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MIDS 137 > Ch 3c (pathology of ovaries + adnexa) > Flashcards

Ch 3c (pathology of ovaries + adnexa) Flashcards

1
Q

What is hydrosalinx?

A

Simple fluid collection in scarred or blocked fallopian tube

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2
Q

How is hydrosalpinx diagnosed?

A

Typically incidentally on EV scan b/c no symptoms

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3
Q

Why does hydrosalpinx occur?

A

Develops after a chronic or old infection, when pyosalpinx gets replaced by serous fluid

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4
Q

SF of hydrosalpinx?

A

-tubular, tortuous, fluid filled mass
-smooth, well defined walls
-unilateral or bilateral
-can become large

(image on slide looks like a pumpkin face)

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5
Q

What is pyosalpinx?

A

Complex fluid collection (pus) in scarred or blocked fallopian tube

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6
Q

SF of pyosalpinx?

A

Similar to hydrosalpinx except there are low level internal echoes representing the pus

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7
Q

When might pyosalpinx be seen in a pt?

A

-if they have PID
-if they have an abscess in pelvis

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8
Q

Symptoms of pyosalpinx?

A

-fever
-increased WBC
-gyne infections
-pelvic pain

(remember to think infection with pyosalpinx)

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9
Q

Where do most simple fluid filled masses originate from in the pelvis?

A

The ovary

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10
Q

What are the 3 sono criteria for simple cysts?

A

1 - smooth, well defined walls
2 - no internal echoes (anechoic)
3 - increased posterior enhancement

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11
Q

SF of an ovarian cyst that may be associated with inflammation (infection), endometriosis or malignancy?

A

-thick, irregular walls
-thick septations greater than 3mm
-complex cysts with internal echoes

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12
Q

Measurement for normal ovary follicles?

A

Less than 3cm

(normally go away on its own + represent normal functioning of ovary)

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13
Q

Measurement considered an ovarian cyst?

A

Greater than 3cm

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14
Q

When should a pt come back for an u/s to check if ovarian cyst is gone?

A

6-8 weeks, after at least 1 period cycle to see if it has resolved on its own

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15
Q

4 types of functional ovarian cysts?

A

-Ovarian follicles
-Follicular cysts
-Corpus luteum cysts
-Theca lutein cysts

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16
Q

What are functional/physiologic ovarian cysts?

A

Cystic structures necessary for menstruation/pregnancy + are normal to find in u/s

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17
Q

SF of ovarian follicles?

A

-Small, anechoic cysts within ovary
-What we normally see when scanning each other

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18
Q

SF of follicular cysts?

A

-Dominant follicle that did not rupture during ovulation
-Appears as a large anechoic cyst (image on slide looks like a bladder)

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19
Q

SF of a corpus luteum cyst?

A

-Greater than 3cm in size
-Occur after follicular phase
-Image on slide looks like 3cm anechoic cyst

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20
Q

SF of a theca lutein cyst?

A

-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

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21
Q

What is a hemorrhagic cyst?

A

Bleeding into a cyst which results in acute pelvic pain

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22
Q

SF of a hemorrhagic cyst?

A

-blood anechoic or hypoechoic
-debris
-internal echoes (blood clots within cyst)

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23
Q

What is ovarian torsion?

A

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)

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24
Q

Who m/c gets ovarian torsion?

A

Women under 30 y/o

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25
Q

Is ovary torsion m/c bilateral or unilateral?

A

Unilateral

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26
Q

Symptoms of ovarian torsion?

A

-localized pain/tenderness
-nausea/vomiting
-palpable pelvic mass

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27
Q

What happens if the ovarian torsion goes untreated?

A

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

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28
Q

What causes ovarian torsion?

A

Presence of a cyst or another type of adnexal mass

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29
Q

SF of ovarian torsion?

A

-enlarged, round ovary greater than 4cm
-heterogeneous (showing areas of necrosis)
-ovarian cyst/mass within ovary
-decrease or absence of CD flow

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30
Q

What is the “whirlpool sign” with ovarian torsion?

A

Presence of coiled, twist or circular vessels within adnexa that indicated torsion

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31
Q

What is the m/c androgen disorder?

A

PCOS (associated with obesity, amenorrhea, anovulation, hirsutism (excessive hair) and infertility

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32
Q

What is an androgen disorder?

A

-Increase in androgen’s that lead to developing male characteristics.
-Hirsutism m/c seen around mouth/chin. -Primarily due to testosterone.

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33
Q

What causes anovulation + infertility with PCOS?

A

Due to abnormal estrogen + androgen production resulting in an imbalance of LH + FSH. Imbalance causes no ovulation which creates fertility issues.

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34
Q

Another name for PCOS?

A

Stein Leventhal syndrome

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35
Q

SF of PCOS?

A

-string of pearls (cysts outlining edge of ovary)
-bilateral large ovaries (over 10cm)
-multiple tiny peripheral follicles
-12 or more follicles seen within ovary

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36
Q

Is PCOS bilateral or unilateral?

A

Bilateral b/c hormonal disorder

37
Q

Are ovarian tumours m/c benign or malignant?

A

80% benign

38
Q

What are the 3 categories of benign ovarian neoplasms?

A

-Germ cell tumours
-Epithelial tumours
-Stromal tumours

39
Q

What are the two m/c benign adnexal neoplasm’s?

A

-Benign cystic teratomas (germ cell tumor)
-Cystadenomas (epithelial tumor)

40
Q

M/c germ cell tumor of pelvis?

A

Benign cystic teratoma

41
Q

What age group m/c gets teratomas?

A

20-40 y/o

42
Q

Another word for teratoma?

A

Dermoid tumor

43
Q

What are teratomas made of?

