brenner tumour of ovary

A

solid tumour resembling thecoma
rarely malignant
coffee bean pattern on histology

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20
Q

Ovarian tumour presentation

A

acute pain - torsion, rupture, haemorrhage
abdo pain, urinary, bowel symptoms, dyspareunia
abdominal distension, pain, nausea, sickness, increased satiety
menorrhagie, dysmenorrhoea
temperature, sepsis
incidental on imaging

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21
Q

Ovarian cancer risk factors

A

age
FH ovarian or breast cancer
HNPCC
Lynch II
nulliparity
primary infertility
endometriosis

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22
Q

What conditions other than ovarian cancer can caused raised Ca125?

A

fibroid
endometriosis
adenomyosis
pelvic inflammatory disease in premenopausal

23
Q

What tumour is AFP a marker for?

A

yolk sac tumour

24
Q

What tumour is LDH a marker for?

A

dysgerminoma

25
What tumour is inhibin a marker for?
granulosa cell tumour
26
What tumour is hCG a marker for?
non-gestational ovarian choriocarcinoma
27
Estimation of risk of malignancy calculation
risk of ovarian cancer U x M x Ca125 U = ultrasound score M = menopausal status (premenopausal = 1, postmenopausal = 3)
28
Benign signs on USS of ovarian mass
unilocular cysts presence of solid components where largest solid component <7mm presence of acoustic shadowing smooth multilocular tumour with largest diameter <100mm no blood flow
29
Malignant signs on USS of ovarian mass
irregular solid tumour ascites at least 4 papillary structures irregular multilocular solid tumour with largest tumour >=100mm very strong blood flow
30
Premenopausal + cyst <50mm management
benign no follow up resolve within 3 menstural cycles
31
Premenopausal and 50-70mm ovarian cyst management
yearly US follow up
32
Premenopausal and ovarian cyst >70mm management
further imaging (MRI) or surgical intervention
33
Postmenopausal and ovarian mass management
transvaginal ultrasound and Ca125 RMI calculation to triage
34
Symptoms of torsion of ovarian cyst
pelvic or abdominal pain fluctuating radiating to loin or thigh nausea vomitig
35
Signs of torsion of ovarian cyst
pyrexia tachycardia generalised abdominal tenderness localised guarding rebound cervical excitation adnexal tenderness adnexal mass
36
Differential diagnosis of ovarian cyst torsion
ectopic pregnancy pelvic inflammatory disease acute appendicitis OHSS rupture cyst fibroid torsion renal colic
37
PCOS symptoms
hyperandrogenism - hirsutism, acne, alopecia menstrual disturbance infertility obesity
38
What criteria are used to diagnose PCOS?
Rotterdam criteria
39
Rotterdam criteria for PCOS diagnosis
2/3 of: clinical or biochemical features of hyperandrogenism oligo-ovulation or anovulation polycystic ovaries on USS [once appropriate investigations have been performed to exclude other causes of menstrual disturbance and androgen excess]
40
Causes of hyperandrogenism other than PCOS
late onset congenital adrenal hyperplasia (21 hydroxylase deficiency distorts steroid pathway causing high 17 hydoxyprogesterone and excess androgens, raised DHEAs) Cushing's syndrome androgen secreting tumours of ovary and adrenals
41
Causes of oligo-amenorrhoea other than PCOS
hypogonadotropic hypogonadism (low FSH, E2 low) premature ovarian failure (high FSH, E2 low) hyperprolactinaemia/adenoma (prolactin very high)
42
PCOS biochemistry/hormonal profile
raised serum levels of LH low or normal levels of FSH raised testosterone and androstenedione low or normal sex hormone binding globulin results in elevated free androgen index
43
PCOS USS findings
polycystic ovaries ovary with 12 or more follicles measuring 2-9mm in diameter and/or increased ovarian volume (>10cm3)
44
Define insulin resistance
reduced glucose response to a given amount of insulin
45
What effect does insulin resistance have on androgens?
insulin helps regulate ovarian function ovaries respond to excess insulin by producing androgens, which can cause anovulation ovarian hyperandrogenism driven by LH in slim women and insulin in overweight women insulin decreases synthesis of SHBG by liver, increasing serum free testosterone
46
What metabolic abnormalities are often present in women with PCOS?
insulin resistance central obesity dyslipidaemia
47
Possible late sequelae of PCOS
T2DM dyslipidaemia hypertension cardiovascular disease endometrial carcinoma (due to unopposed action of oestrogen on endometrium)
48
PCOS management
wish to conceive = manage anovulation not wishing to conceive = treat symptoms overweight = lose weight regularise periods + protect endometrium, want to shed endometrium at least 3 monthly - cyclical OCP, IUS, quarterly progestogens metformin - lowers insulin
49
What testosterone level in women warrants further investigation?
total testosterone >5nmol/L
50
Hirsutism definition
terminal hair growth in a male pattern of distribution (chin, upper lip, chest, upper and lower back)
51
Hyperandrogenism management
COCP antiandrogens (spironolactone)
52
Anovulatory fertility treatment in PCOS
ovulation induction - clomiphene citrate (high risk multiple pregnancy) metformin (manage insulin resistance) IVF surgical ovulation induction
53
Complications of ovulation induction
OHSS (ovarian hyperstimulation syndrome) multiple pregnancy

Obstetrics + Gynaecology (19 decks)

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