Gyne activity questions 5a-6 Flashcards
What is the ultrasound appearance of PCO?
- bilaterally enlarged ovaries (>10mL)
- containing multiple small, 2- to 9-mm follicles (at least 20)
- increased stromal echogenicity
- Ovaries are a rounded shape
- follicles usually located peripherally (“string of pearls”)
What is the classic appearance of a haemorrhagic cyst?
- round
- heterogenous
- well defined
- posterior enhancement
- May occur in all types of functional cysts
- Most frequently seen in corpus luteal cysts
- often accompanied by acute onset of pain
- variable in appearance due to the nature of blood
What is the classic appearance of an acute haemorrhagic cyst?
o usually hyperechoic and may mimic a solid mass
o smooth posterior wall
o shows posterior acoustic enhancement indicating the cystic nature of the lesion.
o Diffuse low-level internal echoes may be appreciated
o although this appearance is more frequently seen in endometriomas
What is the appearance of a haemorrhagic cyst as it haemolyzes?
o reticular-type pattern is demonstrated internally
o intertwining linear internal echoes representing fibrin strands
o should not be confused with septations, which are thicker.
What is the appearance of a haemorrhagic cyst as it retracts?
- concave outer margin with angularity
- compared with a solid mural nodule, which will have a convex outer margin.
- Color Doppler ultrasound will show no flow within the clot
- will demonstrate peripheral vascularity within the cyst wall.
- Care should be taken when assessing for flow in hemorrhagic cysts, because a clot can move and show color without true vascularity.
What questions should you ask yourself when scanning a pelvic mass?
- What neoplasms can I expect at this age? (An adnexal cystic structure may very well look like a functional cyst, but if your patient is 75 years old, it is very unlikely to be a functional cyst!)
- Which ones are the most common?
- Do any of the symptoms point in a certain direction? (Think of the patient with sudden onset dyspareunia. She had the diagnosis of hemorrhagic corpus luteum written all over her clinical history!)
Women who have ovarian carcinoma most commonly present with which of the following symptoms?
Select one:
a. Vaginal bleeding and anorexia
b. Weight loss and dyspareunia
c. Nausea and vaginal discharge
d. Constipation and frequent urination
e. Abdominal distension and pain
(e) Abdominal distension and pain
- 50 percent of women who have ovarian cancer present with abdominal distension
- 50 percent present with abdominal pain.
- Gastrointestinal symptoms, which occur in about 20 percent of affected women, are often secondary to the development of ascites.
- Urinary tract symptoms, caused by the pressure exerted by a rapidly growing mass 15 percent
- and abnormal vaginal bleeding are the initial symptoms of ovarian cancer in 15 percent of affected women.
The following statements about surface epithelial-stromal tumours are true except:
Select one:
a. They arise from the surface epithelium that covers the ovary and the underlying ovarian stroma.
b. There are five categories based on epithelial differentiation: serous, mucinous, endometroid, clear cell and transitional cell.
c. They are almost always malignant.
d. They are the most common ovarian neoplasm.
e. They account for 80-90 percent of all ovarian malignancies.
C
They are almost always malignant.
(they are not)
Serous carcinoma of the ovary can be characterised by all the following statements except:
Select one:
a. It is the most common epithelial carcinoma of the ovary.
b. It is bilateral in approximately half of affected women.
c. They most frequently occur in perimenopausal and postmenopausal women.
d. There is frequently ascites.
e. It is frequently associated with pelvic endometriosis.
(Serous carcinoma is not associated with endometriosis)
The correct answer is E: It is frequently associated with pelvic endometriosis.
True statements about mucinous tumours of the ovary include all the following except:
Select one:
a. They are usually benign.
b. They tend to be bilateral.
c. The tumour can grow to enormous proportions.
d. Rupture of the capsule may lead to pseudomyxoma peritonei.
e. They are the second most common ovarian epithelial tumour.
(Mucinous tumours are less frequently bilateral than their serous counterparts)
The correct answer is B: They tend to be bilateral.
