Chap. 20: Pathology of the ovary Flashcards
Chap. 20: Pathology of the ovary
Functional cysts
Types of functional cysts
• Follicular cysts: a follicle can not reach out to ovulation: a process of ovulation failure can give rise to a functional cysts. In fact, a follicle, if not burst, may continue to grow, becoming a functional cyst. So, the follicular cyst is the distension of a follicle to increase the follicular fluid, secondary to degeneration of the oocyte contained in it
• luteal cysts: is developed for the formation of a hematoma or for the collection of a liquid serum
blood in the corpus luteum after ovulation
• Cysts tecoluteinica: is due to a follicle luteinization not broke, resulting accumulation of fluid in its interior
Functional cysts. follicular cysts. features.
Features
Unilocular with anechoic content
Diameter
• Up to 7-8 cm: cystic follicle
• From 10 cm: follicular cyst itself
Prognosis
• Spontaneous regression in a few weeks: often just wait for the
next menstruation for regression
• Magnification and pain
functional cysts. causes of follicular cysts
Causes
Exaggerated ovarian response to stimulation hormone Abnormalities of ovulation or the corpus luteum
Functional cysts. symptoms of follicular cysts.
Symptoms: Most cysts are asymptomatic. Possible symptoms are:
Pain in the iliac fossa: is similar to that of a renal colic with Jordan positive (From space occupation pelvic) Irregularities of the cycle: it is one of the main indicators of the cyst. It is due to excessive production of estrogen or to altered secretion of gonadotropins
Infertility: the functional activity may result in blocking ovulation for excessive negative feedback on gonadotropin
functional cysts. diagnosis and therapy of follicular cysts
Diagnosis: ultrasound
or therapy:
Progestogens for 4-6 months
Surgery for cysts larger than 5 cm and painful
functional cysts. features and symptoms of luteal cysts
Features
Unilocular
Maximum diameter of 4-5 cm
Content transonic because rich clots
Higher density and vascularity
or Symptoms:same as follicular cysts
functional cysts. diagnosis and therapy of lutheal cysts.
or Diagnosis: ultrasound: the sonographic appearance is jagged with a hyperechoic area, which
represents menstrual blood
or therapy if not recede, we proceed to the estrogen-progestin therapy
PCOS definition. ultrasound, diagnosis
PCOS
It is a syndrome characterized by the presence of numerous cysts on the ovarian surface, and by alterations endocrine borne mainly by the ovary and adrenal gland.
Ultrasound and the diagnosis is simple: you are having, in fact,
more cysts like a crown on the ovarian surface, on which are found also more follicles in growth
which do not undergo maturation.
The ovaries, in fact, fail to ovulate because the surface epithelium is thickened, covered by a capsule
consistency pearly, and avascolarizzato.
PCOS features
Features are:
• Hormonal pattern: the hormonal assays should be carried out immediately after menstruation
or Elevated levels of LH
or Low levels of FSH (with inversion of the relationship FSH / LH) stimulates the growth of new
follicles, which however does not undergo ovulation
or High levels of androgens: cause symptoms such as
Hirsutism
Acne
Irritability
or Low levels of estrogen: determine oligo / chronic anovulation
or High levels of SHBG
or High levels of adrenal hormones (such as 17-hydroxyprogesterone)
PCOS clinical picture
Clinical picture
or hirsutism
or Acne
or Infertility: the ovary, in fact, does not have regular ovulation
or Metabolic Syndrome: recently has given great importance to this aspect:
PCOS clinical picture. metabolic syndrome details
or Metabolic Syndrome: recently has given great importance to this aspect:
Hyperglycemia: you determine insulin resistance and hyperinsulinemia
Hypertriglyceridemia
Hypercholesterolemia
Hypertension
Overweight (especially between 18 and 20) or obesity
PCOS therapy.
Therapy
or regularization of ovulation(in detail in other slide)
or Elimination of imperfections due to acne and irustismo: antiandrogen therapy:
flutamide, finasteride, cyproterone acetate
or reduction of cysts: ovarian drilling: production of micro-cracks on the surface of the ovary
or reduction in prolactin levels: gabergolina or bromocriptine
or NB: progestogens mask the symptoms, but does not give any benefit
Pcos therapy. regularization of ovulation
or regularization of ovulation
Clomiphene to stimulate the production of FSH
GnRH analogues
Recombinant gonadotropins
pathology of the ovary.
Benign neoplasms
features. forms.
Forms:
Solid
Cystic
Mixed
Pathology of the ovary. diagnosis of benign neoplasms.
Diagnosis
Gynecological examination: the cyst appears as a mass (while a malignant cyst
appears as mass):
• Mobile (fixed)
• Do not sore (sore)
• A smooth surface (irregular surface)
• As a taut elastic consistency (hard consistency)
Abdominal ultrasound or transvaginal color Doppler: sonographic findings
suggestive of malignancy are:
• echostructure solid
• Neoangiogenesis
• Presence of vegetations and / or septa
Hormonal assays
Search of tumor markers
Pathology of the ovary. symptoms of benign neoplasms.
Symptoms: may be missing entirely and lead to the discovery of the tumor only forms very advanced. However, most frequent manifestations are:
- Meteorism
- Abdominal pains
- Slowed digestion
- Sense of tenderness and weight
Pathology of the ovary. complications of benign neoplasms.
complications:
Rupture of the cyst tumor in the peritoneum: is due to cystic tumors and causes
acute abdomen
Ovarian torsion of the pedicle with stenosis of the vessels and subsequent necrosis of
cysts: occurs for large tumors
Hemorrhage endocystic
Malignant degeneration: especially cysts borderline
Pathology of the ovary. therapy of benign neoplasms.
or therapy
Of women of childbearing age: enucleation of the cyst by laparoscopy or
laparotomy, trying to preserve the ovary
Of postmenopausal women: annessectomia
pathology of the ovary. Types of benign neoplasms.
or Cystadenoma serous:
or Cystadenoma mucinous:
or Teratomas:
Brenner tumor
ovarian fibroma
pathology of the ovary. Types of benign neoplasms. serous cystadenoma
Cystadenoma serous: originates from epithelial tissue. It is the most common benign tumor, can
be bilateral, but does not reach large dimensions. Has a content and a fluid
aspect serous and may undergo malignant degeneration (in 25% of cases)
pathology of the ovary. Types of benign neoplasms. Cystadenoma mucinous
Cystadenoma mucinous: mucinous epithelial ovarian arises from the cells. Less frequently the previous one, can become very large (up to 40-50 cm) and can be multiloculato. Has a content opalescent consists of mucin and appearance slimy; is also equipped with a capsule of smooth and translucent and has a colorful gray-
bluish. May undergo malignant degeneration
pathology of the ovary. Types of benign neoplasms. teratomas
or Teratomas: the most frequent is the cyst dermaoide, which originates from the germinal tissue. It is a training round, smooth, white-grayish, monoloculare, diameter 5-15 cm. Contains residues embryonic (sebum, hair, hair, teeth, thyroid remnants,
and mandibular bone)
pathology of the ovary. Types of benign neoplasms. Brenner tumor
Brenner tumor is a rare tumor, with a diameter variable (from a few up to 20 cm), solid,
covered by a capsule, more frequent towards the 50 years, with symptoms poor
pathology of the ovary. Types of benign neoplasms. ovarian fibroma
ovarian fibroma: is a solid tumor connective tissue, agenesis, with a smooth surface, of whitish color and variable diameter (from a few mm to 40 cm)
