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CK GYne > DO of the ovaries and oviduct > Flashcards

DO of the ovaries and oviduct Flashcards

1
Q

The most common cause of a simple cystic mass in the reproductive age years is a
________

A

physiologic cyst (luteal or follicular cyst).

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2
Q

Origin of the functional cyst

A

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

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3
Q

The most common cause of a pelvic mass in the reproductive years is______

A

pregnancy

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4
Q

The most common complex adnexal mass in young women is a ______ or ______ Other diagnoses include endometrioma, tuboovarian abscess, and ovarian cancer

A

dermoid cyst or benign cystic teratoma.

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5
Q 
• Pelvic mass in reproductive
years
• β-hCG (–)
• Sonogram: fluid-filled
ovarian simple cyst
A

Functional Ovarian Cyst

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6
Q

Mx of Functional Ovarian Cyst

A

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

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7
Q

________ can be used to help prevent further functional cysts from forming.

A

Oral contraceptive medication

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8
Q

Even if the cyst is simple in appearance, surgical evaluation should be
performed if _____ or _____

A

the cyst is >7 cm or if patient had been on prior steroid contraception

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9
Q

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

A

Polycystic Ovarian Syndrome

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10
Q

_______refers to the presence of nests of luteinized theca cells in the ovarian stroma that may be steroidogenically active.

A

Ovarian hyperthecosis

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11
Q

Difference of Ovarian hyperthecosis vs PCOS

A

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).

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12
Q

PE of Ovarian hyperthecosis

A

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

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13
Q

Unlike PCOS, which occurs only during the reproductive years, hyperthecosis of the
ovaries can occur in_______

A

postmenopausal women

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14
Q

Severe hirsutism and virilization in

postmenopausal women are more often due to __________

A

ovarian hyperthecosis than to virilizing

ovarian tumors.

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15
Q

Mx of Ovarian hyperthecosis

A

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).

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16
Q

_______ 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

A

Luteoma of pregnancy

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17
Q

Importance of Luteoma of pregnancy

A

It can be hormonally active and produce androgens resulting in maternal and fetal hirsutism and virilization.

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18
Q

These are benign neoplasms stimulated by high levels of FSH and β-hCG

A

Theca Lutein Cysts

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19
Q

Natural course of Theca Lutein Cysts

A

The natural course of these tumors is postpartum spontaneous regression
and require only conservative managment

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20
Q

Association of Theca Lutein Cysts

A

They are associated with twins and molar pregnancies but they are only rarely associated with a normal singleton pregnancy.

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21
Q

If sonography shows a complex adnexal mass in a girl or teenager, the possibility of ______of the ovary has to be considered

A

germ cell tumors

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22
Q 
The following serum tumor markers should be obtained: 
lactate dehydrogenase (LDH) for \_\_\_\_\_\_

b-hCG for_____, and

a-fetoprotein for _______

A

dysgerminoma,

choriocarcinoma

endodermal sinus tumor.

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23
Q

In a prepubertal patient who is symptomatic and has ultrasound evidence of an adnexal mass, a _____ is recommended

A

surgical evaluation

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24
Q

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 ______

A

laparoscopic

approach

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25
Q

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

A

laparoscopy or laparotomy

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26
Q

Mx of GCT

A

A unilateral salpingo-oophorectomy and surgical staging (peritoneal and diaphragmatic biopsies, peritoneal cytology, pelvic and para-aortic lymphadenectomy, and omentectomy) should be done

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27
Q

T or F

All patients with germ cell tumors require
postoperative chemotherapy

A

T

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28
Q

MC regimen for GCT

A

The most active regimen used is vinblastine, bleomycin, and cisplatin.

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29
Q

Prognosis of GCT

A

The current survival is >95% in patients with germ cell tumors managed with conservative management and chemotherapy

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30
Q

The most common complex adnexal mass in young women is a ________

A

dermoid cyst or benign cystic teratoma

31
Q

Patients in the reproductive age group with a complex adnexal mass should be
treated _______

A

surgically.

32
Q

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

A

cystectomy

33
Q

dermoid cysts can occur bilaterally in _____

A

10–15% of cases

34
Q

If an ovarian cystectomy cannot be done because of the size of the dermoid cyst, then an _______ is performed

A

oophorectomy

35
Q

Sudden onset of severe lower abdominal pain in the presence of an adnexal mass
is presumptive evidence of _______

A

ovarian torsion

36
Q

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 _______

A

revitalization

laparoscopy or laparotomy

37
Q

Ovarian torsion

If revitalization occurs, an ______can be performed with preservation of the ovary

A

ovarian cystectomy

38
Q

Ovarian torsion

If the ovary is necrotic, a______is performed.

