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2nd Year GYN > Chapter 42: Pathology of Ovaries > Flashcards

Chapter 42: Pathology of Ovaries Flashcards

1
Q

Where are the ovaries found following a hysterectomy?

A

medially, directly superior to the vaginal cuff

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2
Q

Where are ovaries located when difficult to see transvaginally?

A

extremely laterally or superiorly

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3
Q

The cumulous oophorus may be detected as

A

cystlike, 1mm internal protrusion

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4
Q

When will a follicular cyst develop?

A

if the fluid In the nondominant follicles is not reabsorbed

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5
Q

When does the dominant follicle usually disappear?

A

immediately after rupture with ovulation

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6
Q

How does a corpus luteum appear?

A

irregular and contains low echoes

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7
Q

T/F: normal small, punctate, echogenic foci are found in the ovary

A

true, they are nonshadowing and can be multiple

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8
Q

T/F: ovaries synthesize androgens and convert them to estrogens

A

True, at the same time of ovulation

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9
Q

The majority of ovarian masses are

A

simple cysts (benign)

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10
Q

In premenopausal women, ovarian simple cysts are usually

A

functional

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11
Q

What are the differential considerations of simple adnexal cysts?

A
  • functional cyst
  • paraovarian cyst
  • cystadenoma
  • cystic teratoma
  • endometrioma
  • rarely tubo-ovarian abscess
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12
Q

What kind of cysts in postmenopausal women can be fixed with surgery?

A

greater than 5cm and for those containing internal septations and/or solid nodules

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13
Q

In patients of reproductive age, the classic differential considerations of a complex adnexal mass are:

A
  • ectopic pregnancy
  • endometriosis
  • PID
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14
Q

The differential considerations of a solid-appearing adnexal mass include?

A
  • pedunculated fibroid
  • dermoid
  • fibroma
  • thecoma
  • granulosa cell tumor
  • Brenner tumor
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15
Q

What may appear to be a solid mass in the adnexa?

A
  • tubo-ovarian abscess
  • ovarian torsion
  • hemorrhagic cysts
  • ectopic pregnancy
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16
Q

Patients with normal menstrual cycles are best scanned for Doppler studies in the first ___ days of the cycle to avoid confusion with normal changes in the luteal phase

A

10

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17
Q

What is a normal RI in a nonfunctioning ovary?

A

greater than 0.4, or greater than 1

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18
Q

What Doppler signs are worrisome for malignancy in the ovary?

A
  • intratumoral vessels

- low-resistance flow-absence of normal diastolic notch in waveform

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19
Q

Whats the most significant problem with RI ?

A

not a sensitive indicator of malignancy

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20
Q

What are the 4 types of functional cysts?

A
  • follicular
  • corpus luteum
  • hemorrhagic
  • theca-lutein
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21
Q

What is sometimes given to suppress an ovarian cyst?

A

hormonal therapy

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22
Q

Most ovarian cysts measure less than ____ cm and regress during the subsequent menstrual cycle

A

5

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23
Q

A follow-up U/S in ___ weeks is usually scheduled to document a change in ovarian cyst size

A

6

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24
Q

When do follicular cysts form?

A

when a mature follicle fails to ovulate or involute

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25
Q

Describe a follicular cyst

A
  • usually unilateral
  • asymptomatic
  • <2cm
  • can be as large as 20cm
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26
Q

Corpus luteum cysts result from what

A

failure of absorption or from excess bleeding into the corpus luteum

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27
Q

Describe corpus luteum cysts:

A
  • usually <4cm
  • unilateral
  • prone to hemorrhage and rupture
  • usually resolves by 16 weeks with pregnancy
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28
Q

Internal hemorrhage may occur in _____ cysts, or more commonly in _____ cysts

A

follicular, corpus luteal

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29
Q

How does an acute hemorrhagic cyst appear sonographically?

