Ch 3c (pathology of ovaries + adnexa) Flashcards
What is hydrosalinx?
Simple fluid collection in scarred or blocked fallopian tube
How is hydrosalpinx diagnosed?
Typically incidentally on EV scan b/c no symptoms
Why does hydrosalpinx occur?
Develops after a chronic or old infection, when pyosalpinx gets replaced by serous fluid
SF of hydrosalpinx?
-tubular, tortuous, fluid filled mass
-smooth, well defined walls
-unilateral or bilateral
-can become large
(image on slide looks like a pumpkin face)
What is pyosalpinx?
Complex fluid collection (pus) in scarred or blocked fallopian tube
SF of pyosalpinx?
Similar to hydrosalpinx except there are low level internal echoes representing the pus
When might pyosalpinx be seen in a pt?
-if they have PID
-if they have an abscess in pelvis
Symptoms of pyosalpinx?
-fever
-increased WBC
-gyne infections
-pelvic pain
(remember to think infection with pyosalpinx)
Where do most simple fluid filled masses originate from in the pelvis?
The ovary
What are the 3 sono criteria for simple cysts?
1 - smooth, well defined walls
2 - no internal echoes (anechoic)
3 - increased posterior enhancement
SF of an ovarian cyst that may be associated with inflammation (infection), endometriosis or malignancy?
-thick, irregular walls
-thick septations greater than 3mm
-complex cysts with internal echoes
Measurement for normal ovary follicles?
Less than 3cm
(normally go away on its own + represent normal functioning of ovary)
Measurement considered an ovarian cyst?
Greater than 3cm
When should a pt come back for an u/s to check if ovarian cyst is gone?
6-8 weeks, after at least 1 period cycle to see if it has resolved on its own
4 types of functional ovarian cysts?
-Ovarian follicles
-Follicular cysts
-Corpus luteum cysts
-Theca lutein cysts
What are functional/physiologic ovarian cysts?
Cystic structures necessary for menstruation/pregnancy + are normal to find in u/s
SF of ovarian follicles?
-Small, anechoic cysts within ovary
-What we normally see when scanning each other
SF of follicular cysts?
-Dominant follicle that did not rupture during ovulation
-Appears as a large anechoic cyst (image on slide looks like a bladder)
SF of a corpus luteum cyst?
-Greater than 3cm in size
-Occur after follicular phase
-Image on slide looks like 3cm anechoic cyst
SF of a theca lutein cyst?
-Giant corpus luteum cysts in ovary
-Measure 3-20cm in size
-Occurs in pt’s with very high hCG, typically during pregnancy
-Image on slide looks like ovary with multiple big cysts
What is a hemorrhagic cyst?
Bleeding into a cyst which results in acute pelvic pain
SF of a hemorrhagic cyst?
-blood anechoic or hypoechoic
-debris
-internal echoes (blood clots within cyst)
What is ovarian torsion?
Partial or complete rotation of ovary that has an adnexal mass/cyst at the ovarian pedicle which results in severe acute pain
(stalk of ovary twists + cuts off blood supply)
Who m/c gets ovarian torsion?
Women under 30 y/o
Is ovary torsion m/c bilateral or unilateral?
Unilateral
Symptoms of ovarian torsion?
-localized pain/tenderness
-nausea/vomiting
-palpable pelvic mass
What happens if the ovarian torsion goes untreated?
Ovary becomes ischemic + gangrenous and has to have it removed (oophorectomy) b/c no blood flow to ovary anymore due to vessels + ligs being twisted
What causes ovarian torsion?
Presence of a cyst or another type of adnexal mass
SF of ovarian torsion?
-enlarged, round ovary greater than 4cm
-heterogeneous (showing areas of necrosis)
-ovarian cyst/mass within ovary
-decrease or absence of CD flow
What is the “whirlpool sign” with ovarian torsion?
Presence of coiled, twist or circular vessels within adnexa that indicated torsion
What is the m/c androgen disorder?
PCOS (associated with obesity, amenorrhea, anovulation, hirsutism (excessive hair) and infertility
What is an androgen disorder?
-Increase in androgen’s that lead to developing male characteristics.
-Hirsutism m/c seen around mouth/chin. -Primarily due to testosterone.
What causes anovulation + infertility with PCOS?
Due to abnormal estrogen + androgen production resulting in an imbalance of LH + FSH. Imbalance causes no ovulation which creates fertility issues.
Another name for PCOS?
Stein Leventhal syndrome
SF of PCOS?
-string of pearls (cysts outlining edge of ovary)
-bilateral large ovaries (over 10cm)
-multiple tiny peripheral follicles
-12 or more follicles seen within ovary
Is PCOS bilateral or unilateral?
Bilateral b/c hormonal disorder
Are ovarian tumours m/c benign or malignant?
80% benign
What are the 3 categories of benign ovarian neoplasms?
-Germ cell tumours
-Epithelial tumours
-Stromal tumours
What are the two m/c benign adnexal neoplasm’s?
-Benign cystic teratomas (germ cell tumor)
-Cystadenomas (epithelial tumor)
M/c germ cell tumor of pelvis?
Benign cystic teratoma
What age group m/c gets teratomas?
20-40 y/o
Another word for teratoma?
Dermoid tumor
What are teratomas made of?
Teeth, hair + glandular tissues (skin, etc)
Do teratomas commonly turn malignant?
No, rarely
Do pt’s normally have symptoms with teratomas?
No, but may have pain, pelvic pressure or palpable mass
SF of teratoma?
-complex solid masses
-echogenic foci/calcification’s (represents calcium or fat)
-unique appearance
-located on ovaries
-perfect circular shaped masses
-may see strands of hair, skin, teeth, bone, etc
(image on slide looks like bunch of circular masses with strand of hair - really gross)
What is a cystadenoma?