A

unilateral salpingo-oophorectomy

39
Q

Ovaries in the postmenopausal age

group should be atrophic; anytime they are enlarged, the suspicion of _______

A

ovarian cancer arises

40
Q

Only ____ of patients undergoing laparotomy for sonographically detected pelvic
masses actually have ovarian cancer

A

3%

41
Q

_______ is the second most common gynecologic malignancy, with
a mean age at diagnosis of 69 years

A

Ovarian carcinoma

42
Q

______percent of women die of ovarian cancer. It is the most common gynecologic cancer leading to death

A

One

43
Q

RF for ovarian CA

A

These include BRCA1 gene, positive family history, high number of lifetime
ovulations, infertility, and use of perineal talc powder

44
Q

Protective factors for ovarian CA

A

These are conditions that decrease the total number of lifetime ovulations:
oral contraceptive pills, chronic anovulation, breast-feeding, and short reproductive life

45
Q

The most common type of histologic ovarian carcinoma is_____ which predominantly occurs in postmenopausal women.

A

epithelial cancer,

46
Q

Types of epithelial cancer,

A

serous, mucinous, Brenner, endometrioid, and clear cell tumors

47
Q

The most common malignant epithelial cell type is_______

A

serous

48
Q

15%. of cases

Another histologic type of ovarian cancer is the _______ which predominantly occurs in teenagers

A

germ cell tumor,

49
Q

Types of germ cell tumor,

A

dysgerminoma, endodermal

sinus tumors, teratomas, and choriocarcinoma.

50
Q

The most common malignant
germ cell type is _______

It is uniquely x-ray sensitive.

A

dysgerminoma

51
Q

5% of the cases . The third type of ovarian tumor is the _______ which is
functionally active

A

stromal tumor,

52
Q

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

A

granulosa-theca cell tumors,

Sertoli-Leydig cell tumors

53
Q

Mx of stromal tumors

A

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)

54
Q

Cx of stromal tumors

A

They metastasize infrequently, and then

they require chemotherapy (vincristine, actinomycin, and Cytoxan

55
Q

• Postmenopausal pelvic
mass
• Masculinization
• ↑ testosterone level

A

Sertoli-Leydig Tumor

56
Q
  • Postmenopausal woman
  • Pelvic mass
  • ↑ hCG level
A

Choriocarcinoma

57
Q

Postmenopausal woman
• Pelvic mass
• ↑ CEA or CA-125 level

A

Serous Carcinoma

58
Q

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 ______
A

should also be drawn for the possibility of ovarian epithelial cancer

germ cell tumors.

stromal tumors.

59
Q

Ovarian CA stages

A

Stage I: Spread limited to the ovaries
Stage II: Extension to the pelvis
Stage III: Peritoneal metastases or positive nodes
Stage IV: Distant metastases

60
Q

This is the most common stage at

diagnosis for Ovarian Ca

A

Stage III: Peritoneal metastases or positive nodes

61
Q

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
______

A

laparoscopically

62
Q

If the patient is not a good surgical candidate or the patient desires to maintain her uterus and contralateral ovary, a _______

A

USO is sufficient treatment

63
Q

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.

A

TAH and BSO

64
Q

Ovarian CA Malignant Histology. In this case, a debulking procedure (cytoreduction) should be performed.

This procedure consists of a _____

A

TAH and BSO, omentectomy, and bowel resection, if necessary.

Postoperative chemotherapy (carboplatin and Taxol) should be administered.

65
Q

Ff up of malignant histology for ovarian CA

A

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

66
Q

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

A

tumors of low malignant potential

67
Q 
• Postmenopausal bilateral
pelvic masses
• Weight gain, anorexia
• Abdominal “shifting
dullness
A

Ovarian Carcinoma with

Peritoneal Metastasi

68
Q

_______ is the triad of ascites, pleural effusion, and benign ovarian fibroma

A

Meigs syndrome

69
Q

The most common method of ovarian carcinoma spread is by

A

peritoneal dissemination (exfoliation) and is commonly seen metastatic to the omentum and to the GI tract.

70
Q

The cause of death of patients with advanced ovarian carcinoma is

A

bowel obstruction.

71
Q

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
_____

A

exploratory laparotomy

frozen section evaluation.

72
Q

If ovarian carcinoma is confirmed, then a debulking (cytoreductive) surgical procedure should be performed. This procedure usually includes a

A

TAH, BSO, omentectomy, and, frequently, bowel resection

73
Q

Ovarian CA with ascites post op

A

Postoperatively patients should be treated with 6 courses of a standard
chemotherapy regimen, which includes Taxol and carboplatin

CK GYne (9 decks)

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