Ch. 42: Path of Ovaries Images and Class notes Flashcards
Normal Ovary with long axis paralleling the internal iliac vessels
What are the arrows pointing to?
Echogenic foci in ovaries
What is being measured and what are the arrows pointing to?
Follicular cyst and follicles
Paraovarian Cyst
Endometrioma
–b/c it’s so homogeneous
Cystic Teratoma/Dermoid
What is the white thing in the center?
Dermoid plug
Hemorrhagic Cyst or it could also be a Cystadenoma
Follicular Cyst
Corpus Luteum Cyst
Corpus luteum cyst
Hemorrhagic Cyst
Hemorrhagic Cyst
Hemorrhagic cyst
Theca-Lutein Cyst
Ovarian Hyperstimulation Syndrome
Polycystic Ovarian Syndrome
Peritoneal Inclusion Cyst
Endometriosis
Endometrioma
Ovarian Torsion
Ovarian Carcinoma
*papillary projections into a cystic structure
Mucinous Cystadenoma
Mucinous Cystadenocarcinoma
*Large size and septations are characteristic; septal nodularity is marked.
Serous Cystadenocarcinoma
*Extensive nodularity in both images shows vascularity confirming the morphologic suspicion of a malignant mass
Dermoids
*Echogenic nodule in the image on the left
*“tip of the iceberg” sign in the image on the right
Dermoid
*Predominantly echogenic mass with a fat-fluid level
Dermoid
*Mass of varying echogenicity with hair-fluid level and highly echogenic fat-containing dermoid plug
Dermoid
*Dermoid plug and dermoid mesh
Granulosa
Fibroma
Functional cysts have a function. What are the 4 functional cysts?
Theca Lutein = high levels of hCG; gest. trophoblastic disease
Follicular Cyst = ovulation
Corpus Luteum cyst = when corpus luteum fails to involute
Hemorrhagic Cyst = could be b/c of follicular or corpus luteum rupture
What does PCOS look like? (typically 2 different ways)
“string of pearls” or can also look normal
What syndrome is PCOS also known as?
Stein-Leventhal–it is a type of PCOS
What are the symptoms of Stein-Leventhal?
What age group does it usually happen in?
What does it result in?
Symptoms: infertility, oligo, obesity, and hirsutism
Age group: late teens-early 20s
Results in: early pregnancy loss
Simple cysts look simple. What are the 4 cysts that can appear simple?
Follicular cyst
corpus luteum cyst
paraovarian cyst
cystic teratoma
What are the cysts that can appear complex? (6)
Complex cysts:
hemorrhagic
cystic teratoma
endometrioma
theca lutein
ovarian hyperstimulation syndrome
cystadenoma
What masses can appear complex? (4)
cystadenoma
ectopic mass
endometrioma
PID
The more complex it looks, the more likely it could be a:
malignancy
What are common solid, benign masses? (6)
Dermoid/cystic teratoma
fibroid
fibroma
thecoma
granulosa cell tumor
Brenner tumor
What is the malignant form of a Dermoid/Cystic Teratoma?
What test can detect it?
Dysgerminoma–it’s a very rare malignant germ cell tumor
*Can be detected with a lactate dehydrogenase blood test
What are the Epithelial Tumors? (5)
mucinous cystadenoma or cystadenocarcinoma
serous cystadenoma or cystadenocarcinoma
clear cell
Brenner tumor
Endometroid
What type of material will you see in a mucinous cystadenoma or cystadenocarcinoma?
gelatin-like material
How do serous cystadenoma/cystadenocarcinoma septations appear in contrast to mucinous?
Serous have thicker septations than mucinous
What are the Germ Cell Tumors? (3)
Teratomas AKA Dermoids
Dysgerminoma
Endodermal Sinus Tumor (very rare)
What are the 3 layers of Dermoids?
ectoderm, mesoderm, endoderm
Which are more likely to be malignant–mature or immature germ cell tumors?
Immature germ cell tumors are the malignant type. Mature are benign.
What are the Stromal Tumors? (5)
Granulosa
Thecoma
Fibroma
Sertoli-Leydig, AKA androblastoma
Arrenoblastoma–masculizing
What’s the most common benign cyst?
Dermoid
This is an epithelial tumor. It is 15-30 cm, has a gelatinous substance. It is multilocular, complex, but can also appear simple. On US, the walls will look more thin. What is it?
Mucinous Cystadenoma
This is also an epithelial tumor, but it’s large. It also has pseudomyxoma peritonei and complex ascites. Its walls are thick and irregular. It has septations and often papillary projections. What is it?
Mucinous Cystadenocarcinoma
This is an epithelial tumor. It’s the 2nd most common benign cyst. It’s usually smaller than a mucinous tumor. What is it?
Serous Cystadenoma
This is an epithelial tumor. It accounts for 60-80% of all carcinomas. It’s smaller than mucinous, but still large. It has irregular borders and a loss of capsular definition. It is multilocular, contains septations, and papillary projections. What is it?
Serous Cystadenocarcinoma
What is a Brenner Tumor AKA?
Is it common?
What type of tumor is it?
