ERU- 18 The Ovaries and Fallopian Tubes

Question 1

What is the blood supply to the ovary

Answer 1

Ovarian artery (direct branch of the aorta and ovarian branches of the uterine artery

Question 2

Where do the ovarian veins drain?

Answer 2

Right > inferior vena cava

Left > left renal vein

Question 3

What is a Graafian follicle?

Answer 3

The dominant follicle of the ovary. The one that will ovulate. All others will regress.

Question 4

What is the cumulus oophorus?

Answer 4

The part of the dominant follicle that contains the ovum.

Question 5

What is a corpus albican?

Answer 5

A corpus luteum that has regressed.

Graafian follicule > corpus luteum > corpus albicans

Question 6

How does blood flow in the ovarian artery differ on spectral Doppler though the menstrual cycle

Answer 6

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.

Question 7

What preserves the corpus luteum cyst in pregnancy?

Answer 7

hcg hormone produced by he trophoblastic cells of the pregnancy

Question 8

What diagnoses are associated with theca lutein cysts?
What lab finding is associated?
What symptom is associated?

Answer 8

Molar pregnancy, multiple gestation, and ovarian hyperstimulation syndrome.
hCG >100,000
hyperemesis

Question 9

What is a dermoid cyst / Cystic teratoma?

Answer 9

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

Question 10

What are the three germ cell layers?

Answer 10

ectoderm, mesoderm, endoderm

Question 11

What sonographic finding is associated with cystic teratoma?

Answer 11

“tip of the iceberg” sign

Caused by the greater part of the mass being obscured by shadowing

Question 12

What is Meigs syndrome?

Answer 12

Benign ovarian tumor with ascites and pleural effusion. Associated with thecomas.

Question 13

What is a thecoma?

Answer 13

Benign ovarian sex cord-stromal tumor. Usually seen in postmenopausal women.
Estrogen producing. Can cause postmenopausal bleeding. Can cause Meigs syndrome

Question 14

What is a granulosa cell tumor

Answer 14

Most common estrogen secreting tumor. Malignant potential. Can cause precocious puberty, AUB, and postmenopausal bleeding. Increased risk for endometrial carcinoma due to estrogen stimulation.

Question 15

What is a fibroma?

Answer 15

A benign sex cord stromal tumor that does NOT produce estrogen, but can cause Meigs syndroms

Question 16

Sex cord stromal tumors
Thecoma Benign estrogen Meigs
Granulosa ?Malignant estrogen no Meigs
Fibroma: Benign no estrogen Meigs

Question 17

What is a Brenner Tumor (transitional cell tumor)

Answer 17

Small, solid, benign, unilateral ovarian tumors. May be associated with Meigs syndrome

Question 18

What is an endometrioma?

Answer 18

A benign, blood filled tumor associated with endometriosis. Associated with painful menses. “chocolate cysts”

Question 19

What is a cystadenoma?

Answer 19

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.

Question 20

Malignant ovarian disease
Cystadenocarcinoma (serous and mucinous)
Krunkenberg tumor
sertoli-Leydig cell tumor (androblastoma)
dysgerminoma 
yolk sac tumor
endometrial tumor

Question 21

What differentiates a cystadenoma from a cystadenocarcinoma, by ultrasound and lab?
For mucinous cystadenocarcinoma?

Answer 21

thicker septations and more papillary projections
Elevated CA 125

Pseudomyxoma peritonei for mucinous tumors

Question 22

What are Krunkenberg tumors?

Answer 22

Bilateral ovarian tumors that have metastasized from (usually) the stomach.
Have a “moth eaten” appearance on ultrasound.

Question 23

Describe a Sertoli-Leydig cell tumor?

Answer 23

Ovarian tumor with malignant potential. Sex cord stromal tumor. Causes virilization and hirsutism. See in younger women (30’s)

Question 24

Describe a dysgerminoma

what is the male equivalent to this tumor?

Answer 24

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

Question 25

Yolk sac tumor

Answer 25

Second most common malignant germ cell tumor.
Poor prognosis. Seen in younger females. Rapid growth.
Elevated AFP.

Question 26

Endometrioid tumor

Answer 26

Highest incidence of malignancy.
Seen in age 40’s and 50’s.
Hx of endometrial issues (cancer, -iosis, hyperplasia)

Question 27

Describe ultrasound findings concerning for ovarian cancer

Answer 27

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

Question 28

Tumor marker for:
yok sac tumor
dysgerminoma
serous or mucinous cystadenocarcinoma

Answer 28

AFP
LDH (and maybe hcg)
CA 125

Question 29

ovarian torsion findings on US

Answer 29

>5cm
usually right sided
possible multi follicular development
"whirlpool" sign
Excessive free fluid
Decreased absent blood flow by comparison

Question 30

5 segments of the fallopian tube

Answer 30

interstitial > isthmus > ampulla >infundibulum > fimbriae

ampulla is longest and most tortuous segment (ectopics)

Question 31

How is ovarian volume calculated?

Answer 31

L x W x H x 0.5233

Question 32

Ovarian masses that can look like a pedunculated uterine fibroid include

Answer 32

Thecoma
Fibroma
Granulosa cell tumor