DO of the ovaries and oviduct Flashcards
The most common cause of a simple cystic mass in the reproductive age years is a
________
physiologic cyst (luteal or follicular cyst).
Origin of the functional cyst
During the reproductive years the ovaries are functionally active, producing a dominant follicle in the first half of the cycle and a corpus luteum after ovulation in the second half of the menstrual cycle
The most common cause of a pelvic mass in the reproductive years is______
pregnancy
The most common complex adnexal mass in young women is a ______ or ______ Other diagnoses include endometrioma, tuboovarian abscess, and ovarian cancer
dermoid cyst or benign cystic teratoma.
• Pelvic mass in reproductive years • β-hCG (–) • Sonogram: fluid-filled ovarian simple cyst
Functional Ovarian Cyst
Mx of Functional Ovarian Cyst
the sonogram shows a simple cyst it is probably benign but careful
follow-up is needed.
Follow-up examination should be in 6–8 weeks, at which time the functional cyst should have spontaneously resolved
________ can be used to help prevent further functional cysts from forming.
Oral contraceptive medication
Even if the cyst is simple in appearance, surgical evaluation should be
performed if _____ or _____
the cyst is >7 cm or if patient had been on prior steroid contraception
The ovaries are bilaterally enlarged with multiple peripheral cysts (20-100 in each ovary).
This is due to high circulating androgens and high circulating insulin levels causing arrest of folliclular development in various stages
Polycystic Ovarian Syndrome
_______refers to the presence of nests of luteinized theca cells in the ovarian stroma that may be steroidogenically active.
Ovarian hyperthecosis
Difference of Ovarian hyperthecosis vs PCOS
These nests, or islands, of luteinized
theca cells are scattered throughout the stroma of the ovary, rather than being confined to areas around cystic follicles, as in polycystic ovary syndrome (PCOS).
PE of Ovarian hyperthecosis
However, women with ovarian hyperthecosis have more severe hirsutism, with shaving
being common.
Virilization is frequent, with clitoral enlargement, temporal balding, deepening of the voice, and a male habitus
Unlike PCOS, which occurs only during the reproductive years, hyperthecosis of the
ovaries can occur in_______
postmenopausal women
Severe hirsutism and virilization in
postmenopausal women are more often due to __________
ovarian hyperthecosis than to virilizing
ovarian tumors.
Mx of Ovarian hyperthecosis
using oral contraceptive pills both to
suppress androgen production (by reducing LH stimulation of the theca cells) and to decrease free androgens (by stimulating sex hormone binding globulin).
_______ is a rare, non-neoplastic tumor-like mass of the ovary that emerges
during pregnancy and regresses spontaneously after delivery.
It is usually asymptomatic and
is found incidentally during a cesarean section or postpartum tubal ligation
Luteoma of pregnancy
Importance of Luteoma of pregnancy
It can be hormonally active and produce androgens resulting in maternal and fetal hirsutism and virilization.
These are benign neoplasms stimulated by high levels of FSH and β-hCG
Theca Lutein Cysts
Natural course of Theca Lutein Cysts
The natural course of these tumors is postpartum spontaneous regression
and require only conservative managment
Association of Theca Lutein Cysts
They are associated with twins and molar pregnancies but they are only rarely associated with a normal singleton pregnancy.
If sonography shows a complex adnexal mass in a girl or teenager, the possibility of ______of the ovary has to be considered
germ cell tumors
The following serum tumor markers should be obtained: lactate dehydrogenase (LDH) for \_\_\_\_\_\_
b-hCG for_____, and
a-fetoprotein for _______
dysgerminoma,
choriocarcinoma
endodermal sinus tumor.
In a prepubertal patient who is symptomatic and has ultrasound evidence of an adnexal mass, a _____ is recommended
surgical evaluation
Pre-pubertal adnexal mass MX
Simple mass. If the ultrasound shows the consistency of the mass to be simple (no
septations or solid components), this mass can be evaluated through a ______
laparoscopic
approach
Pre-pubertal adnexal mass MX
If the mass has septations or solid components, a_______ or ______
should be performed, depending on the experience of the surgeon
laparoscopy or laparotomy
Mx of GCT
A unilateral salpingo-oophorectomy and surgical staging (peritoneal and diaphragmatic biopsies, peritoneal cytology, pelvic and para-aortic lymphadenectomy, and omentectomy) should be done
T or F
All patients with germ cell tumors require
postoperative chemotherapy
T
MC regimen for GCT
The most active regimen used is vinblastine, bleomycin, and cisplatin.
Prognosis of GCT
The current survival is >95% in patients with germ cell tumors managed with conservative management and chemotherapy
The most common complex adnexal mass in young women is a ________
dermoid cyst or benign cystic teratoma
Patients in the reproductive age group with a complex adnexal mass should be
treated _______
surgically.
