Class 7 Flashcards
Where do most cystic pelvic masses originate from?
The ovaries
Ultrasound appearance of Cystic Pelvic Mass
Smooth well defined borders
Lack of internal echoes
Posterior enhancement
What does the size of a pelvic cyst determine? What are the results of each of the sizes of cyst measuring <3cm, 3-5cm, >5cm, and >10cm?
- < 3 cm - usually resolve (follicular)
- 3 - 5 cm - followed by US; most resolve, but some enlarge
- > 5 cm - followed by US; 60% resolve in 3 months
- > 10 cm - rarely resolve (have more malignant potential; are surgically removed)
Where are Ovarian follicles located?
In both ovaries
Ultrasound Appearance of Ovarian follicles
Small anechoic structures
True or False: DOMINANT FOLLICLE REACHES 2.0-2.5 CM BEFORE OVULATION OCCURS
True
Are Follicular Cyst bilateral or unilateral?
unilateral
How large can a Follicular Cyst get?
1.0 - 10.0cm in size
True or False: Few Follicular Cysts resolve or change size
False: Most resolve or change in size
How large can a Corpus Luteum Cyst get?
5 - 8cm
True or False: Corpora lutea forms after dominant follicle ruptures. (Reaches 3 cm in size)
True
True or False: Corpus Luteum Cysts in pregnancy RESOLVES if fertilization occurs
False: Corpus Luteum Cysts remains if fertilization occurs and only resolves between 10 to 16 weeks after estimated last menstrual period (LMP)
What causes a Theca Lutein Cyst?
Caused by high levels of human chorionic gonadotropin
50% of Theca Lutein Cysts are associated with?
Gestational Trophoblastic Disease (Molar Pregnancy)
Drug therapy for infertility (ovarian hyperstimulation syndrome) is known to cause?
Theca Lutein Cysts
Theca Lutein Cysts are:
Bilateral or Unilateral?
Unilocular or Multilocular?
Small or Large?
Bilateral
Multilocular
Large (3-20cm)
How long after evacuation of molar pregnancy do Theca Lutein Cysts persist?
2-4 Months
Paraovarian Cysts are found in what ligament?
Broad ligament
True or False: it is difficult to determine if Paraovarian Cysts are ovarian or paraovarian
True
What is the largest that a paraovarian cyst can reach in cm?
15cm
Are paraovarian cyst permanent?
Yes, they do not regress or change with time
What are differential Diagnoses of Paraovarian Cyst?
Serous cystadenoma or Endometrioma
What is Ovarian Torsion?
Complete or incomplete rotation of ovary on its vascular pedicle
Ovarian Torsion causes what?
Causes arterial, venous, or lymphatic occlusion
Ultrasound Appearance of Ovarian Torsion
On ultrasound, may appear as a large ovary with hypoechoic and hyperechoic areas
Ovarian Torsion occurs most commonly in what age group?
Most common in childhood or women < 30 years of age
Signs and symptoms of Ovarian Torsion?
- Acute onset of pelvic pain
- Nausea
- Vomiting
In Polycystic Ovaries, endocrine disorders result in?
High free serum testosterone
High LH or FSH
Ultrasound Appearance of Polycystic Ovaries
- Normal ovaries
- Bilaterally enlarged ovaries with multiple small follicles around periphery
What are the categories of benign Ovarian Neoplasms?
Epithelial tumors
Germ cell tumors
Stromal tumors
What percentage of Ovarian Neoplasms are benign?
80%
What are the 3 types of Epithelial neoplasms?
- Serous cystadenoma
- Mucinous cystadenoma
- Brenner tumor
Epithelial Neoplasms: Serous Cystadenoma
- More common than mucinous cystadenoma (not as large)
- Contain serous fluid
- Bilateral 25% of time
- Usually unilocular
- May have septations (thin) and papillary projections
- Malignant counterpart: serous cystadenocarcinoma
Epithelial Neoplasms: Mucinous Cystadenoma
-Larger than serous cystadenoma (up to 15-30 cm)
-Filled with thick mucin
-Bilateral in < 5% of cases
-Cystic with multiple thicker septations
Debris filled
-With rupture—Pseudomyxoma Peritonei
Epithelial Neoplasms: Brenners Tumor
- Not common (1 - 2% of all ovarian neoplasms)
- Solid firm tumor
- On US, may see solid echogenic or hypoechoic mass with anechoic spaces
- Small to 8 cm in size
- Most common in post menopausal patient
- US unable to differentiate between other solid ovarian tumors
Benign Cystic Teratoma
AKA: dermoid cyst, teratoma
- Common germ cell tumors
- Most common in premenopausal women
- Most common ovarian tumor for women less than 20 years of age
- Have little malignant potential
Ultrasound appearance of Benign Cystic Teratoma
- Complex with internal echoes and posterior acoustic shadowing
- Tip of the iceberg sign
- Unilocular or multilocular cyst with internal echoes or mural echogenic projections
- Echogenic mass with acoustic shadowing
- Fat/fluid or hair/fluid level
- Echo poor mass with echogenic or echo poor central portion
What are the kinds of Stromal Tumors?
Fibroma
Thecoma
Sertoli-leydig
Stromal Tumors: Fibroma
5 % of ovarian tumors
More common in 50’ s or 60 ‘s
90% unilateral
5-16 cm in size
Solid and hypoechoic - often shadow posteriorly
The most common tumor associated with Meigs’ syndrome
Stromal Tumors: Fibroma: Meig’s Syndrome
TRIAD OF MEIGS’ SYNDROME
- Benign ovarian tumor (fibroma)
- Ascites
- Pleural effusion
- SYMPTOMS SUBSIDE AFTER TUMOR REMOVAL
Stromal Tumors: Thecoma (Theca Cell Tumor)
1 - 2 % OF OVARIAN TUMORS
SOLID
ESTROGEN PRODUCING
MOST COMMON IN POST MENOPAUSAL PATIENTS WITH ABNORMAL UTERINE BLEEDING
MAY BE LARGE (UP TO 30 CM)
UNILATERAL
HYPOECHOIC AND MAY CAST LARGE SHADOW POSTERIORLY
Stromal Tumors: Sertoli-Leidig Cell tumor
- Rare
- Less than .5% of ovarian tumors
- Most occur in patient < 30 years
- Secrete androgens
Signs and symptoms of Sertoli-Leidig Cell Tumors
Pain
Abdominal swelling
Masculinization effects due to increased testosterone
Ultrasound Appearance of Sertoli-Leidic Cell Tumors
Solid echogenic mass
