Chapter 44- Ovarian Pathology Flashcards
Where is a cumulus oophorous found?
within the dominant follicle
what is a corpus luteum
a ruptured dominant follicle seen in the post-ovulation luteal phase
how does a corpus luteum appear sonographically?
anechoic with thick walls and a “ring of fire” effect with color doppler
what are echogenic foci and what causes them
small echogenic but non-shadowed cystic areas in an ovary caused by previous infection or hemorrhage
When might volume of an ovary be considered abnormal?
If it is more than double the volume of the opposite ovary
what is the normal post-menopausal ovary volume
less than 8 mL
when might surgical intervention be considered for a follicular cyst
if the cyst is greater than 6cm for more than 8 weeks
how does a follicular cyst appear sonographically
more than 3 cm and anechoic with thin walls and posterior enhancement
what might cause the development of a follicular cyst
if the fluid from non-dominant follicles is not reabsorbed.
what is the function of the ovary
produce the oocytes and hormones needed for ovulation
what are the majority of ovarian masses?
benign simple cysts
if a cyst is more complex, what can we assume about it?
if it is more complex it is more likely to be malignant, especially with ascites
are serous or mucinous tumors more common?
serous
if a mass has absent or minimal blood flow, what can we assume about it?
it is more likely to be benign.
what are some examples of a functional cyst
follicular, corpus luteum, theca lutein
What is the largest type of functional cyst?
Theca-Lutein
What is the most common benign ovarian tumor?
Dermoid/Teratoma
What is the second most common benign ovarian tumor?
Serous Cystadenoma
What is the most common pelvic organ to develop metastatic disease
Ovaries
What stage of ovarian cancer does metastasis usually mimic?
Stage II or III
What is a Krukenberg tumor?
A metastatic tumor that drops to the ovary from GI tract or other organs or spreads through the lymphatic system
What is the most common ovarian cancer? What percent of all ovarian cancer?
Serous Cystadenocarcinoma is 60-80% of all ovarian cancers.
Which ovarian tumors are typically larger, serous or mucinous?
Mucinous are larger
What are germ cell tumors?
tumors in adolescent ovary or testicle that come from primitive sex cells
What is the most common cause of ovarian enlargement (5+ cm) in young women?
Functional cysts from normal ovarian function
What is PCOS
bilaterally enlarged polycystic ovaries with a “string of pearls appearance” PCOS is an endocrine disorder that comes from a hormone imbalance
Who does PCOS affect and what are the symptoms
Women in their late teens-20s. Symptoms may be amenorrhea, obesity, infertility, hirtuism
What is a Theca Lutein cyst and what are symptoms?
a large, bilateral, multiloculated functional cyst. Symptoms include elevated HCG
What is the relation between Molar Pregnancy and Theca Lutein cysts
Theca lutein cysts are seen in 30% of molar pregnanies.
What is a common cause of Ovarian Hyperstimulation Syndrome and what are the symptoms?
OHS is caused by a complication with fertility treatment. They may cause pain and ascites
What are the differences in symptoms between mild and severe Ovarian Hyperstimulation Syndrome
Mild: enlarged ovaries <5 cm. Severe: enlarged ovaries >10 cm, thin-walled cysts, pleural effusions
What is a para-ovarian cyst and where do they come from?
A simple cyst in the adnexal region and broad ligament next to the ovary that comes from remnant of Wolffian or Mullerian duct
Who is at risk for a paraovarian cyst and what are the symptoms?
women from 20-40, possible torsion or bleeding but otherwise asymptomatic
What is Diffuse Endometriosis? Is it more or less common?
Endometrial tissue is present outside uterus. More common than localized, but rarely diagnosed with sonography.
What is Localized Endometrioma? Who does it affect?
A “chocolate cyst” that 30-40% of women develop as a result of endometriosis.
How do “chocolate cysts” appear sonographically
Well-defined, cystic with posterior enhancement, homogeneous, found in multiple areas
What is ovarian torsion? How is it identified?
When an ovary twists on its pedicle. the ovary has no color flow and is > 4cm.
The right ovary is 3x more likely to have torsion.
How likely is it that an ovary will have torsion more than once?
Once torsion occurs, it is 10% more likely to happen again.
1 in 70 women develop ovarian carcinoma. At what age is it most common?
60% between the ages of 40 and 60.
What happens during stage I and II ovarian cancer
Stage one: the disease is in one or both ovaries. Stage two: it spreads to other pelvic tissues like the uterus or fallopian tubes
What happens during stage III and IV ovarian cancer
Stage three: the disease spreads into the abdomen or peritoneum. Stage four: it spreads to other organs such as the liver
What is ascites
hypoechoic fluid with bright echos in potential spaces
Epithelial tumors are the most common ovarian malignancies occuring 80-90% of the time. Which kind is more common, serous or mucinous?
Serous is more common (30% of new growths). Mucinous is second most common (20-25% of new growths)
What is Mucinous Cystadenoma?
It is 15-30 cm, unilateral, and multiloculated with thin walls
What are the symptoms of Mucinous Cystadenoma and who does it affect?
It affects women 13-45 causing pressure, pain, and increase in abdomen size.
What is Mucinous Cystadenocarcinoma?
Malignant, cystic, likely to rupture which leads to ascites. They may have thick, irregular walls, septations, projections, etc.
What are the symptoms of Mucinous Cystadenocarcinoma and who does it affect?
Pelvic pressure and pain with rupture that affects women aged 40-70
What is Serous Cystadenoma?
Usually unilateral, up to 20cm, multiloculated with and septationsirregular borders
What are the symptoms of Serous Cystadenoma and who does it affect?
Pelvic pressure and bloating that affects women from 40-50
What is Serous Cystadenocarcinoma?
Cyst with septations or projections, possible calcifications, ascites that may invade other organs and is more commonly bilateral.
What are the symptoms of Serous Cystadenocarcinoma and who does it affect?
Pelvic fullness or bloating that usually affects women 45-65 with history/ familial history of cancer and/or tamoxifen exposure.
What is a teratoma or dermoid tumor?
Most common germ cell tumor that is up to 40 cm and any size/appearance. May contain fat, hair, cartilage, bone, or teeth.
Who do dermoid tumors affect and what are the symptoms?
Women of reproductive age. Pain and abdominal pressure
What is a fibroma
an abundance of fibrous tissue with great variation in size, ascites with fibromas >5cm, hypoechoic mass
When might a teratoma be malignant?
In older women
Who is most at risk for fibroma and why?
Older women at risk, since fibroma is rarely associated with estrogen production
What is thecoma?
a rate, benign, estrogen dependent post-menopausal tumor
Meigs syndrome is a benign condition. What is it associated with?
ascites
What is a granulosa
Neoplasm composed of cells resembling a graafian follicle. May occur woth or without torsion. similar echogenicity to uterine fibroid
Who is affected by granulosa?
50% after menopause, 45% during reproductive years, 5% in adolescence.
What is metastasis
Cancer that can arise from breast, upper GI tract, and other organs directly or through lymphatic spread. Frequently bilateral and associated with ascites. Solid or complex.
What is Dysgerminoma
Entirely solid ovarian mass in woman under 30 years.
What are the most common ovarian neoplasms seen in pregnancy?
Dysgerminoma and Serous cystadenoma