Dermoid cyst Mx
At the time of surgery an ovarian ____should be attempted to preserve ovarian function in the reproductive age. Careful evaluation of the opposite adnexa should be performed
cystectomy
dermoid cysts can occur bilaterally in _____
10–15% of cases
If an ovarian cystectomy cannot be done because of the size of the dermoid cyst, then an _______ is performed
oophorectomy
Sudden onset of severe lower abdominal pain in the presence of an adnexal mass
is presumptive evidence of _______
ovarian torsion
The management of the torsion should be to untwist the ovary and observe the
ovary for a few minutes in the operating room to assure ______. This can be performed with _______
revitalization
laparoscopy or laparotomy
Ovarian torsion
If revitalization occurs, an ______can be performed with preservation of the ovary
ovarian cystectomy
Ovarian torsion
If the ovary is necrotic, a______is performed.
unilateral salpingo-oophorectomy
Ovaries in the postmenopausal age
group should be atrophic; anytime they are enlarged, the suspicion of _______
ovarian cancer arises
Only ____ of patients undergoing laparotomy for sonographically detected pelvic
masses actually have ovarian cancer
3%
_______ is the second most common gynecologic malignancy, with
a mean age at diagnosis of 69 years
Ovarian carcinoma
______percent of women die of ovarian cancer. It is the most common gynecologic cancer leading to death
One
RF for ovarian CA
These include BRCA1 gene, positive family history, high number of lifetime
ovulations, infertility, and use of perineal talc powder
Protective factors for ovarian CA
These are conditions that decrease the total number of lifetime ovulations:
oral contraceptive pills, chronic anovulation, breast-feeding, and short reproductive life
The most common type of histologic ovarian carcinoma is_____ which predominantly occurs in postmenopausal women.
epithelial cancer,
Types of epithelial cancer,
serous, mucinous, Brenner, endometrioid, and clear cell tumors
The most common malignant epithelial cell type is_______
serous
15%. of cases
Another histologic type of ovarian cancer is the _______ which predominantly occurs in teenagers
germ cell tumor,
Types of germ cell tumor,
dysgerminoma, endodermal
sinus tumors, teratomas, and choriocarcinoma.
The most common malignant
germ cell type is _______
It is uniquely x-ray sensitive.
dysgerminoma
5% of the cases . The third type of ovarian tumor is the _______ which is
functionally active
stromal tumor,
Types of stromal tumors
These include ____which secrete estrogen
and can cause bleeding from endometrial hyperplasia and
__________, which secrete testosterone and can produce masculinization syndromes
granulosa-theca cell tumors,
Sertoli-Leydig cell tumors
Mx of stromal tumors
Patients with stromal tumors usually present with early stage disease and are treated either with removal of the involved adnexa (for patients who desire further fertility) or a TAH and BSO (if their family has been completed)
Cx of stromal tumors
They metastasize infrequently, and then
they require chemotherapy (vincristine, actinomycin, and Cytoxan
• Postmenopausal pelvic
mass
• Masculinization
• ↑ testosterone level
Sertoli-Leydig Tumor
- Postmenopausal woman
- Pelvic mass
- ↑ hCG level
Choriocarcinoma
Postmenopausal woman
• Pelvic mass
• ↑ CEA or CA-125 level
Serous Carcinoma
CA-125 (cancer antigen 125) and CEA (carcinoembryonic antigen) ______.
- LDH, hCG, and a-fetoprotein should be drawn for the possibility of_____
- Estrogen and testosterone should be drawn for the possibility of ______
should also be drawn for the possibility of ovarian epithelial cancer
germ cell tumors.
stromal tumors.
Ovarian CA stages
Stage I: Spread limited to the ovaries
Stage II: Extension to the pelvis
Stage III: Peritoneal metastases or positive nodes
Stage IV: Distant metastases
This is the most common stage at
diagnosis for Ovarian Ca
Stage III: Peritoneal metastases or positive nodes
Ovarian CA
If abdominal or pelvic CT scan shows no evidence of ascites or spread to the abdominal cavity, and if the surgeon is an experienced laparoscopist, then the evaluation could be performed
______
laparoscopically
If the patient is not a good surgical candidate or the patient desires to maintain her uterus and contralateral ovary, a _______
USO is sufficient treatment
If the USO by frozen section is benign and the patient is a good surgical candidate, then a _______ may be performed even though it is benign disease because the uterus and ovaries are not unusual sites of pathology in a woman.
TAH and BSO
Ovarian CA Malignant Histology. In this case, a debulking procedure (cytoreduction) should be performed.
This procedure consists of a _____
TAH and BSO, omentectomy, and bowel resection, if necessary.
Postoperative chemotherapy (carboplatin and Taxol) should be administered.
Ff up of malignant histology for ovarian CA
If the pathology report was carcinoma, then she would be followed up every 3 months for the first 2 years and then every 6 months for the next 2 years with follow-up of the CA-125 tumor marker
Another entity of ovarian cancer is the borderline tumors also known as
_______. These are characterized by no invasion of the basement
membrane and can also be treated conservatively
tumors of low malignant potential
• Postmenopausal bilateral pelvic masses • Weight gain, anorexia • Abdominal “shifting dullness
Ovarian Carcinoma with
Peritoneal Metastasi
_______ is the triad of ascites, pleural effusion, and benign ovarian fibroma
Meigs syndrome
The most common method of ovarian carcinoma spread is by
peritoneal dissemination (exfoliation) and is commonly seen metastatic to the omentum and to the GI tract.
The cause of death of patients with advanced ovarian carcinoma is
bowel obstruction.
After an abdominal pelvic CT scan confirms the presence of ascites and the adnexal mass, an ______ and surgical staging should be performed.
A salpingo-oophorectomy of the enlarged ovary should be done and sent for
_____
exploratory laparotomy
frozen section evaluation.
If ovarian carcinoma is confirmed, then a debulking (cytoreductive) surgical procedure should be performed. This procedure usually includes a
TAH, BSO, omentectomy, and, frequently, bowel resection
Ovarian CA with ascites post op
Postoperatively patients should be treated with 6 courses of a standard
chemotherapy regimen, which includes Taxol and carboplatin