A

Teeth, hair + glandular tissues (skin, etc)

44
Q

Do teratomas commonly turn malignant?

A

No, rarely

45
Q

Do pt’s normally have symptoms with teratomas?

A

No, but may have pain, pelvic pressure or palpable mass

46
Q

SF of teratoma?

A

-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)

47
Q

What is a cystadenoma?

A

Benign tumor from glandular tissue

48
Q

M/c type of benign cystic ovarian tumor?

A

Cystadenoma

49
Q

Is it hard to tell if a cystadenoma is benign or malignant?

A

Yes, must look for secondary signs (ascites, fixation of mass) + symptoms to help us determine that

50
Q

What is the malignant form of a cystadenoma called?

A

Serous/mucinous cystadenoma

51
Q

Symptoms that indicate malignant cystadenoma?

A

-pelvic pressure
-bloating
-acute onset of pain upon rupture

(palpable pelvic mass with B or M b/c of lg mass size)

52
Q

What age group m/c gets cystadenomas?

A

20-50 y/o

53
Q

SF of cystadenomas?

A

-unilateral
-measures 5-15cm

Malignant:
-septations
-solid components present
-papillary projections from wall

Benign:
-simple cyst

54
Q

What is a brenner tumor?

A

-Transitional cell tumor
-Uncommon
-Solid tumor from ovarian surface epithelium

55
Q

What age group m/c get brenner tumors?

A

50-70 y/o

56
Q

Symptoms of brenner tumor?

A

Asymptomatic, or palpable pelvic mass, pain, abnormal uterine bleeding

57
Q

Size of brenner tumors?

A

Wide range from microscopic to 30cm

58
Q

Do brenner tumors commonly turn malignant?

A

No, rare

59
Q

SF of brenner tumors?

A

-solid hypoechoic mass
-wall calcifications
-looks similar to leiomyoma/fibroids

(image on slide looks twinkly)

60
Q

What are theca cell tumors (thecomas)?

A

Estrogen producing solid ovarian masses

61
Q

Another name for thecomas?

A

Fibrothecomas

62
Q

What type of cancer often accompanies thecomas b/c of high estrogen production?

A

Adenocarcinoma

63
Q

SF of thecomas?

A

-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)

64
Q

Who m/c gets thecomas?

A

Menopausal + postmenopausal women

65
Q

What hormone do thecomas produce?

A

Estrogen

66
Q

What is a fibroma?

A

Similar to thecoma, but does NOT produce any hormones (no estrogen)

67
Q

SF of fibroma?

A

Similar to thecoma, on slide it looks like a big hypoechoic solid mass

68
Q

What are sertoli-leydig cell tumors?

A

Incredibly rare tumors that produce androgens + develop male characteristics

69
Q

Another name for sertoli-leydig cell tumors?

A

Sertoli stromal tumor, arrhenoblastoma, androblastoma

70
Q

Symptoms of sertoli-leydig cell tumors?

A

-pain or abdomen swelling
-1/3 have masculinization effects from increased androgen levels

71
Q

SF of sertoli-leydig cell tumors?

A

-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)

72
Q

What is the triad for meigs syndrome?

A

-ascites
-pleural effusion
-ovarian neoplasm

73
Q

What type of mass is meigs syndrome?

A

-fibroma
-thecoma
-granulosa tumor

74
Q

Is meigs syndrome common?

A

Rare b/c must have all 3 classic triad symptoms

75
Q

What are paraovarian/paratubal cysts?

A

Cysts that develop from wolffian duct structures or from tubal epithelium

76
Q

How common are paraovarian/paratubal cysts?

A

10% of all adnexal masses

(wide range of ages get this)

77
Q

SF of paraovarian/paratubal cysts?

A

-thin walled
-unilocular
-no internal echoes
-located in adnexa, not ovary!
-develops in peritoneum + is not connected to anything
-common (incidental finding)

78
Q

What are peritoneal inclusion cysts?

A

Fluid filled masses from the accumulation of serous fluid b/w adhesion’s or layers of peritoneum

79
Q

Who m/c gets peritoneal inclusion cysts?

A

Pt’s with history of pelvic adhesion’s or surgery (after cell injury)

80
Q

SF of peritoneal inclusion cysts?

A

-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)

81
Q

What SF sign is specific to peritoneal inclusion cysts?

A

Spider in a web sign - septations in fluid surrounding intact ovary

82
Q

What % of cancers in the female population are ovarian malignancies?

A

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)

83
Q

Risk factors for ovarian malignancy?

A

-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)

84
Q

How complex is ovarian malignancy?

A

Very b/c cancer originates from at least 4 different cell populations. Many different environments for cancer to come from.

85
Q

M/c form of ovarian malignancy?

A

Cystadenocarcinomas (epithelial)

From chart:
Epithelial = 65-75%
Germ cell neoplasms = 15-20%
Metastases to ovary = 5-10%
Sex cord stromal = 5-10%

86
Q

SF of ovarian malignancy?

A

-complex cystic masses with septations
-very large up to 30-40cm
-nodular or papillary growths/protrusions
-ascites

(bilateral disease suspicious of malignancy)

87
Q

4 stages with ovarian malignancy?

A

1 - cancer in ovary
2 - extends beyond ovary, but stays in pelvis
3 - extends beyond pelvis into retroperitoneum, etc
4 - metastasizes distally

88
Q

2 main symptoms of ovarian malignancy?

A

Main: abdominal bloating (77%) + pain (58%)

Other: pressure from enlarging pelvic mass, hormone activity such as masculine symptoms, vag bleeding, etc

89
Q

Are metastases to the ovary common?

A

Yes, commonly arises from breast or colon cancer

MIDS 137 (14 decks)

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