A

hyperechoic and may mimic a solid mass..usually has a smooth posterior wall and show post. enhancement

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30
Q

After time how does a hemorrhagic cyst appear ?

A

internal pattern becomes more complex, the clotted blood becomes more echogenic and may show a fluid level

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31
Q

What are the largest functional cysts?

A

theca-lutein cysts

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32
Q

How do theca-lutein cysts appear?

A

very large, bilateral, multiloculated cystic masses

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33
Q

What are theca-lutein cysts associated with?

A

high levels of hCG, and seen most frequently in association with gestational trophoblastic desease

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34
Q

What is ovarian hyperstimulation syndrome?

A

a frequent iatrogenic complication of ovulation induction, can result in mild-sever forms

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35
Q

What can occur in severe cases of ovarian hyperstimulation syndrome?

A

severe pelvic pain, abdominal distention, notably enlarge ovaries (>10cm)

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36
Q

What is PCOS?

A

an endocrine disorder associated with chronic anovulation

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37
Q

PCOS includes what syndrome?

A

Stein-Leventhal syndrome

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38
Q

What is seen with Stein-Leventhal syndrome?

A
  • infertility
  • oligomenorrhea
  • hirsuitism
  • obesity
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39
Q

WHEN does PCOS typically occur?

A

late teens and twenties

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40
Q

Clinical signs of PCOS:

A
  • amenorrhea
  • obesity
  • infertility
  • hirsutism
  • early pregnancy loss
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41
Q

Son findings of PCOS:

A
  • multiple tiny cysts around periphery of ovary

- can be normal sized or enlarged

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42
Q

What is ovarian remnant syndrome?

A

When a cystic mass is seen in the adnexa after an oophorectomy..typically after technically difficult surgery when not all ovarian tissue is removed. This tissue becomes functional and produces cysts with a thin rim of ovarian tissue in the wall

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43
Q

Describe peritoneal inclusion cysts:

A

lined with mesothelial cells and are formed when adhesions trap peritoneal fluid around the ovaries, resulting in large adnexal masses..sonographically they appear as multiloculated cystic adnexal masses

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44
Q

What accounts for 10% of adnexal masses?

A

paraovarian cysts

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45
Q

Where do paraovarian cysts arise from?

A

the broad ligament and usually are of mesothelial or para mesonephric origin

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46
Q

What age is most common for paraovarian cysts?

A

30-40

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47
Q

When can a specific diagnosis of paraovarian cyst be made?

A

only by demonstrating a normal ipsilaterl ovary close to, but separate from, the cyst..may contain small nodular areas and have septations

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48
Q

Where are omental cysts found?

A

higher in the abdomen

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49
Q

Where are urachal cysts found?

A

midline in the anterior abdominal wall

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50
Q

In premenarchal girls, small follicles of what size are common?

A

less than 9mm

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51
Q

Small simple cysts of postmenopausal ovaries are how common?

A

15% of time, and commonly change in size and dissapear

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52
Q

Where can endometriosis be found?

A
  • ovary
  • fallopian tube
  • broad ligament
  • external surface of uterus
  • scattered over peritoneum
  • cul-de-sac
  • bladder
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53
Q

What does the localized form of endometriosis consist of’?

A

discrete mass(endometrioma/chocolate cyst) that can be found in multiple sites

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54
Q

T/F: endometriomas are typically symptomatic?

A

false, they are asymptomatic

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55
Q

Sonographic appearance of endometrioma?

A

well-defined, unilocular of multilocular, predominantly cystic mass containing diffuse homogenous, low-level internal echoes

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56
Q

With ovarian torsion, what is often found in the pelvis?

A

free fluid

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57
Q

What accounts for 3% of gynecologic operative emergencies?

A

ovarian torsion

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58
Q

Ovarian torsion often involves what?

A

fallopian tube

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59
Q

Clinical findings of ovarian torsion:

A
  • acute severe unilateral pain
  • fever
  • nausea
  • vomiting
  • palp mass felt 50% of time
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60
Q

The right ovary is __ times more likely to torse than the left?

