Green–top Guideline No. 62 Management of Suspected Ovarian Masses in Premenopausal Women Flashcards
What is an Endometrioma ?
Endometriomas, also known as chocolate cysts, are a type of ovarian cyst caused by endometriosis.
What percentage of woman will have surgery due to an ovarian mass in their lifetime ?
10%
What are ovarian germ cell tumours ?
Ovarian germ cell tumors (OGCTs) are a rare group of ovarian neoplasms that arise from primitive germ cells of the ovary. They account for 5–10% of all ovarian tumors but are more common in young women and adolescents, with the majority being benign
What is the most common type of germ cell tumour ?
Mature Teratoma (Dermoid Cyst) – The most common germ cell tumor (95% of cases), containing elements from all three germ layers. Are benign.
Name three aggressive germ cell tumours
Immature Teratoma (contains immature neural tissue, more aggressive).
Yolk Sac Tumor (produces α-fetoprotein [AFP], aggressive).
Choriocarcinoma (produces β-hCG, rare and aggressive)
What is the most common malignant germ cell tumour ?
Dysgerminoma (most common malignant OGCT, sensitive to chemotherapy, associated with gonadal dysgenesis) associated with high LDH levels
What are signs and symptoms of ovarian malignancy ?
persistent abdominal distension, appetite change including increased satiety, pelvic or
abdominal pain, increased urinary urgency and/or frequency
In which other conditions can a CA-125 be raised ?
fibroids, endometriosis, adenomyosis and
pelvic infection.
What are the three main types of ovarian malignancy in order of highest prevalence ?
Epithelial in the most common accounting for 90% of case, epithelia tumours include serous,mucinous, endometroid and clear cell, their marker is CA-125 but is only raised in 50% of early cases
Then we have germ cell tumours with account for 5-10% these are yolk sac (AFP), dysgerminoma (LDH), immature teratoma and choirocarcioma(HCG), associated with younger patients
Of similar prevalence we have sex cord stromal tumours these are granulosa cell tumours (E2 and inhibit), sertoli - leydig cell tumours (testosterone) and fibroma which can cause miens syndrome
Name two very rare random ovarian maligancies
Metastatic Tumors (Krukenberg Tumor) – Bilateral ovarian masses from GI cancer (signet-ring cells, usually gastric cancer).
Small Cell Carcinoma of the Ovary – Highly aggressive, seen in young women.
How do you calculate the RMI ?
RMI I combines three presurgical features: serum CA-125 (CA-125); menopausal status (M); and ultrasound score (U).
How is ultrasound scored ?
The ultrasound result is scored 1 point for each of the following characteristics:
multilocular cysts
solid areas,
metastases
ascites
bilateral lesions
What are the B rules ?
🌿 B-Rules (Benign): “US-SAN”
Think of a “US-SAN” (ultrasound sanctuary) where everything is calm and benign.
🔹 U – Unilocular cyst (simple, no solid parts)
🔹 S – Shadows (acoustic shadows, e.g., dermoid)
🔹 S – Small solid part (<7mm)
🔹 A – Avascular (Color Score 1)
🔹 N – Non-thickened multilocular cyst (≤10 cm)
What are the M Rules ?
⚠️ M-Rules (Malignant): “IR-PAIN”
Think of “IR-PAIN” (Irregular Pain = Malignancy)
🔺 I – Irregular solid tumor
🔺 R – Really big (>10 cm, multilocular-solid)
🔺 P – Papillary projections (≥4 protrusions)
🔺 A – Ascites (free fluid in abdomen)
🔺 I – Intense blood flow (Color Score 4, high vascularity)
🔺 N – Not smooth (Irregular borders)
What are we doing with simple cyst 50-70mm
Yearly US
