Congenital and Benign Ovaries and Fallopian Tubes -Gambone Flashcards
What is Turner’s Syndrome? What gonadal abnormality does this lead to?
45 XO
streaked gonads (rudimentary)
(also short stature, low estrogen and high FSH, often present with primary amenorrhea)
What is Androgen Insensitivity? What will the pt present with phenotypically?
46 XY male that phenotypically looks female due to a lack of androgen receptors
–> male pseudohermaphrodite
scant pubic hair (no androgen receptors) and large breasts (lack of estrogen opposition)
gonads should be removed after puberty
What complications can arise from DES exposure in utero?
tubes may be shortened, distorted or clubbed
What are the differences between a follicular cyst, lutein cyst and hemorrhagic cyst?
Follicular cyst: ovarian follicle fails to rupture
Lutein cyst: forms when corpus luteum (CL) becomes cystic (>3cm)
Hemorrhagic cysts: more likely to cause symptoms; develops when ovarian vessels invade CL and bleed
What is a theca-lutein cyst? What hormone level will be elevated?
a molar pregnancy causing high levels of hGC
no fetus but has a placenta
What is a luteoma of pregnancy? What can this lead to in the fetus? How is this treated?
a rare ovarian tumor that has a rapid androgen effect in response to the elevated hCG –> lead to high androgen levels and masculinization of the mother and fetus
can lead to ambiguous genitalia
normally spontaneously regress after delivery
What is the pathophysiology of PCOS (polycystic ovarian syndrome)? What is the resulting phenotype?
chronic anovulation
causes increased sensitivity of pituitary to GnRH ==> persistent LH ==> increased androgens, suppressed FSH
androgen excess==> hirsutism of the arms, thighs, and and face, insulin resistance
What is the classical ultrasound finding in PCOS?
string of pearls sign
=multiple follicles lines up along the ovarian cortex (most are arrested and atretic)
When are hemorrhagic ovarian cysts considered to be a surgical emergency?
when they undergo torsion==> rupture and cause intra-abdominal bleeding (normally arterial) and shock
What findings allow for the presumptive diagnosis of a functional ovarian cyst during reproductive years? How can this be confirmed?
mass between 5-8 cm is palpated, mobile, unilateral and without ascites
normally regress over several cycles
can be confirmed on pelvic US
What are the 3 main types of benign neoplastic ovarian tumors?
- epithelial (serous and mucinous types)
- stromal (Brenner, fibroma, sertoli-leydig and granulosa)
- germ cell (teratoma)
What is a Brenner Tumor?
dysgerminoma derived from sex cords and specialized stroma
–> smooth, small tumor
normally benign
What is a Sertoli-Leydig tumor?
produces huge androgen effect –> male body habitus and lack of breast development, acne, hirsuitism
many have palpable masses on pelvic exam
high malignancy rate
What is Meig’s syndrome? What normally presents with Meig’s syndrome?
Meigs: pelvic neoplasm with ascites and hydrothorax
ovarian fibroma
What is a teratoma?
a germ cell tumor that may contain many types of tissue (hair, teeth, bone, thyroid)
- slow growing
- may be bilateral
What is the preferred treatment for a benign ovarian tumor in women of reproductive age (16-48)?
bimanual pelvic exam
observation
OC to prevent new cysts from growing
re-examine in 6 weeks
US to confirm cystic nature
if persistent–> further explore to r/o malignancy
What is the recommended treatment for hormonally active tumors?
oopherectomy
TAH-BSO may be indicated in older patients with persistent or recurrent neoplastic lesions
What surgical procedures are required for an ovarian or adnexal torsion?
if no necrosis, may untwist
if necrosis has occurred–> unilateral adnexectomy
surgical emergency
What is the difference between an Ovarian Remnant and a Residual Ovary Syndrome?
Ovarian Remnant==> unintentional ovarian tissue remaining
- FSH may be low if it is still present & producing estrogen (will be high if no estrogen producing tissue present)
- can cause pain from inflammation and scar tissue
Residual=left intentionally to preserve ovarian function (i.e. so young women don’t have to be on hormone therapy)
Is CA-125 considered a diagnostic tool?
NO! ==> low + predictive value
used to monitor cancer progression though