A

3

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61
Q

Describe ovarian torsion sonographically?

A
  • typically enlarged ovary
  • heterogenous in appearance(edema, hemorrhage, necrosis)
  • may vary in size
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62
Q

A combination of what three things leads to ovarian carcinoma detection

A
  • physical exam
  • lab
  • imaging
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63
Q

What is the fourth leading cause of cancer death?

A

ovarian cancer

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64
Q

What is the leading cause of death from gynecologic malignancy in the US? What %?

A

ovarian carcinoma, 25%

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65
Q

_____% of ovarian malignancies occur in women between 40-60 years of age

A

60%

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66
Q

About ____% of ovarian cancers involve women over 60, with risk increasing with age

A

80%

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67
Q

At the time of initial detection, 50% of women present with stage __ of ovarian cancer

A

stage 3

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68
Q

What blood chemistry test MAY be helpful in detecting ovarian cancer?

A

CA 125

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69
Q

Ovarian cancer most commonly presents as _____, but can also appear as what?

A

predominantly cystic;

complex, cystic or solid mass

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70
Q

Differential diagnoses of ovarian carcinoma Include:

A
  • endometriosis
  • hemorrhagic cyst
  • ovarian torsion
  • PID
  • benign ovarian neoplasms
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71
Q

Masses less than ___ cm in their longest axis are much more likely to be benign, whereas masses larger than ____ cm are much more likely to be malignant

A

5; 10

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72
Q

Increasing age correlates with ______ incidence of ovarian malignancy?

A

increased

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73
Q

What cancers increase risk of ovarian cancer?

A

breast and colon…because of genetic mutations in the BRCA1 and BRCA2 genes

74
Q

What is the strongest risk factor of ovarian cancer?

A

family history of ovary cancer

75
Q

Risk factors of ovarian cancer include (6):

A
  • family history
  • increasing age
  • nulliparity
  • infertility
  • uninterrupted ovulation
  • late menopause
76
Q

Clinical symptoms of ovarian cancer include (6):

A
  • vague abdominal pain
  • swelling
  • indigestion
  • frequent urination
  • constipation
  • weight change (ascites)
77
Q

Describe Stage 1 of ovarian cancer?

A

limited to ovary

78
Q

Describe Stage 2 of ovarian cancer?

A

limited to pelvis

79
Q

Describe Stage 3 of ovarian cancer?

A

limited to abdomen-intraabdominal extension outside pelvis/retroperitoneal nodes/extension to small bowel/omentum

80
Q

Describe Stage 4 of ovarian cancer?

A

hematogenous disease (liver parenchyma)/ spread beyond abdomen

81
Q

How does ovarian cancer appear sonographically?

A
  • presents with adnexal mass
  • lesions with irregular walls
  • thick , irregular septations
  • mural nodules and
  • solid echogenic elements
82
Q

What are surface epithelial-stromal tumors?

A

gynecologic tumors that arise from the surface epithelium and cover the ovary and the underlying stroma

83
Q

What are the most common of all ovarian neoplasms and malignancies?

A

surface epithelial-stromal tumors

84
Q

Epithelial tumors account for ___% of all ovarian neoplasms and ____% of all ovarian malignancies

A

65-75%

80-90%

85
Q

Epithelial tumors can be divided into 5 categories:

A
  • serous
  • mucinous
  • endometroid
  • clear cell
  • transitional cell (Brenner)
86
Q

What is the most common kind of epithelial tumor?

A

serous tumor, accounting for 30% of all ovarian neoplasms

87
Q

Mucinous tumors account for ___-___% of ovarian neoplasms

A

20-25%

88
Q

The benign or low-malignancy potential form of epithelial tumors is

A

adenoma

89
Q

The malignant form of epithelial tumors is termed

A

adenocarcinoma

90
Q

T/F: Serous and mucinous tumors vary greatly In size, and may be found to fill the pelvis and extend into the abdomen?