Germ cell tumours include all the following except: Select one: a. Dysgerminoma b. Granulosa cell tumour c. Embryonal carcinoma d. Teratoma e. Endodermal sinus tumour
The correct answer is B: Granulosa cell tumour
True statements about ovarian neoplasms in children include all the following except:
Select one:
a. Ninety percent are malignant.
b. They are most often of germ cell origin.
c. Epithelial tumours are rare in prepubertal girls.
d. Epithelial tumours in prepubertal girls are benign in 90 percent of cases.
e. Tumours of germ cell origin are frequently malignant.
The correct answer is A: Ninety percent are malignant.
Endodermal sinus tumours are characterised by all the following statements except:
Select one:
a. They are rare.
b. They are malignant and have a poor prognosis.
c. They secrete alpha-fetoprotein (AFP).
d. They are diagnosed at the median age of 19 years.
e. They secrete hCG.
Epithelial tumours of the ovary, which are rare in prepubertal girls, are benign in approximately 90 percent of all cases.
The correct answer is E: They secrete hCG.
Which of the following statements regarding cystic teratomas is UNTRUE?
Select one:
a. They account for 15-20 percent of all ovarian neoplasms.
b. 10-15 percent are bilateral.
c. They are virtually always benign but they can undergo malignant degeneration producing a squamous cell carcinoma.
d. They primarily occur in postmenopausal women.
e. They are almost always asymptomatic.
f. They usually contain hair, sebum and fat.
g. They are also referred to as ‘dermoid cyst’.
The correct answer is D: They primarily occur in postmenopausal women.
select the description with which it is most likely to be associated.
Cystic teratoma
A. Frequently associated with virilisation.
B. Can be associated with endometrial carcinoma.
C. Has a low malignancy potential and tends to recur more than five years following the original diagnosis.
D. Primary tumour is from gastric or colonic origin.
E. Most common ovarian neoplasm in the reproductive age group.
F. Large number of signet ring adenocarcinoma cells.
G. Most common ovarian neoplasm in women older than 40.
(E)
Germ cell tumours/Cystic Teratomas are the most common tumours in children and young women. Ninety-five percent of germ cell tumours are benign cystic teratomas.
select the description with which it is most likely to be associated.
Sertoli-Leydig cell tumour
A. Frequently associated with virilisation.
B. Can be associated with endometrial carcinoma.
C. Has a low malignancy potential and tends to recur more than five years following the original diagnosis.
D. Primary tumour is from gastric or colonic origin.
E. Most common ovarian neoplasm in the reproductive age group.
F. Large number of signet ring adenocarcinoma cells.
G. Most common ovarian neoplasm in women older than 40.
(A)
Sertoli Leydig Cell tumours, which represent less than one percent of ovarian tumours, may produce symptoms of virilisation.
select the description with which it is most likely to be associated.
Granulosa cell tumour
A. Frequently associated with virilisation.
B. Can be associated with endometrial carcinoma.
C. Has a low malignancy potential and tends to recur more than five years following the original diagnosis.
D. Primary tumour is from gastric or colonic origin.
E. Most common ovarian neoplasm in the reproductive age group.
F. Large number of signet ring adenocarcinoma cells.
G. Most common ovarian neoplasm in women older than 40.
(B, C)
Granulosa and theca cell tumours often are associated with excessive oestrogen production, which may cause precocious puberty, postmenopausal bleeding or menorrhagia. These tumours are associated with endometrial carcinoma in 15 percent of cases. Because these tumours are quite friable, affected women frequently present with symptoms caused by tumour rupture or intraperitoneal bleeding. They are low-grade malignancies that tend to recur more than five years after the initial diagnosis.
select the description with which it is most likely to be associated.
(d) Krukenberg’s tumour
A. Frequently associated with virilisation.
B. Can be associated with endometrial carcinoma.
C. Has a low malignancy potential and tends to recur more than five years following the original diagnosis.
D. Primary tumour is from gastric or colonic origin.
E. Most common ovarian neoplasm in the reproductive age group.
F. Large number of signet ring adenocarcinoma cells.
G. Most common ovarian neoplasm in women older than 40.
(D, F)
Krukenberg’s tumours are typically bilateral solid masses of the ovary that nearly always represent metastasis from another organ usually the stomach or colon. They typically contain ‘signet-ring’ cells.
