Disorders of the Ovary Flashcards
What are the four types of ovarian cysts?
Follicular cysts
Corpus luteum cysts
Theca leutein cysts
Endometriomas
Which type of ovarian cyst is described below?
Simple cysts resulting from failure of ovulation
Fluid of incompletely developed follicle is not reabsorbed, producing an enlarged cyst
Typically asymptomatic - However bleeding and torsion can occur
Follicular cysts
Most follicular cysts typically disappear spontaneously within what time frame?
60 days
What type of medication has been recommended for follicular cysts but may not produce quicker resolution than expectant management, however may keep new cysts from forming
OCPs
Which type of ovarian cyst is described below?
Thin-walled unilocular cysts
Sizes from 3-11cm
When corpus luteum exceeds 3cm, it becomes known as a cyst
Corpus Luteum Cyst
Which type of ovarian cyst is described below?
Associated with pregnancy (increased gonadotropins)
More common with multiple gestations and trophoblastic disease
Typically bilateral
Multicystic
Theca Lutein Cyst
Which type of ovarian cyst is described below?
Benign
Palpable mass on ovary
Occur as a consequence of ovarian endometriosis
Grow up to 6-8cm
“chocolate cysts”
Endometriomas
Most Corpus Luteum cysts typically disappear spontaneously within what time frame?
Typically resolves over 1-2 months in menstruating patients
Which ovarian cyst is typically seen in first trimester of pregnancy?
Corpus Luteum Cyst
A patient with a Corpus Luteum Cyst typically presents with this triad of signs/symptoms
Unilateral lower quadrant pain
Missed period
Adnexal enlargement on PE
In a case of suspected corpus luteum cyst, what other condition needs to be ruled out ASAP in the workup?
ectopic pregnancy
What type of medication is used for prevention of corpus luteum cysts?
OCPs
Recurrent hemorrhagic corpus luteum cysts should raise suspicion of what?
bleeding disorder
What is a complication of a corpus luteum cyst to keep in mind?
If rupture occurs, may require surgery to stop the bleeding
What is the least common functional cyst?
Theca Lutein Cyst
What ovarian cyst is associated with pregnancy
(increased gonadotropins), especially with multiple
gestations?
Theca Lutein Cyst
“chocolate cysts”
Endometriomas
Polycystic Ovarian Syndrome is also known as what?
Stein-Leventhal syndrome
Common endocrine disorder with unknown etiology
Affects 5-10% of reproductive age women
Characterized by persistent anovulation
Polycystic Ovarian Syndrome
Unrecognized and untreated Polycystic Ovarian Syndrome is an important risk factor for what disease process?
CVD
Persistent anovulation in polycystic ovarian syndrome leads to what complications/conditions?
Enlarged polycystic ovaries
Secondary amenorrhea or oligomenorrhea
Infertility issues
What are the essentials of diagnosis for polycystic ovarian syndrome?
Clinical or biochemical evidence of hyperandrogenism
Oligoovulation or anovulation
Polycystic ovaries on ultrasound
What is the “typical patient” for polycystic ovarian syndrome?
Typically an obese female with hirsutism with or without acanthans nigricans who is complaining of either missed periods or infertility
Has many signs of metabolic syndrome
List some signs and symptoms of polycystic ovarian syndrome?
Infertility
Chronic menstrual irregularities
Hyperandrogenism
Insulin Resistance
Obesity
Hirsutism
Virilization
Amenorrhea
Abnormal uterine bleeding
Normal menstruation
Acanthosis nigricans
What ultrasound sign is a classic finding of polycystic ovarian syndrome?
“string of pearls” sign
What are some disorders to keep in mind for a differential diagnosis of polycystic ovarian syndrome, since these conditions also present with high androgen levels with anovulation and polycystic ovaries?
Cushing Syndrome
CAD – congenital adrenal hyperplasia
Androgen secreting adrenal tumors
What is a major treatment of PCOS?
