L4 - Ovarian Cysts

Question 1

OVUM PRODUCTION

i) what is the most immature stage of production? why do each of these compete to be?
ii) what does the primary follicle develop into?
iii) what remains in the ovary once the ovum has been released? what does this eventually become?
iv) what type of cyst can develop before the egg is released?

Answer 1

i) primordial follicle
- each compete to be a primary follicle

ii) primary follicle > graffian follicle
iii) corpus luteum remains and eventually becomes corpus albicans
iv) follicular cyst

Question 2

OVARIAN CYSTS

i) what % of women of reproductive age have an ovarian cyst?
ii) how does it most commonly present?
iii) what % are benign?
iv) which group of women has a higher incidence of malignancy
v) name three possible symptoms? what effects may it have on the bladder and colon

Answer 2

i) 10%
ii) most commonly presents with acute pain
iii) 90% are benign
iv) higher incidence of malignancy in post menopausal women

v) asymptomatic, pain due to stretching, menstrual disturbance (interferes w hormonal balance)
- pressure on bowel/colon > change in bowel habit

Question 3

WORRISOME SIGNS OF OVARIAN CYSTS

i) over what measurement is a cause for concern in pre menopausal women?
ii) over what measurement is it a cause for concern in post menopausal women?
iii) which imaging modality is used to look at complexity of cysts? give four signs to look for
iv) name four complications of ovarian cysts and explain each

Answer 3

i) pre meno >8cm
ii) post meno >5cm
iii) use USS to look for solid mass, septae within cyst, bilateral, free fluid around (prod by malignancy)

iv) torsion - ovary twists round blood supply
rupture - spontaneous or activity induced
hamemorhage - into the cyst is most common
infection - rare unless bground of appendicitis etc

Question 4

CASE REPORT 1

i) name a possible presenting feature
ii) name two US appearances that wouldnt be cause for concern
iii) what may be seen on abdo exam (2)
iv) what do the symptoms of a ruptured cyst depend on? what effect may blood stained contents have?
v) name two sequale of cyts rupture

Answer 4

i) right iliac fossa pain
ii) no solid component and no divisions
iii) tenderness and guarding

iv) depdend on character of contents
- blood stained can irritate peritoneum

v) peritonitis and pseudomyxoma peritonei (mucus containing cyst)

Question 5

CASE REPORT 2

i) how may a haemmorhagic cyst appear on US?
ii) what is management determined by?
iii) what is a cause for concern in cyst haemmorhage? why?
iv) what may look similar to a haemmorhagic cyst and may present with chronic rather than acute pain?

Answer 5

i) speckled appearance
ii) management is determined by symptoms
iii) cyst haemmorhage out of cyst > blood into abdo can make patient unstable
iv) endometrioma can look similar but has chronic pain rather than acute

Question 6

CASE REPORT 3

i) give four symptoms/signs of ovarian torsion
ii) what is expected to be seen in abdomen? (2) what about WBCs?
iii) what positional location would a mass expected to be seen in torsion?
iv) what type of surgical treatment is usually required?

Answer 6

i) acute abdo pain, nausea, vomiting, tachycarida, high temp

ii) lower abdo guarding and rigidity
- leucocytosis (high WBCs)

iii) high
iv) salpingo-oophorectomy (poss laproscopic)

Question 7

TYPES OF CYST IN THE OVARY

i) which type of cyst may be benign, borderline or malignant? can borderline cysts invade?
ii) what two categories can germ cell cysts be? what are they made of?
iii) name a type of cyst that can be benign/malignant and is found in hormone producing areas of the ovary

Answer 7

i) epithelial
- borderline cysts cant invade

ii) germ cell - benign or malignant
- made of primordial follicles

iii) stromal

Question 8

CASE REPORT 4

i) which type of cyst can arise from germ cells? how is this treated?
ii) name three tumour markers that a malignant germ cell tumour may express?
iii) are GCT slow or rapid growing?

Answer 8

i) dermoid cyst - treat with ovarian cystectomy
ii) AFP, bHCG and LDH
iii) rapid

Question 9

CASE REPORT 5

i) which type of tumour may present with hair recession, hirtuism, clitoromegaly and a mass?
ii) how may periods be affected in this tumour?

Answer 9

i) stromal tumour
ii) amennorhea

Question 10

STROMAL TUMOURS

i) name four symptoms
ii) how may it appear on US? what is the treatment?
iii) what is the most common type? what hormone does it produce?
iv) what is the prognosis

Answer 10

i) hirtuism, clitoromegaly, hair recession, ammenorhea

ii) very vascular and solid
- treat with laparoscopy or laparotomy

iii) granulosa cell tumour
- produces oestrogen

iv) very good

Question 11

EPITHELIAL OVARIAN TUMOURS

i) how is benign/borderline/maligant indicated?
ii) what three things does risk of malignancy index comprise of? what is the threshold for onc referral?
iii) which marker is highly elevated in ovarian cancer? what is its normal level?

Answer 11

i) on US

ii) menopausal status, complexity on US, CA125 marker
- threshold of 25 for onc refer

iii) CA125 elevated
- normal level is 35

Question 12

OVARIAN CANCER AND PROGNOSIS

i) is the prognosis good or poor?
ii) what is the most common site of metastases?
iii) at what stage do most present?

Answer 12

i) poor
ii) omentum
iii) late stage

Question 13

CASE REPORT 6

i) name two surgical treatments for widespread ovarian cancer?
ii) what may also be used upfront to treat?
iii) what does bevacizumab target?

Answer 13

i) resection or debulking
ii) chemotherapy
iii) VEGF

Question 14

SCREENING FOR OVARIAN CANCER

i) is it specific? is there many false positives?
ii) give three inidcations for screening?

Answer 14

i) not very specific and lots of false positives
ii) life time risk, 1st degree relative with ovarian/breast cancer, 2 or more relatives (BRCA mut?)