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Gynaecological pathology & sexual health > Lec7 Ovarian Cysts > Flashcards

Lec7 Ovarian Cysts Flashcards

1
Q

How are the ovaries linked to the uterus?

A

By the ovarian ligament

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2
Q

What is separates the uterus and rectum?

A

The peritoneal pouch - the Pouch of Douglas

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3
Q

From when are the primordial follicles present in a female?

A

Primordial follicles are present in the baby in utero

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4
Q

Name two types of cyst and when they occur

A

Functional cyst - forms in the Graafian follicle stage

Luteal cyst - form in the corpus luteum stage

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5
Q

When women ovulate, they often feel a pain in one side, what is this pain from?

A

When the corpus luteum has breached the capsule and causes injury.

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6
Q

What can happen in a luteal cyst?

A

May have some bleeding - haemorrhage - from it

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7
Q

What are the complications of ovarian cysts?

A
  1. Torsion
  2. Rupture
  3. Haemorrhage
  4. Infection
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8
Q

What must you try to do in an ovarian cyst rupture?

A

Try to manage conservatively if this is appropriate i.e. only if it is not a medical emergency

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9
Q

What is important to consider in a ruptured cyst?

A

The contents of the rupture and how much of it there is

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10
Q

Why is it important to consider the contents of the rupture?

A

Can cause peritonitis
or
pseudomyxoma peritonei

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11
Q

What does adnexum mean?

A

Next to the womb

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12
Q

What must you always remember to do?

A

Do a pregnancy test

CANNOT MISS an ECTOPIC PREGNANCY

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13
Q

What might be causing tenderness in an ovarian cyst haemorrhage?

A

The bleeding likely to cause the pain

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14
Q

What can be the result of untreated ectopic pregnancy?

A

Death

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15
Q

Why are ovaries prone to cyst formation?

A

Because of their dynamic nature

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16
Q

Why does torsion occur?

A

The ovarian arteries (come from high up near the renal arteries) and ovarian ligament make a sort of hammock which the ovaries hang off. The ovarian arteries wrap around the ovary so in torsion the ovary can get twisted and pulled upwards

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17
Q

Name the different cell types in the ovary

A

Germinal epithelium
Germ cells
Stroma

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18
Q

What happens in the germinal epithelium?

A

Most cysts occur from the germinal epithelium

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19
Q

What does the germ cell layer produce?

A

Makes eggs

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20
Q

What does the stroma produce?

A

Hormones

21
Q

What other tissue types can form tumours?

A

Fibrous tissue and fat

22
Q

What is the usual treatment of ovarian torsion?

A

Salpingo-oophorectomy

23
Q

How can most cysts be treated?

A

With conservative management

24
Q

Are most cysts symptomatic or asymptomatic?

A

Asymptomatic - a woman may have cysts that come and go away and not even be aware of it

25
Q

What is the first type of imaging you would do with any presentation of pain in these kind of scenarios?

A

Ultrasound

26
Q

What are the second most common cysts after functional cysts?

A

Benign dermoid cysts

27
Q

What cell type do benign dermoid cysts come from?

A

The germ cell layer

28
Q

What do you test for if you are worried the dermoid cyst might be malignant?

A

Tumour markers e.g.
Beta HCG - raised in germ cell tumours
Alpha lactate dehydrogenase - raised in dysgerminomas

29
Q

What can often be found inside germ cell cysts?

A

Teeth, hair, nails, thyroid tissue, bone because the germ cells make the eggs - make the babies so have the potential to make any cell type in the body

30
Q

What can rupture of a dermoid cyst cause?

A

Peritonitis

31
Q

A pt presents with recent onset of amenorrhoea, hair recession, hirsutism, clitoromegaly and tender mass on left side of pelvis. What is the diagnosis likely to be?

A

A androgen producing tumour

Sertoli-leydig cell tumour most common in this scenario

32
Q

Which cell layer do androgen producing tumours come from?

A

The stroma

33
Q

What is the treatments and prognosis for a stage 1 androgen producing tumour?

A

Treatment is laparotomy of the tumour and prognosis is good because rarely bilateral

34
Q

What are the types of epithelial ovarian tumour possible?

A

Benign
Borderline
Malignant

35
Q

How do you calculate the Risk of malignancy index?

A

RMI = Menopausal status x Ultrasound score x CA125

36
Q

Above what score is deemed cancer?

A

A score of 250 and above

37
Q

Why is USS complexity important?

A

Important but not the be all and end all

If there is high complexity - more septae or more divisions it is more worrying likely to be malignant

38
Q

Out of the cancers limited to the ovary - how many out of ten produce CA125?

A

7/10

39
Q

What is the prognosis of women diagnosed with Epithelial Ovarian Cancer?

A

It is rare

Of those women diagnosed with it - most women won’t survive 5 years

40
Q

Why is there no screening test rolled out nationally?

A

Because can use USS and CA125 but they are not accurate enough to create a nationwide screen - not cost effective - could miss lots of cases or could give lots of false positives

41
Q

Why is epithelial ovarian cancer a silent disease?

A

60-80% women present at an advanced stage
Due to abdominal symptoms or symptoms from distant metastasis
General malaise, weight loss

42
Q

A stage one epithelial ovarian tumour once lifted out you might have cured her: true or false?

A

True - if it is smooth - even if it is heavy - can get really heavy ones weighing 30kg+ but likely to be cured

43
Q

What presentation is harder to get rid of?

A

Cauliflower presentation of the tumour - harder to get all the bits out - more likely to metastasise

44
Q

Why is there an opportunity for several different types of tumours in the ovary?

A

Because of the diversity of the tissue types

45
Q

What is the effect on malignancy with increasing age?

A

Increasing age = increasing malignancy

46
Q

What determines management of a tumour?

A

The type of tumour and stage of disease at presentation

47
Q

When is it more likely that a cure is possible

A

At early stages of the disease

48
Q

What increases chances of malignancy?

A

Increasing age

High complexity of the tumour

49
Q

How common are ovarian cysts presenting in gynae?

A

4th most common cause of gynae admission

Gynaecological pathology & sexual health (1 decks)

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