Exercise and weight control
In PCOS, this medication is used to reduce insulin-resistance, thus targeting the pathophysiologic basis for PCOS
Metformin
This condition is a gynecological emergency and results in hypoxia and necrosis of ovary leading to an acute abdomen
Ovarian Torsion
twisting of ovary or ovary + tube
Ovarian Torsion
This gynecological emergency can be seen during treatment of infertility with ovulation-inducing medications
Ovarian Torsion
Acute onset of severe abdominal/pelvic pain often accompanied by nausea and vomiting is the common presentation of what gynecological emergency?
Ovarian Torsion
What is the clinical definition of infertility in women <35?
Women < 35 years: failure to conceive after 12 months of frequent,
unprotected sex
What is the clinical definition of infertility in women >35?
Women >35 years: failure to conceive after 6 months
List some common causes of infertility
PCOS
Thyroid disorders
Hyperprolactinemia
History of PID
endometriosis
What is the most common teratoma?
dermoid cyst
A benign germ cell neoplasm
Teratoma
What is the median age for a teratoma?
30 year olds
What is the malignancy risk for a teratoma?
<1% malignancy risk
What percentage of teratomas are bilateral?
10-20%
What is the pathophysiology of teratomas?
Derived from primary germ cells
Contain well-differentiated tissue from all embryonic germ layers
What is a risk of teratoma to be worried about and why?
High fat content
Causing buoyant tendency in the pelvis 🡪 HIGH risk of torsion!!
A surgical removal of a teratoma is the treatment due to the risk of these two complications
ovarian torsion
Spillage of contents can lead to chemical peritonitis
Benign germ cell tumor
Usually found in young women
Typically asymptomatic finding on bimanual exam
Dermoids
What percentage of dermoids are bilateral?
15%
Second most common gynecologic malignancy
Ovarian Cancer
Most common cause of death of women who develop a gynecologic
malignancy – 50% morbidity
Ovarian Cancer
What is the lifetime risk of ovarian cancer?
1%
This is a disease of post-menopausal women, with the highest incidence between 65-74 y/o
Ovarian Cancer
What therapy does not increase risk of ovarian cancer
HRT
What percentage of ovarian cancers develop sporadically?
90%
A familial pattern is seen in patients with family history containing which genes/conditions?
BRCA 1
BRCA 2
HNPCC
Why is ovarian cancer usually diagnosed at Stage III or IV?
Typically develops with few signs or symptoms until the disease is widely disseminated throughout the abdomen
Early diagnosis is difficult due to lack of effective screening tools
What is the most common type of ovarian cancer?
Epithelial Cell tumors
What are the different types of ovarian cancers and how are they categorized?
categorized by the cell type
Epithelial Cell tumors
Germ Cell tumors
Stromal Cell tumors
List some risk factors for ovarian cancer
Genetics (highest) – 8-13% have a genetic predisposition
Early menarche
Late menopause
Nulligravidity/nulliparity
Infertility (NOT infertility treatment)
Endometriosis
Older age
First degree relatives
Environmental
What are the lifetime risks of developing ovarian cancer with the BRCA mutations?
BRCA1: 50% lifetime risk
BRCA2: 27% lifetime risk
What are the lifetime risk of developing ovarian cancer with Lynch Syndrome (HNPCC)?
12% lifetime risk
What are some environmental risk factors for ovarian cancer?
Talc
Smoking
Diet high in fat
Lack of exercise
obesity
What are some protective factors against ovarian cancer?
Multiparity
OCPs - 5 year usage = 50% reduction
Breastfeeding
Chronic anovulation
Total hysterectomy
Bilateral tubal ligation
What is an imperfect test but could potentially help in the screening of ovarian cancer?
Ca-125 cancer antigen (>35 is abnormal)
Why is Ca-125 cancer antigen an imperfect test for ovarian cancer?
May also be elevated in multiple other cancers or disorders – limits its usefulness in premenopausal women
Normal CA-125 does not rule out ovarian cancer
False positives and negatives
When elevated in a post-menopausal woman with a pelvic mass, high suspicion but NOT diagnostic for cancer
CA-125
CA-125 has a better use for what in ovarian cancer?
Baseline measurement is useful for evaluating success of treatment – good marker for treatment progress
