Ch. 44 Pathology of the Ovaries Flashcards
The primary role of sonography in the evaluation of ovarian masses is
to indicate the need for surgical or medical intervention
A functional ovarian cyst is NOT
a chocolate cyst
The majority of ovarian masses are
simple cysts
Of the epithelial ovarian tumors that occur before menopause, _______ are malignant
7%
Of the epithelial ovarian tumors that occur after menopause, ______ are malignant
33%
The more complex the ovarian tumor is sonographically, the _____ likely it is to be malignant
more
The presence of ascites with an ovarian tumor ______ the likelihood of malignancy
increases
Serous ovarian tumors are typically
large
______% of serous ovarian tumors are bilateral
50%
When one ovary is ______ than other one, it is considered abnormal
two times larger
Ovarian masses can be differentiated from pedunculated fibroids by
identifying a connection to the uterus
Doppler of the ovaries should be performed
anytime an abnormality is seen
The normal ovarian artery should have an RI of
> .4
______ are the most common cause of ovarian enlargement in premenopausal women
functional cyst
______ occurs when the follicle fails to rupture or degenerate
follicular cyst
_______ are usually simple cysts
follicular cysts
______ occur when the corpus luteum fails to degenerate or has excessive bleeding
corpus luteum cysts
______ are common during the 1st trimester of pregnancy
corpus luteum cysts
Follicular cysts are usually ______
unilateral
______ is sometimes used to encourage regression of follicular cysts
hormone therapy
Resolution of a corpus luteum cyst usually occurs by the ______ week of pregnancy
16th
Doppler flow to a corpus luteum cyst is
low resistance
Polycystic ovarian disease is a ______ disorder
endocrine
Polycystic ovarian disease is associated with
absent ovulation
______ arise from the broad ligament and account for about 10% of adnexal masses
paraovarian cysts
The size of a ______ does not change with the ovarian cycle
paraovarian cyst
_____ are more likely to have their shape changed by adjacent structures because they are not surrounded by ovarian tissue
paraovarian cyst
______ are bilateral, large, complex ovarian masses that are associated with molar pregnancies
theca-lutein cysts
An increased incidence of ______ is associated with the use of pergonal for infertility
theca-lutein cysts
Odd-shaped fluid collections in the abdomen may be created by
adhesions
Small simple ovarian cysts occur in female fetuses and newborns due to
maternal hormones
Simple ovarian cysts in postmenopausal women that measure _____ are not likely to be malignant
<5cm
______ is a blood test that may be used to help screen for ovarian cancer
CA 125
_______ often makes ovaries difficult to see due to blurring of tissue planes and adhesions
endometriosis
The term adenoma refers to a _____ tumor
benign
The term adenocarcinoma refers to a _____ tumor
malignant
______ is a benign tumor that is quite large and is lined with mucinous elements from teh cervix and/or bowel
mucinous cystadenoma
______ tumors often appear sonographically as multiloculated tumors with differing echogenicities within the different compartments of the tumor
mucinous
Mucinous cystadenoma is usually
unilateral
Mucinous cystadenocarcinoma is usually
bilateral
Mucinous cystadenocarcinoma are prone to rupture, causing _____
pseudomyxoma peritoneum
______ are the second most common benign ovarian tumor and are usually unilateral
serous cystadenoma
Which is larger, serous or mucinous
mucinous cystadenoma
______ is made of septated cysts with nodules along the walls and irregular borders
serous cystadenoma
_______ is the most common ovarian cancer
serous cystadenocarcinoma
In cases of serous ovarian tumors, bilateral tumors suggest
malignancy
In cases of serous cystadenocarcinoma, ascites develops due to
peritoneal tumor implants
______ is a rare, benign, fibrous epithelial tumor of the ovary
brenner’s tumor
_______ is a rare, malignant tumor of the ovary that is resistant to chemotherapy
clear cell carcinoma
The majority of germ cell tumors are
complex
______ are germ cell tumors that arise from a single oocyte
dermoids
______ are the most common tumor of the ovary
dermoids
About 80% of dermoids are found in women of _____ age
child bearing
______ is another name for dermoid
teratoma
_______ of dermoids have cystic component
95%
______ is a very rare teratoma made up of thyroid tissue
struma ovarii
Teratomas are more likely to become malignant in women who are
over 40 year olds
_____ often contain fat, teeth, and hair
dermoids
______ is a malignant tumor that usually occurs in women less than 30 years old
dysgerminoma
______ are malignant, fast growing tumors that occur in women 10-20 years of age
immature teratoma
_______ tumors are usually very hypoechoic, solid, adnexal masses that occur in middle aged women
stromal
_______ is a complication of fibroma tumor involving massive ascites and pleural effusion
meigs syndrome
_______ is a rare ovarian tumor that secretes estrogen
granulosa
_______ is usually unilateral and may resemble endometrioma
granulosa
______ is an ovarian tumor that secretes androgens
arrhenoblastoma
______ is a solid, usually unilateral, ovarian mass that causes amenorrhea and infertility
arrhenoblastoma
______ is the lading cause of death from gynecologic malignancy in the US
ovarian carcinoma
About _____ of patients suffering from ovarian carcinoma are over 50 years old
85%
Ovarian cancer is easily detectable in the early stages because of early onset of symptoms
false
The five-year survival rate for stage 1 ovarian cancer is
90%
The five-year survival rate for stage IV ovarian cancer is
5%
The strongest risk factor for ovarian cancer is
family history of ovarian or breast cancer
Over _____ of women are in advanced stages of ovarian cancer by the time they see their doctor
70%
______ is caused by rotation of the ovary, twisting the blood vessels closed
ovarian torsion
Mrs. Smith went to the doctor because her abdomen was becoming more and more distended. Sonography demonstrated a large, septated, vascular ovarian mass, ascites, and three hypoechoic masses in the liver. What is the probable diagnosis? What stage is it?
