Gynaecology: Ovaries

Question 1

What are follicular/corpus luteum cysts? When do they occur? Symptoms?

Answer 1

Cysts arising from developing ovum

Only occur in reproductive years

Usually asymptomatic but may have pain

often multiple and resolve on their own

Question 2

What is PCOS?

Answer 2

Polycystic ovary syndrome

Young women

SIgns of hyperandrogenism:
Hirtuism
Deepening of voice
Infertility
Amennorrhoea

Question 3

Histology: Multiple follicular cysts on ovary, with associated loss of period, hirtuism, deepening of voice

Answer 3

PCOS

Question 4

Is PCOS a risk of cancer?

Answer 4

Can cause endometrial hyperplasia or endometrial carcinoma

Question 5

What is endometriosis? When does it occur?

Answer 5

Extra-uterine presence of endometrial glands and stroma

Disease of reproductive years, disappears after menopause

Question 6

Common sites of endometriosis

Answer 6

Ovary, pouch of douglas, fallopian tube, peritoneum

Unusal sites: intestine, bladder, lung

Question 7

Symptoms of endometriosis

Answer 7

Pain (may be cyclical)
Abnormal uterine bleeding
Infertility (due to scarring of ovary)

Symptoms depend on site (eg bladder may have haematuria)

Question 8

Explain the retrograde menstruation theory of endometriosis

Answer 8

Instead of going down through cervix, some of the endometrium from menstruation refluxes up through the fallopian tubes

Chief theory

Question 9

Explain coelomic metaplasia theory of endometriosus

Answer 9

Theory is that the mesothelial lining of the peritoneam and abd. cavity can undergo a metaplasia into endometriosis

Question 10

Explain the lymphatic/vascular dissemination theory of endometriosis

Answer 10

Endometriosis spreads by lymphatci or vascular dissemination, explaining rare cases of endometriosis in the lungs

Question 11

Ovarian cancer presenting symptoms

Answer 11

• Non specific
• Pain
• Abdo. uterine bleeding
• Abd. mass
• MALIGNANT ASCITES
• Incidental finding on imaging
• Often advanced at presentation

Question 12

Associations ovarian epithelial tumours (most common) (6)

Answer 12

• Postmenopausal
• Low parity
• Early menarche/late menopause
• Incessant ovulation theory (few children so ovulates more)
• OCPs protect
• BRCA1 and BRCA2

Question 13

Pathogenesis of surface epithelial tumours

Answer 13

Unclear cause, thought to arise from surface epithelium though a very small number arise from endometriosis

Question 14

3 classes of primary epithelial ovarian tumours

Answer 14

Benign
Borderline
Malignant

Question 15

Gross appearance of ovarian tumour

Answer 15

Usually solid and cystic

benign tumours are predominently cystic

malignant are more solid

Question 16

What is a mucinous cystadenoma?

Answer 16

Benign tumour with a single layer of mucin secreting epithelium

Question 17

Histology: Lots of epithelial proliferation with papillary formations but no invasion into underlying stroma

Answer 17

Borderline ovarian tumour

Question 18

What is a mucinous adenocarcioma?

Answer 18

Malignant epithelial mucin secreting ovarian tumour

Question 19

What is a clear cell carcinoma>

Answer 19

Malignant tumour with clear cytoplasm in the tumour cells

Question 20

Stage 1 Ovarian cancer

Answer 20

Confined to one of the ovaries

Question 21

Stage 2 ovarian cancer

Answer 21

Tumour involves the pelvis

Question 22

Stage 3 ovarian cancer

Answer 22

Extends outside pelvis into abdomen

Question 23

Stage 4 ovarian cancer

Answer 23

Distant metastases

Question 24

What stage are ovarian tumours most often picked up?

Answer 24

Stage 3 with 25% FIVE YEAR SURVIVAL

Question 25

Investigations for ovarian cancer

Answer 25

RMI (risk of malignancy index) scoring tool with 3 factors:

1. Menopausal status
2. Serum CA125 tumour marker
3. USS to see if tumour is cystic or solic

Question 26

Treatment for ovarian cancer

Answer 26

• Total abdominal hysterectomy, with removal of tubes, ovaries, and OMENTUM
• Peritonal washings taken for examination

If young woman, consider unilateral salpingo-oophorectomy to preserve fertility

Chemotherapy for anything greater than stage 1C

Question 27

Common sites of primary tumours which spread to the ovaries

Answer 27

Other gynae cancers eg uterus
Colorectum most common
Pancreas
Stomach
Breat

Question 28

Are secondary ovarian carcinoma unilateral or bilateral?

Answer 28

Often bilateral.

Primary tumours can also be bilateral!

Question 29

What are germ cell tumours?

Answer 29

Tumours arising from germ cells in ovary.

Most common is benign cystic teratoma (dermoid cyst)

Malignant germ cell tumours are rare but may occur in young girls

Question 30

What is a teratoma? Can it progress?

Answer 30

Dermoid cyst or benign cystic teratoma. Derived from germ cell layers.

May contain skin, teeth, hair, gut.

Rarely may develop into squamous carcinoma

Question 31

What is an immature teratoma?

Answer 31

More malignant form of germ cell tumour due to immature elements

Question 32

WHat is a yolk sac tumour?

Answer 32

Very aggressive tumour that responds well to chemo

Question 33

What is the serum marker for a yolk sac tumour

Answer 33

serum alpha fetoprotein

Question 34

What is the serum marker for a choriocarcinoma?

Answer 34

Serum HCG

Question 35

What are sex cord stromal tumours? When do they occur? What do they secrete?

Answer 35

Arise from stroma of ovary, uncommon, usually in middle aged females, may secrete hormones and present with hormonal manifestations

Can be benign or malignant

Question 36

Hormonal effects of sex stromal tumours?

Answer 36

Virilisation in a young female
Precocious puberty
Can secrete oestrogen and result in endometrial hyperplasia or an endometrial cancer

Question 37

What is a fibroma?

Answer 37

Benign ovarian neoplasm

Question 38

What is Meigs syndrome?

Answer 38

Fibroma of ovary associated with both ascites and pleural oedema

This will disappear with excision of the BENIGN lesion

Question 39

What is a granulosa cell tumour?

Answer 39

Variant of sex cord stromal tumour

MALIGNANT but low grade, metastasies 20 years later

Usually in middle aged or elderly.

Question 40

What is the seromarker of a granulosa cell tumour?

Answer 40

Inhibin