Transitional cell
It’s uncommon and mostly benign
Epithelial tumor
Is a clear cell tumor usually benign or malignant?
What type of tumor is it?
Usually malignant
Epithelial tumor
What are the stromal tumors? (5)
fibroma
thecoma
granulosa
Sertoli-Leydig
arrenoblastoma
What syndrome is a fibroma associated with?
Who is it usually seen in?
Is it unilateral or bilateral?
How does it appear on US?
Associated with Meig’s syndrome–which is ascites and pleural effusion
Seen in postmenopausal women
Usually unilateral
Appears hypoechoic with posterior enhancement
What are the 3 stromal tumors that are associated with estrogen productions?
Thecoma = benignt and unilateral, hypoechoic w/ post. enhancement.
Granulosa = most common hormone estrogenic, but it’s rarely found, less common than a thecoma, may have echogenicity similar to a fibroid.
Sertoli-Leydig = may be assoc. w/ estrogen, it’s rare, occurs in women less than 30, unilateral, virilization, and solid hypoechoic.
Meigs syndrome is associated with what ovarian tumor?
Fibroma
During a pelvic sonogram you visualize a small cyst located adjacent to the ovary. What is the most likely etiology of this cyst?
Paraovarian cyst
The most common benign ovarian tumor is the:
cystic teratoma/dermoid
The ovarian cyst associated with distinctly elevated levels of human chorionic gonadotropin is the:
theca lutein cyst
The cystic mass commonly noted with a pregnancy is the:
corpus luteum
The dominant follicle prior to ovulation is termed:
graafian follicle
After the graafian folicle ruptures, the remaining structure is termed the:
corpus luteum
Normal ovarian flow is said to be:
High resistant during mentruation and low resistant at the time of ovulation.
The malignant ovarian tumor with gastrointestinal origin is the:
Krukenberg tumor
The malignant ovarian mass that is associated with pseudomyxoma peritonei is the:
Mucinous cystadenocarcinoma
All of the following adnexal masses may appear sonographically similar to a uterine leiomyoma except:
paraovarian cyst
The ovarian tumor associated with an elevated serum lactate dehydrogenase is the:
Dysgerminoma
What is a tumor of ectopic endometrial tissue?
Endometrioma
A 24 yr old female patient presents to the ER department with severe left lower quadrant pain, nausea, and vomiting. The sonographic examination reveals an enlarged ovary with no detectable Doppler signal. What is the most likely diagnosis?
Ovarian torsion
Which of these is an estrogen-producing ovarian tumor: Brenner tumor, fibroma, thecoma, or endometrioma
thecoma
A 55 yr old patient presents to the US department with a history of pelvic pressure, abdominal swelling, and abnormal uterine bleeding. A pelvic sonogram reveals a large, multiloculated cystic mass with papillary projections. Which one of these is the most likely diagnosis: serous cystadenocarcinoma, cystic teratoma, androblastoma, or dysgerminoma
serous cystadenocarcinoma
A patient with an ovarian mass presents with an elevated serum alpha-fetoprotein. Which of the following would be the most likely: ovarian fibroma, ovarian thecoma, cystic teratoma, or yolk sac tumor
yolk sac tumor
The ovarian cyst associated with gestational trophoblastic disease is the:
theca lutein cyst
A malignant ovarian neoplasm that appears sonographically as a cystic structure with thin septations and/or papillary projections and is more often bilateral is often known as ______________ cystadenocarcinoma.
serous
Also known as a transitional cell tumor, is a rare benign tumor, sonographically often appear as a small, hypoechoic tumor that may contain calcifications:
Brenner tumor
Partial or complete rotation of the ovarian pedicle on its axis is:
ovarian torsion
This is a benign tumor of the ovary associated with ascites and pleural effusion:
Meigs syndrome
This is a rare malignant germ cell tumor in a woman less than 30 years of age that appears sonographically as an entirely solid mass:
dysgerminoma
An ovarian tumor with an abundance of fibrous tissue that is rarely associated with estrogen production is known as a __________________.
Fibroma
What is the pelvic organ that is more involved with metastatic disease?
ovary
What is another name for an endometrioma?
chocolate cyst
A benign ovarian neoplasm that is filled with a sticky, gelatin like material is known as a _______________ cystadenoma.
mucinous
This is the most common benign tumor of the ovary:
dermoid/cystic teratoma
As time goes by the appearance of a hemorrhagic cyst becomes more:
complex
A metastatic tumor that metastasizes to the ovaries from the gastrointestinal tract is known as:
Krukenbergs Tumor
Cystic structure that lies adjacent to the ovary:
paraovarian cyst
A feminizing neoplasm composed of cells resembling the graafian follicle is known as a __________ cell tumor.
granulosa
This describes the intraperitoneal extension of mucin-secreting cells that result from the rupture of a mucinous cystadenocarcinoma:
pseudomyxoma peritonei
Rare, benign, estrogen producing ovarian neoplasm that is most often seen in postmenopausal women:
thecoma
A localized tumor of endometriosis:
endometrioid
Granulosa cell tumors, thecomas, fibroma and Sertoli-Leydig cell tumors fall under the category of __________ tumors.
sex cord stromal