serous ovarian cystadenocarcinoma, stage 4
Mrs. Johnson went to the doctor complaining of pelvic fullness. Sonography demonstrated a large, septated ovarian mass and mild ascites. CT demonstrated no lymph node involvement, uterine involvement or distant mets. Her diagnosis was ovarian cancer. What stage was it?
stage 1
What are the three main sonographic categories of ovarian mass
cystic, complex, solid
What characteristics must be present to classify an ovarian cyst as a simple cyst
anechoic, smooth walled, posterior enhancement
Abnormal doppler waveforms of ovarian vessels can be seen in what conditions besides cancer
ectopic pregnancies, corpus luteum cysts, PID, endometriosis
Describe the two possible explanations for how endometriosis happens
- reflux out of the tubes and plants in pelvic area outside the uterus
- stem cells develop into endometrial tissue due to hormonal stimulus or irritation
What lab values need to be investigated when there is a suspected germ cell tumor of the ovary
AFP and hCG
Sally went to the emergency room with extreme pain in the right side of her pelvis. Sonography demonstrated a large, hypoechoic right ovary with no doppler signal. What was the probable diagnosis
ovarian torsion
Result from persistent corpus luteum or abnormal follicle that fails to rupture
functional cysts
Sonographic appearance of a functional cyst
simple or complex cyst 1-10cm in size
If a cyst larger than 6cm persists longer than 8 weeks, ________
surgery is usually considered
Usually functional in premenopausal women. MUST be anechoic, smooth walled and demonstrate posterior enhancement
simple cyst
Mass with both cystic and solid components
complex ovarian mass
Any tumor may have cystic components, so must demonstrate whether a cystic lesion is
complex or simple
Masses made up of solid material
solid ovarian mass
Solid ovarian masses can be difficult in diagnosis due to variations in
normal ovarian size
When one ovary is ________ of the other, it is suspicious for solid ovarian mass
twice the size
In women under 40, ________ complex ovarian masses are malignant
1 in 15
In women over 40, _______ are malignant
1 in 3
Premenopausal patients and patients on cyclic HRT should be scanned in the
1st 10 days of their cycle
Resistive Index=
systolic peak-diastolic velocity/systolic
Pulsatility Index=
systolic peak-diastolic/mean velocity
Usually unilateral and 1-8cm in size, thin walled, simple cysts, regresses on their own
follicular cysts
Infertility, oligomenorrhea, hirsutism, obesity, patients develop body hair, facial hair and lower voice
stein-leventhal syndrome
Enlarged ovaries with multiple tiny cysts around periphery of ovary, “string of pearls sign” always bilateral
stein-leventhal syndrome
10% of adnexal masses, no ovarian tissue around them
paraovarian cysts
Arise from the ovary- associated with molar pregnancy, multiple gestation, high hCG levels
theca-lutein cysts
Located in the omentum-upper abdomen
omental cyst
located in midline abdominal wall peritoneum superior to the bladder
urachal cysts
15% of postmenopausal patients have small simple ovarian cysts (<3cm)
simple cysts in post menopausal women
______% of endometriosis cases affect the ovaries
80
Focal collection of ectopic endometrial tissue, often located in the ovary. Focal, well defined cystic, complex or solid with post enhancement CHOCOLATE CYST
endometrioma
Cysts with thick septations and areas of solid tissue are often
malignant
Arises from surface epithelium that covers the ovary
epithelial tumors
Epithelial tumors account for _______ of all ovarian neoplasms and _______ of all ovarian malignancies
65-75%, 90%
Mucinous cystadenocarcinoma is found in ______ of menopausal women
10%
Endometroid tumors are almost always ________ and _______ are bilateral
malignant, 25-30
Transitional cell, also called fibroepithelioma, rare and usually bening
brenner tumor
Types of stromal tumors
granulosa cell tumor, fibroma, thecoma, sertoli-leydig cell tumor
Usually occurs in childhood and young adulthood, associated with adnexal masses
ovarian torsion
With ovarian torsion, which ovary is more likely to torse? What does it mimic?
Rt ovary 3 times more likely than left, appendicitis