A

True

91
Q

In general, are the serous tumors bigger or smaller than mucinous tumors?

A

smaller

92
Q

What is pseudomyxoma peritonei*?

A

penetration or rupture of the tumor capsule of an epithelial tumor may lead to intraperitoneal spread of mucin-secreting cells that fill the peritoneal cavity with a gelatinous material

93
Q

Pseudomyxoma peritonei may be sonographically similar to what?

A

ascites or it may contain multiple septations in the fluid that fills much of the pelvis and abdomen

94
Q

Describe mucinous cystadenoma

A
  • unusually large (can be 15-30cm)
  • -most common cystic tumor
  • usually unilateral
  • cyst filled with sticky, gelatin-like substance
  • multilocular cystic space
95
Q

What is the most common cystic tumor of the ovaries?

A

mucinous cystadenoma

96
Q

What are the clinical findings of mucinous cystadenoma?

A
  • pressure
  • pain
  • increased abdominal girth
97
Q

What are the sonographic findings of mucinous cystadenoma?

A

simple or septate thin-walled multilocular cysts

98
Q

Mucinous cystadenocarcinomas are ___% bilateral when malignant?

A

15-20%

99
Q

Mucinous cystadenocarcinomas most frequently occur in women of what age range?

A

40-70 years

100
Q

T/F: mucinous cystadenocarcinomas are likely to rupture and cause ascites?

A

true

101
Q

What are clinical indications of mucinous cystadenocarcinomas?

A

pelvic pressure and pain when ruptured

102
Q

What are sonographic findings of mucinous cystadenocarcinomas?

A

ascites with bright punctate echoes, thick, irregular walls and septations

103
Q

What is the second most common benign tumor of the ovary?

A

serous cystadenoma

104
Q

Describe serous cystadenomas

A
  • unilateral
  • smaller than mucinous cysts
  • unilocular or multilocular cysts with septations
105
Q

Clinical findings of serous cystadenomas

A
  • pelvic pressure

- bloating

106
Q

Sonographic finding of serous cystadenomas are what?

A

multilocular cyst that may or may not have a nodule

107
Q

What are clinical findings of serous cystadenocarcinoma?

A

fullness and bloating

108
Q

What are sonographic findings of serous cystadenocarcinoma?

A

multilocular cysts containing chambers of varying size with septated, internal papillary projections…solid elements or bilateral tumors suggest malignancy

109
Q

What are endometrioids?

A

epithelial ovarian tumors

110
Q

The peak age range of endometrioid tumors is what?

A

50-60 years

111
Q

Endometrioid tumors are often associated with what?

A

endometrial adenocarcinoma

112
Q

T/F: nearly all endometrioids are malignant?

A

true

113
Q

___%-_____% of endometrioids are bilateral

A

25-30%

114
Q

What are sonographic findings of endometrioids?

A
  • cystic masses that contain papillary projections

- occasionally appear predominantly solid with areas of hemorrhage or necrosis

115
Q

Clear cell tumors are of what origin?

A

mullerian duct, and are a variant of endometrioid carcinoma

116
Q

Clear cell tumors are nearly always _____ and are bilateral about ___% of the time

A

malignant, 20% of time

117
Q

What is the peak age range of clear cell tumors?

A

50-70 years

118
Q

Brenner tumors are most often

A

benign

119
Q

Sonographic findings of Brenner tumors:

A
  • unilateral and small, typically less than 1-2cm
  • although solid they may be hypoechoic with no posterior acoustic enhancement
  • multiple calcifications may be present
120
Q

Brenner tumor AKA

A

transitional cell tumors

121
Q

How uncommon are Brenner/ Transitional Cell tumors?

A

2% of ovarian neoplasms

122
Q

What is the age range of Brenner tumors?

A

40-70

123
Q

T/F: Brenner tumors are symptomatic?

