Differential Diagnoses - Pelvic Masses Flashcards
t or f: ovarian masses less than 5 cm that are not suspicious of malignancy and asymptomatic are often observed - no surgical intervention needed
TRUE - larger cysts (greater than 5 cm) can be considered for surgical resection
which ovarian cysts are the most common functional cysts?
follicular cysts
what is the physiology behind the development of a follicular cyst?
failure of rupture or incomplete resorption of the ovarian follicle is what results in the cyst
what are the contents of a follicular cyst?
estrogen-rich fluid (ovarian cyst is granulosa cell lined)
t or f: follicular cysts are typically asymptomatic when small (less than 5 cm)
TRUE
what is the greatest risk for ovarian torsion?
large size
t or f: follicular cyst pain tend to be bilateral
FALSE - unilateral abdominal and pelvic pain with abrupt pain indicating possible ovarian torsion
what is a sign on US that indicates ruptured ovarian cyst?
fluid in the cul-de-sac
t or f: no treatment is necessary for most functional cysts
TRUE - most will resolve spontaneously within two months
t or f: OCP may aid in the resolution of ovarian cysts for symptomatic patients
TRUE - chronically symptomatic cysts can also be managed with OCP
what must be done if an ovarian cysts does not resolve on its own within two months?
laparotomy/laparoscopy to evaluate/rule out neoplasm/endometriosis
what are the two types of lutein cysts?
corpus luteal and theca lutein
bilateral theca lutein cysts are often seen in what situation?
molar pregnancies due to increased BHCG levels
what is the physiology of the corpus luteum cyst?
When a follicle does release its egg, the ruptured follicle begins producing large quantities of estrogen and progesterone in preparation for conception. This changed follicle is now called the corpus luteum. Sometimes, however, the escape opening of the egg seals off and fluid accumulates inside the follicle, causing the corpus luteum to expand into a cyst.
what type of adnexal pain is produced by corpus luteum cysts?
unilateral
what is the physiology behind a theca lutein cyst?
increased levels of HCG causes follicular overstimulation and leads to the development of these cysts
t or f: theca lutein cysts are often multiple and bilateral
TRUE
what is the etiology of the development of TOA (most of the time)?
abscess involving the ovary and fallopian tube is most often a consequence of PID
what kind of antibiotics should be used to treat TOA?
TOA is a polymicrobial process of broad-spectrum antibiotics should be used
how does primary TOA develop?
as a result of a complication of an ascending infection of the reproductive tract
how does secondary TOA develop?
as a result of something such as bowel pert or from general intraperitoneal spread of infection (TOA can also result in association with pelvic surgery or malignancy)
what is one way to know that the pelvic was in fact a TOA?
the quick response to antibiotic treatment
what is the treatment for TOA that does not respond to antibiotics?
laparoscopic or US guided drainage
what is the medical term for chocolate cysts?
endometriomas
what is the result of ectopic endometrial tissue in the ovary?
endometrioma
t or f: 50% of women with endometriosis will develop an endometrioma
TRUE
how is the definitive diagnosis of an endometrioma made?
laparoscopy and biopsy with hemosiderin laden macrophages
t or f: the only treatment for endometriomas is surgical as medical therapy is completely ineffective
TRUE
ultrasound findings include hypo echoic areas with calcifications and internal debris - what is the most likely diagnosis?
benign cystic teratoma
what is the other name for a cystic teratoma
dermoid cyst
what is the most common ovarian germ cell tumor?
dermoid cyst
t or f: cystic teratomoas are more common in women over 50
FALSE! more common in young women aged 12–30
what 3 types of tissue can be found within a cystic teratoma?
tissue of ectodermal, mesodermal and endodermal - remember, the tissue is mature (benign) and may include skin, bone, hair and teeth
oocytes that are able to develop into teratomas undergo arrest in development after what stage of the cell cycle?
meiosis I
almost all mature cystic teratomas have what karyotype?
46 XX
what are the origins of the three main types of ovarian teratomas?
epthelium, sex cord and germ cells
what is the treatment for a teratoma of the ovary?
excision (cystectomy) or oophrectomy for women no longer wanting to conceive
t or f: nulliparity is a risk factor for ovarian teratomas
TRUE
elevated serum of which CA marker indicates an increased likelihood that n ovarian tumor is malignant?
CA-125 (definitive diagnosis is biopsy)
how is ovarian cancer staged?
surgically
in women with early stage ovarian CA what is the TOC?
TAH w/ bilateral salpingo-oophorectomy
leiomyomas are most commonly of which type?
subserousal
which type of leiomyomas are most likely to present as menorrhagia?
submucosal and intramural
t or f: pregnancy with fibroids increases carrier risks of abruption, dysfunctional bleeding and breech position.
TRUE
t or f: about 3/4 of fibroids recur after myomectomy.
FALSE - more like 1/3
what is the definitive treatment for fibroids?
hysterectomy
