ERU- 18 The Ovaries and Fallopian Tubes Flashcards
What is the blood supply to the ovary
Ovarian artery (direct branch of the aorta and ovarian branches of the uterine artery
Where do the ovarian veins drain?
Right > inferior vena cava
Left > left renal vein
What is a Graafian follicle?
The dominant follicle of the ovary. The one that will ovulate. All others will regress.
What is the cumulus oophorus?
The part of the dominant follicle that contains the ovum.
What is a corpus albican?
A corpus luteum that has regressed.
Graafian follicule > corpus luteum > corpus albicans
How does blood flow in the ovarian artery differ on spectral Doppler though the menstrual cycle
Early follicular and late luteal: HIGH resistance and increased impedance with low or absent end-diastolic flow. Resistive index = 1.
Late follicular/early luteal (Day 7-17): LOW resistance with low impedance and higher diastolic flow. Resistive index 0.5.
What preserves the corpus luteum cyst in pregnancy?
hcg hormone produced by he trophoblastic cells of the pregnancy
What diagnoses are associated with theca lutein cysts?
What lab finding is associated?
What symptom is associated?
Molar pregnancy, multiple gestation, and ovarian hyperstimulation syndrome.
hCG >100,000
hyperemesis
What is a dermoid cyst / Cystic teratoma?
The most common benign ovarian tumor.
A cyst resulting from the retention of an unfertilized ovum that differentiates into 3 germ cell layers containing any number of tissues including glands, bone, hair, fat, sebum
What are the three germ cell layers?
ectoderm, mesoderm, endoderm
What sonographic finding is associated with cystic teratoma?
“tip of the iceberg” sign
Caused by the greater part of the mass being obscured by shadowing
What is Meigs syndrome?
Benign ovarian tumor with ascites and pleural effusion. Associated with thecomas.
What is a thecoma?
Benign ovarian sex cord-stromal tumor. Usually seen in postmenopausal women.
Estrogen producing. Can cause postmenopausal bleeding. Can cause Meigs syndrome
What is a granulosa cell tumor
Most common estrogen secreting tumor. Malignant potential. Can cause precocious puberty, AUB, and postmenopausal bleeding. Increased risk for endometrial carcinoma due to estrogen stimulation.
What is a fibroma?
A benign sex cord stromal tumor that does NOT produce estrogen, but can cause Meigs syndroms
Sex cord stromal tumors
Thecoma Benign estrogen Meigs
Granulosa ?Malignant estrogen no Meigs
Fibroma: Benign no estrogen Meigs
What is a Brenner Tumor (transitional cell tumor)
Small, solid, benign, unilateral ovarian tumors. May be associated with Meigs syndrome
What is an endometrioma?
A benign, blood filled tumor associated with endometriosis. Associated with painful menses. “chocolate cysts”
What is a cystadenoma?
The most common neoplasm of the ovary.
Serous cystadenoma: 50% benign. Sonographically presents as large bilateral anechoic lesions contains septations and/or papillary projections.
Mucinous cystadenoma: Usually unilateral and very large (up to 50cm). Contains internal debris.
Malignant ovarian disease Cystadenocarcinoma (serous and mucinous) Krunkenberg tumor sertoli-Leydig cell tumor (androblastoma) dysgerminoma yolk sac tumor endometrial tumor
What differentiates a cystadenoma from a cystadenocarcinoma, by ultrasound and lab?
For mucinous cystadenocarcinoma?
thicker septations and more papillary projections
Elevated CA 125
Pseudomyxoma peritonei for mucinous tumors
What are Krunkenberg tumors?
Bilateral ovarian tumors that have metastasized from (usually) the stomach.
Have a “moth eaten” appearance on ultrasound.
Describe a Sertoli-Leydig cell tumor?
Ovarian tumor with malignant potential. Sex cord stromal tumor. Causes virilization and hirsutism. See in younger women (30’s)
Describe a dysgerminoma
what is the male equivalent to this tumor?
Most common malignant germ cell tumor of the ovary. Occurs in younger women (<30). Present with psudoprecocious puberty.
Elevated serum lactate dehydrogenase. May also have elevated hcg.
Seminoma
Yolk sac tumor
Second most common malignant germ cell tumor.
Poor prognosis. Seen in younger females. Rapid growth.
Elevated AFP.
Endometrioid tumor
Highest incidence of malignancy.
Seen in age 40’s and 50’s.
Hx of endometrial issues (cancer, -iosis, hyperplasia)
Describe ultrasound findings concerning for ovarian cancer
Complex mass solid wall nodules in a cystic mass Thick septations (>3mm) wall thickening irregular wall or poorly defined margins blood flow in septations ascites
Tumor marker for:
yok sac tumor
dysgerminoma
serous or mucinous cystadenocarcinoma
AFP
LDH (and maybe hcg)
CA 125
ovarian torsion findings on US
>5cm usually right sided possible multi follicular development "whirlpool" sign Excessive free fluid Decreased absent blood flow by comparison
5 segments of the fallopian tube
interstitial > isthmus > ampulla >infundibulum > fimbriae
ampulla is longest and most tortuous segment (ectopics)
How is ovarian volume calculated?
L x W x H x 0.5233
Ovarian masses that can look like a pedunculated uterine fibroid include
Thecoma
Fibroma
Granulosa cell tumor