A

false, usually an incidental finding and always benign

124
Q

Germ cell tumors are derived from what?

A

primitive germ cells of the embryonic gonad

125
Q

Germ cell tumors account for __-__% of ovarian neoplasms, with approx. ___% being benign cystic teratomas

A

15-20%

95%

126
Q

Germ cell tumors include what 5 types?

A
  • teratomas
  • dysgerminoma
  • embryonal cell carcinoma
  • choriocarcinoma
  • transdermal sinus tumor (rare, occurring in adolescents)
127
Q

What is the most common benign ovarian neoplasm (20%)?

A

cystic teratoma/ dermoid

128
Q

Dermoids/cystic teratomas occur most frequently when?

A

reproductive years

129
Q

What are the three layers of dermoids?

A
  • ectoderm
  • mesoderm
  • endoderm
130
Q

What do dermoids/cystic teratomas consist of?

A
  • fatty sebaceous material
  • hair
  • cartilage
  • bone’
  • teeth
131
Q

Clinical findings of dermoid tumors?

A
  • asymptomatic
  • abdominal pain
  • enlargement and pressure
  • pedunculated
  • subject to torsion
132
Q

Sonographic findings of dermoid tumors

A
  • completely cystic
  • cystic with echogenic mural nodule (dermoid plug)
  • fat/fluid level
  • high amplitude echoes with shadowing or complex mass with internal septations
133
Q

Echogenic dermoids may be confused with

A

bowel

134
Q

What is the most common ovarian malignancy occurring in childhood?

A

dysgerminoma

135
Q

What is dysgerminoma?

A

rare malignant germ cell tumor that is bilateral in 15% of cases

136
Q

An entirely solid ovarian mass in a woman less than 30 is usually

A

dysgerminoma

137
Q

What are the two most common ovarian neoplasms seen in pregnancy?

A
  • dysgerminoma

- serous cystadenoma

138
Q

Children with dysgerminomas present with

A

precocious puberty and an elevation in serum hCG levels

139
Q

*What is the tumor marker used for dysgerminoma?

A

an elevation in serum lactate dehydrogenase

140
Q

What is the testicular equivalent to the dysgerminoma?

A

seminoma

141
Q

How do dysgerminomas appear sonographically?

A

hyperechoic solid mass with areas of hemorrhage and necrosis on US, may show speckle pattern of calcifications

142
Q

Endodermal sinus tumor AKA

A

yolk sac tumor

143
Q

Describe endodermal sinus tumors

A
  • rare
  • rapidly growing
  • unilateral
  • women under 20
  • increased serum AFP may be seen
  • poor prognosis
144
Q

What is the second most common malignant ovarian germ cell neoplasm?

A

endodermal sinus tumor AKA yolk sac tumor

145
Q

What are sex cord-stromal tumors?

A

solid adnexal masses that arise from the sex cords of the embryonic gonadal and/or ovarian stroma

146
Q

What are included in sex cord-stromal tumors? (4)

A
  • granulosa cell tumors
  • thecoma
  • fibroma
  • sertoli-leydig tumors
147
Q

A granulosa is a feminizing neoplasm composed of what?

A

cells resembling a graafian follicle

148
Q

What is the most common hormone-active estrogenic tumor of the ovary but is rarely found?

A

granulosa

149
Q

What are the most common stromal tumors?

A
  • thecomas

- fibromas

150
Q

Describe thecomas and fibromas appearance and who they are found in

A

-benign solid hypoechoic adnexal masses occurring in middle aged women

151
Q

Both thecomas and fibromas arise from

A

ovarian stromas

152
Q

What are thecomas?

A

tumors with an abundance of thecal cells

153
Q

Describe thecomas

A
  • usually benign
  • unilateral
  • show signs of estrogen production
154
Q

What are fibromas?

