Exam #3 Flashcards
Land mark used to find the ovary
The common iliac vessels - the Ovaries will typically be found in the anexa, medial to these vessels
Sonographic features that a mass is more indicative of benign disease processes
Fluid filled, anechoic, thin well defined wall
Sonographic features that a mass is more indicative of malignant disease
Solid, complex, thick irregular walls/ septation.
Simple cyst sonographic findings
- Anechoic
- Thin walled
- Round/oval
- Sharp margins
- Increased through transmission (ETT)
Benign cyst are also known as _______ and are hormonally active cysts that usually result from stimulation of released ________.
- Functional cysts
- Pituitary gonadotropins (hormones of the female cycle)
Dominant follicle vs cyst
Dominant follicles measure <3cm and Cysts measure >/= 3 cm
Corpus luteum
- Will release progesterone.
- This is the dominant follicle after it releases the egg.
- The ring of fire (increased blood flow) can be see when color is turned on.
- Will be considered a cyst if >3cm.
- If pregnancy occurs the corpus luteum should resolve wby 16 wk gestation.
Follicular Cyst
- Sonographic apperance
- >3cm
- Anechoic
- ETT
- Smooth borders
- (<1cm = normal follicle, 1cm to <3cm = dominant follicle)
- Symptomatic with the occurrence of:
- Hemorrhage - will find fluid in the posterior cul-de-sac
- Torsion
- Rupture
Polycystic Ovary disease
or
Polycystic Ovarian Syndrome (PCOS)
- Also known as?
- Caused by?
- Appearance?
- Common patient findings?
- Also known as STEIN-LEVENTHAL SYNDROME
- Benign- Caused by Endocrine disorder- hormonal imbalance (LH/FSH)
- Bilateral, large ovaries with multiple, tiny cysts (string of pearls around the peripheral)
- Common patient findings
- Obesity
- Amenorrhea
- Anovulation
- Hirsutism
- Infertility
Hemorrhagic cyst
-Symptoms; acute onset of pain -Appearance dependent on age - Acute Anechoic - Late acute Solid mass - Resolving Complex mass
Theca Lutein cyst
- -Functional cyst caused by increased levels if hcg (hormonal)
- -Largest of the functional cyst. 3cm to 20cm.
- -Bilateral enlarged ovaries with multiple septated cysts
- -Associated with gestational trophoblastic disease
This cyst is Associated with gestational trophoblastic disease.
Theca Lutein cyst
Torsion
- Partial of complete rotation of the overy
- Sonographic apperance;
- doppler exam - look for little to no venous and arterial flow
-
Acute - Enlarged ovary with edema, hypoechoic
- Acute sudden onset of abd pain
- Chronic - more complex, Hyperecoic
Surface Epithelial Tumors
Benign
- Serous Cystadenoma
- Mucinous Cystadenoma
- Transitional Cell or Brenner Tumor
Surface Epithelial Tumors
Melignant
- Cystadenocarcinoma (serous, and mucinous less common)
- Endometroid
- Clear Cell
- Undifferentiated carcinoma
Stromal Neoplasms
(Sex cord)
Benign
- Fibroma
- Thecoma
- Sertoli-Leydig tumor
Stromal Neoplasma
(sex cord)
Malignant
- Granulosa-teca cell tumor
- Androblastoma (Sertoli-Leydig tumor)
Most common systic ovarian tumor
Cystadenomas
Comes from Epithelial tissue
Comes in two forms
- Serous Cystadenoma -
contain thin, serous fluid*; some with thin septations and/or papillary projections; *more common than mucinous.
* unilocular and bilateral 2. Mucious Cystadenoma-
contain thicker mucin; can grow extremely large, 15 to 30 cm, with prominent septations and debris.
Serous vs Mucinous
Cystadenomas
Benign
Epithelil Tumers
- Serous cystadenomas: Benign - contain thin, serous fluid*; some with *thin septations and/or papillary projections; more common than mucinous.