Benign tumor from glandular tissue
M/c type of benign cystic ovarian tumor?
Cystadenoma
Is it hard to tell if a cystadenoma is benign or malignant?
Yes, must look for secondary signs (ascites, fixation of mass) + symptoms to help us determine that
What is the malignant form of a cystadenoma called?
Serous/mucinous cystadenoma
Symptoms that indicate malignant cystadenoma?
-pelvic pressure
-bloating
-acute onset of pain upon rupture
(palpable pelvic mass with B or M b/c of lg mass size)
What age group m/c gets cystadenomas?
20-50 y/o
SF of cystadenomas?
-unilateral
-measures 5-15cm
Malignant:
-septations
-solid components present
-papillary projections from wall
Benign:
-simple cyst
What is a brenner tumor?
-Transitional cell tumor
-Uncommon
-Solid tumor from ovarian surface epithelium
What age group m/c get brenner tumors?
50-70 y/o
Symptoms of brenner tumor?
Asymptomatic, or palpable pelvic mass, pain, abnormal uterine bleeding
Size of brenner tumors?
Wide range from microscopic to 30cm
Do brenner tumors commonly turn malignant?
No, rare
SF of brenner tumors?
-solid hypoechoic mass
-wall calcifications
-looks similar to leiomyoma/fibroids
(image on slide looks twinkly)
What are theca cell tumors (thecomas)?
Estrogen producing solid ovarian masses
Another name for thecomas?
Fibrothecomas
What type of cancer often accompanies thecomas b/c of high estrogen production?
Adenocarcinoma
SF of thecomas?
-unilateral
-measures up to 20cm
-solid hypoechoic mass in ovary
-possible cystic changes + calcification
-looks similar to leiomyoma/fibroid
(image on slide has streaky appearance)
Who m/c gets thecomas?
Menopausal + postmenopausal women
What hormone do thecomas produce?
Estrogen
What is a fibroma?
Similar to thecoma, but does NOT produce any hormones (no estrogen)
SF of fibroma?
Similar to thecoma, on slide it looks like a big hypoechoic solid mass
What are sertoli-leydig cell tumors?
Incredibly rare tumors that produce androgens + develop male characteristics
Another name for sertoli-leydig cell tumors?
Sertoli stromal tumor, arrhenoblastoma, androblastoma
Symptoms of sertoli-leydig cell tumors?
-pain or abdomen swelling
-1/3 have masculinization effects from increased androgen levels
SF of sertoli-leydig cell tumors?
-echogenic or hypoechoic masses
-non specific
-homogeneous ovarian mass
(slide image shows split screen of LO, looks large and solid with a few anechoic spots)
What is the triad for meigs syndrome?
-ascites
-pleural effusion
-ovarian neoplasm
What type of mass is meigs syndrome?
-fibroma
-thecoma
-granulosa tumor
Is meigs syndrome common?
Rare b/c must have all 3 classic triad symptoms
What are paraovarian/paratubal cysts?
Cysts that develop from wolffian duct structures or from tubal epithelium
How common are paraovarian/paratubal cysts?
10% of all adnexal masses
(wide range of ages get this)
SF of paraovarian/paratubal cysts?
-thin walled
-unilocular
-no internal echoes
-located in adnexa, not ovary!
-develops in peritoneum + is not connected to anything
-common (incidental finding)
What are peritoneal inclusion cysts?
Fluid filled masses from the accumulation of serous fluid b/w adhesion’s or layers of peritoneum
Who m/c gets peritoneal inclusion cysts?
Pt’s with history of pelvic adhesion’s or surgery (after cell injury)
SF of peritoneal inclusion cysts?
-displaces ovaries
-located by the adnexa
-“spider in a web” sign (multiple septations within fluid surrounding an intact ovary
(slide image looks entirely anechoic with echogenic spider in middle making a web)
What SF sign is specific to peritoneal inclusion cysts?
Spider in a web sign - septations in fluid surrounding intact ovary
What % of cancers in the female population are ovarian malignancies?
5%, not too common. Although it has a high mortality rate due to late stage diagnosis + low cure rate. Very deadly.
(if not metastasized, survival rates close to 90%, however usually always has spread when diagnosed)
Risk factors for ovarian malignancy?
-old age (over 50 y/o)
-nulliparity (never given birth)
-early onset of menses
-late menopause
-postmenopausal estrogen use for over 10 years
-obesity
-family history of ovarian/breast cancer
-delayed childbearing (mom is over 35 when giving birth)
How complex is ovarian malignancy?
Very b/c cancer originates from at least 4 different cell populations. Many different environments for cancer to come from.
M/c form of ovarian malignancy?
Cystadenocarcinomas (epithelial)
From chart:
Epithelial = 65-75%
Germ cell neoplasms = 15-20%
Metastases to ovary = 5-10%
Sex cord stromal = 5-10%
SF of ovarian malignancy?
-complex cystic masses with septations
-very large up to 30-40cm
-nodular or papillary growths/protrusions
-ascites
(bilateral disease suspicious of malignancy)
4 stages with ovarian malignancy?
1 - cancer in ovary
2 - extends beyond ovary, but stays in pelvis
3 - extends beyond pelvis into retroperitoneum, etc
4 - metastasizes distally
2 main symptoms of ovarian malignancy?
Main: abdominal bloating (77%) + pain (58%)
Other: pressure from enlarging pelvic mass, hormone activity such as masculine symptoms, vag bleeding, etc
Are metastases to the ovary common?
Yes, commonly arises from breast or colon cancer