A

stromal tumors with an abundance of fibrous tissue

155
Q

Fibromas are rarely associated with

A

estrogen production

156
Q

Ascites has been reported in up to ___% of patients with fibromas larger than 5 cm

A

50%

157
Q

What is Meigs syndrome?

A

associated ascites along with pleural effusion with ovarian mass … occurs in 1-3% of women with fibroma, but can occur with other neoplasms as well

158
Q

T/F: Sertoli-Leydig tumors are rare

A

true

159
Q

Sertoli-Leydig tumors generally occur in women of what age

A

under 30

160
Q

Almost all sertoli-leydig tumors are

A

unilateral, with malignancy occurring in 10-20%

161
Q

What is Sertoli-Leydig tumor?

A

sex-cord stromal ovarian lesions derived from testicular cell types, contain cells with chromosomal abnormalities and often produce testosterone

162
Q

Sertoli-Leydig tumors result in virilization of how many patients?

A

1/3

163
Q

What are symptoms of virilization?

A
  • loss of secondary sex characteristics
  • acne
  • male pattern baldness
  • deepening of the voice
  • clitoral enlargement
  • potential menstrual disorders or abdominal swelling
164
Q

What are lab findings of Sertoli-Leydig tumors?

A

abnormal quantities of circulating hormones, particularly testosterone

165
Q

What are sonographic findings of Sertoli-Leydig tumors?

A
  • typically measure 5-15cm
  • smaller tumors usually appear solid with an echo texture similar to fibroids
  • larger tumors are often multiloculated with cystic components
  • generally the larger the tumor the more likely a malignancy
166
Q

What is arrhenoblastoma?

A

masculinizing ovarian tumor that occurs in females 15-65 years

167
Q

What are clinical findings for arrhenoblastoma?

A

same as for other pelvic masses with the addition of amenorrhea and infertility

168
Q

What are the sonographic findings of arrehnoblastoma

A

solid mass with cystic components, lobulated and well encapsulated

169
Q

______ are more involved with metastatic desease than any other pelvic organ and often mimic the appearance of advanced stage 2 to 3 primary ovarian cancer

A

ovaries

170
Q

Approximatley __% of ovarian neoplasms are metastatic in origin

A

5-10%

171
Q

Where can ovarian metastatic disease come from?

A

breast, upper gi tract, other pelvic organs by direct extension or lymphatic spread

172
Q

Metastatic disease to ovaries is frequently ____ and associated with _____

A

bilateral, ascites

173
Q

How does mets appear sonographically?

A

usually completely solid or solid with a moth eaten cystic pattern that occurs when they become necrotic

174
Q

What is Krukenberg’s tumor?

A

drop mets to the ovaries from the GI tract, prmiarily from the stomach, but also from the biliary tract, GB, and pancreas (typically solid)

175
Q

Cystic mets masses in the ovaries tend to result more commonly from what?

A

rectosigmoid colon cancers

176
Q

The ovary is a common site of mets from carcinoma of the ____

A

bowel

177
Q

What are the sonographic findings of Krukenberg’s tumor?

A
  • frequently bilateral
  • often associated with ascites
  • may be solid masses that diffusely infiltrate and increase the bulk of the ovarian parenchyma
178
Q

What is the least common of all gynecologic malignancies?

A

carcinoma of the fallopian tube (1%)

179
Q

Carcinoma of the fallopian tube occurs most frequently in

A

postmenopausal women with pain, vaginal bleeding, and a pelvic mass

180
Q

How does carcinoma of the fallopian tube appear sonographically

A

sausage shaped, complex mass with cystic and solid components often with papillary projections..clinical and sonographic findings are similar to ovarian carcinoma

181
Q

What pelvic masses can be found that are not gynecologic in origin?

A
  • pelvic kidneys
  • omental cysts
  • impacted feces in colon
  • colonic cancer or masses
  • distended bladder
  • hydroureters
  • abscesses
  • retroperitoneal masses

2nd Year GYN (9 decks)

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