- unilocular and bilateral
- Mucinous cystadenomas: Benign - contain thicker mucin*; can grow extremely large, 15 to 30 cm, with *prominent septations and debris
- Bilateral less than 5% of the time
Brenner Tumors/Transitional cell
-
Benign Solid ovarian tumors from the surface of the epithelium
- Rare, almost always benign
- Often women after age 40
- range from microscopic to 8 cm in diameter
- Sonographic appearance:
- Hypoechoic*, solid masses that may contain *calcifications.
- Mimics alot of other tumors
- Sonographically similar appearance to leiomyoma, thecoma, and fibroma.
Germ Cell Tumors/Neoplasms
Benign
Benign Teratoma
AKA
Cystic teratoma or Dermoid
Germ Cell Tumors/Neoplasms
Malignant
Dysgerminoma
Choriocarcinoma
Dermoid
AKA: Benign Teratomas or Cystic Teratomas
- Most common germ cell tumor
- Benign
- The are composed of derivatives of all three germ layers
- endoderm
- mesoderm
-
ectoderm
- Teratomas can include teeth, hair, bone, fat and glandular tissue.
- Sonographic appearance -
- complex mass, solid with and without shadowing - hair can be seen floating in fluid
- Can mimic bowel gas or feces
- “Tip of the iceberg” sign -a very echogenic anterior component and a posterior shadow – due to the high attenuation of the calcified materials within.
Stromal Tumrors
(Sex cord)
Ovarian Fibromas
- Benign tumor
- Unilateral
- Sonographic appearance
- Solid
- hypoechoic with shadowing
- >5cm
- 50% will have ascites
-
Meig’s syndrome;
-
Triad of symptoms
- Benign pelvic mass
- Hydrothorax
- Ascites
-
Triad of symptoms
Thecomas
- Stromal Tumor (sex cord)
- Benign
- Estrogen-producing, Hypoechoic, solid, ovarian mass
- unilateral
- Can be up to 30cm
- 70% postmenopausal women
- Patinet symtoms may include postmenopasal bleeding
Serous vs Mucinous
Cystadenocarcinoma
Epithelial - Malignant
- Serous
- Irregular borders
- complex
- Think septations
- Ascites
- fastgrowing
- Musunous
- Think with multiple septations
- pseudomyxoma peritonei
Benign Vs Malignant
Fetures
-
Benign
- Fluid-filled structures
- No internal echos
- Smooth walls
- ETT
- Thin septations
-
Malignant
- Increased amount of solid tissue in complex masses
- Irregular walls
- Thick irregular septations
- Cystic masses with papillary projections
- Ascites
Signs and symptoms of ovarin cancer
“Silent killer”
Often not found until advanced stage because symptoms can be vague and non-gynecologic
- Symtoms
- Abdominal bloating
- Fatigue
- GI disturbances
- Urinary symptoms
- Abdominal pain/ pelvic pain
- Menstrual irregularities
Endometrioid Tumor
&
Clear Cell Tumor
Melignent Epithelial Tumors
Most common Malignant Germ Cell Turmer
Dysgerminoma
most common germ cell malignancy
- Occur in younger women (30 years of age)
- Tumor highly radiosensitive, with high survival rate
- US: solid with possible cystic areas
Immature Teratoma
Highly malignant- spreads easily
Stromal Tumors (sex cord)
Granulosa-theca cell tumor
Vs
Sertoli-Leydig Tumor
Granulosa-theca cell tumor
Can produce large amounts of estrogen
Sertoli-Leydig Tumor
Elevated testosteron levels, this causes masculinization
Metastatic disease
(OVARY)
mets to ovary usually from colon (52%),breast (17%), or gastric carcinoma -Krukenberg Tumor (10%)
- Metastatic ovarian carcinomas have an ultrasound appearance of:
- Bilateral enlarged ovaries
- Solid masses
- Can have cystic degeneration form necrotic changes
- Associated ascites
Krukenberg Tumor
most commonly arises from mets from gastric cancer
Stages of ovarian carcinoma
- Stage I -Growth limited to the ovaries
- Stage II -Growth beyond ovaries but limited to true pelvis
- Stage III -Growth beyond the pelvis, superficial liver metastases
- Stage IV -Distant metastases or pleural involvement, liver parenchymal metastases
How Cancer Metastasizes
- Diret
- Peritoneal
- Lymphatic
