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Gynaecology > BENIGN OVARIAN TUMOURS/CYSTS > Flashcards

BENIGN OVARIAN TUMOURS/CYSTS Flashcards

1
Q

What are the 4 main broad types of benign ovarian tumour which divide tumours based on the type of cell they are derived from?

A

Physiological cysts

Benign epithelial tumours

Benign germ cell tumours

Benign sex cord stromal tumours

(There are other benign ovarian tumours such as endometriotic cysts, but these 4 are the most important)

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2
Q

Apart from physiological tumours, what is the most common type of benign ovarian tumour found in women under 40?

A

Germ cell tumours

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3
Q

Apart from physiological tumours, what is the most common type of benign ovarian tumour found in women over 40?

A

Epithelial tumours

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4
Q

What are the risk factors for benign ovarian tumours?

A

Obesity

Infertility

Early menarche

Hypothyroidism

Tamoxifen therapy

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5
Q

What are the three types of physiological ovarian cyst?

A

Follicular cyst - most common

Luteal cyst

Theca lutein cyst

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6
Q

Which type of physiological ovarian cyst is most likely to rupture?

A

Luteal cysts

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7
Q

What are the 4 types of benign epithelial ovarian tumour?

A

Serous cystadenoma - most common

Mucinous cystadenoma

Endometrioid cystadenomas

Brenner tumours

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8
Q

What are the 2 types of benign germ cell ovarian tumour?

A

Mature cystic teratoma (also called a dermoid cyst)

Mature solid teratomas

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9
Q

What are the 2 types of benign sex cord stromal ovarian tumour?

A

Theca cell tumours

Fibromas

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10
Q

What are the symptoms associated with benign ovarian tumours/cysts?

A

Pain
Abdominal swelling
Pressure effects on bowel or bladder
Hormonal effects secondary to secretion from tumour

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11
Q

What are the hormonal effects that might be associated with an oestrogen secreting tumour?

A

Menstrual irregularity
Postmenopausal bleeding
Precocious puberty

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12
Q

How might you be able to exclude gastrointestinal aetiology in a patient who presents with pain consistent with an ovarian cyst?

A

Bimanual examination will reveal either adnexal tenderness or a mass.

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13
Q

What investigations should be done for someone who presents with any of the symptoms of an ovarian cyst (pain, swelling, pressure effects on bladder/bowel, hormonal effects)?

A 
FBC
CRP
High vaginal and endocervical swab
Urine pregnancy test/or serum hCG
Pelvic ultrasound
Serum CA125
Serum alpha fetoprotein (if US reveals complex ovarian mass)
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14
Q

What two factors does your management of a patient with a benign asymptomatic ovarian cyst/tumour depend on?

A

Age

Size of tumour

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15
Q

How would you manage a 25 year old patient found to have a 3 cm ovarian cyst?

A

Reassure

Observe cyst with US

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16
Q

What is the cut off in terms of size of benign ovarian tumour above which you would proceed to surgery despite a lack of symptoms? Why?

A

Above 5 cm. Above this size, the risk of ovarian torsion is significant.

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17
Q

How do you manage a patient found to have a physiological cyst on their ovaries?

A

Reassurance. Most will spontaneously resolve. You can monitor with ultrasound.

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18
Q

What are the complications associated with benign ovarian cysts?

A

Ovarian torsion

Rupture of cyst - can cause sepsis or peritonism

Continued pain and dyspareunia

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19
Q

What is Meig’s syndrome?

A

Triad of ascites, pleural effusion and benign ovarian tumour

20
Q

What are the benign ovarian tumours most commonly associated with Meig’s syndrome?

A

Fibroma

Brenner tumour (epithelial tumour)

Occasionally granulosa cell tumour

21
Q

What is a follicular cyst?

A

Occurs when rupture does not occur & follicle continues to growh

22
Q

What is a corpus luteal cyst?

A

When the CL fails to involute and continues to enlarge after ovulation

23
Q

How do follicular cysts appear?

A

smooth, thin walled & unilocular

usually < 10cm

24
Q

How do CL cysts appear?

A

can look complex
grossly yelllow
unilocular
thick walls

25
Q

What are theca lutein cysts?

What does it look like?

A

Luteinised follicle cysts that form as a result of overstimulation from high HCG/sensitivity to hCG
(GTD, multiple gestation, ovarian hyperstimulation)

can appear complex - bilateral multiseptated cystic

26
Q

How do follicular/CL cysts present?

A

asymptomatic

can rupture/haemorrhage

27
Q

How to theca lutein cysts present?

A

asymptomatic
maternal virilisation, hyperemesis gravidarum, pre-eclampsia or thyroid dysfunction

resolve after hCG eliminated

28
Q

PCOS presentation (in terms of adnexal mass)

A

enlarged ovaries w multiple follicles

rarely presents w adnexal masses

29
Q

List pregnancy related adnexal masses

A

corpus luteum of pregnancy
luteoma
decidualisation of endometrioma
ectopic pregnancy

30
Q

List adnexal masses that are stimulated by hormones?

A

endometrioma

leiomyoma

31
Q

List 2 infectious/inflammatory causes of adnexal masses?

A

tubo-ovarian abscess

hydrosalpinx

32
Q

What are the most common benign neoplasms in reproductive age patients?

A

mature cystic teratoma (dermoid)
serous cystadenoma
mucinous cystadenoma

33
Q

Which tumour secretes bHCG & LDH?

A

dysgerminoma (malignant germ cell tumour)

34
Q

Which tumour secretes AFP?

A

yolk sac tumour (malignant germ cell tumour)

35
Q

Which tumour is associated w Schiller-Duval bodies

A

yolk sac tumour (malignant germ cell tumour)

36
Q

What are the 3 types of sex-cord stromal tumours?

A

granulosa cell tumour (malignant)
Sertoli Leydig (benign)
fibroma (benign)

37
Q

Which tumour can become huuuuge?

A

mucinous cystadenoma

38
Q

List benign ovarian differentials for adnexal mass

A 
follicular cyst
CL cyst
luteoma of pregnancy
theca lutein cyst
PCOS
endometrioma
cystadenoma
benign ovarian germ cell tumours (mature teratoma)
benign sex cord stromal tumour (sertoli-leydig, fibroma)
39
Q

List malignant ovarian causes for adnexal masses

A

epithelial cancers
malignant ovarian germ cell tumour (choriocarcinoma, dysgerminoma, yolk sac tumour)
malignant sex cord stromal tumour (granulosa cell tumour)

40
Q

List 2 benign tubal causes

A

ectopic pregnancy

hydrosalpinx (from scarring of PID)

41
Q

List a malignant tubal causes

A

epithelial carcinoma

42
Q

List benign extraovarian/tubal causes

A

paraovarian cyst
paratubal cyst
pedunculated/cervical fibroid
tubo-ovarian abscess

43
Q

List malignant extraovarian/tubal causes

A

metastatic endometrial cancer

cystadenocarcinoma (rare)

44
Q

List benign non-gynae causes

A 
constipation
appendiceal abscess
diverticular abscess
pelvic abscess
bladder diverticulum
ureteral diverticulum
pelvic kidney
peritoneal cyst
45
Q

List malignant non-gynae causes

A

appendiceal neoplasm
bowel cancer
mets
retroperitoneal sarcoma

Gynaecology (19 decks)

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