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Clin Med - Repro > Lecture 17 - Ovarian Disorders > Flashcards

Lecture 17 - Ovarian Disorders Flashcards

1
Q

Ovarian cysts

A

derived from a neoplastic process –growth of tissues –that occurs within the ovary
most arise in the ovary of fallopian tube (para-ovarian cyst)

rarely cancerous in young populations

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2
Q

What lab do you need to run for any women of childbearing age that presents with pelvic pain or irregular bleeding?

A

BhCG

risk of ectopic pregnancy

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3
Q

What is the clinical presentation of people with ovarian cysts?

A

most are asymptomatic

may also cause:
pelvic pain 
-dull/sharp
-constant/intermettent 
pelvic pressure/fullness
painful intercourse
bloating
torsion

adnexal fullness, tenderness

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4
Q

What are the two compartments of ovary?

A

cortex (outer portion)
-follicles/eggs here
medulla (inner potion)

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5
Q

Simple vs complex cyst

A

simple:
- filled with serous/watery fluid
- composed of granulosa cells (SAME cells as follicles)
- Thin walled
- regress spontaneously
- almost always benign
- can reach 5-7cm, typically not much larger

Complex:

  • may be fluid filled: blood, mucous, etc
  • solid component
  • internal debris
  • thick walled
  • sepations
  • papilla
  • typically benign, but should have lower threshold of suspicion (>5cm, >45yo)
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6
Q

Functional cysts

A

arise from normal ovarian function (less common in menopausal women)
resolve spontaneously

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7
Q

Chocolate cysts

A

endometrioma causing a cyst

“ground glass” appearance on US

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8
Q

What causes a cyst in the ovaries?

A

Endometrioma
Theca Lutein Cysts
Medullary and germ cell tumors

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9
Q

Endometrioma

A

cause behind cyst formation

“chocolate cysts”
complex
ground glass appearance on US
ectopic growth of endometrial tissue –more pain on periods

will likely have elevated CA 125

typically does NOT resolve spontaneously

Tx: expectant management (watch and wait)
laparoscopy removal
OCP
Lupron in the form of depo

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10
Q

Elevated CA 125

A

doesn’t always have to mean cancer (tumor marker for ovarian cancer)
can be endometrioma

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11
Q

Theca Lutein Cysts

A 
RARE 
luteinized follicular cysts 
96% bilateral 
seen in pregnancy, molar pregnancy, multiple gestation, ovulation induction, GnRH analogue use, DM 
common denominator HCG

typically resolved after source of HCG is removed

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12
Q

Medullary and germ cell tumors

A

of the ovaries

neoplasia related to gene expression changes that lead to mitosis

these cysts do NOT typically resolve with time and should be monitored or resected

mature cystic teratoma (AKA dermoid cyst)

  • germ cell tumor –> ectodermal, mesoderm, endodermal
  • represents 70% of ovarian neoplasms age 10-30 yo
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13
Q

Immature teratoma

A

= cancer

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14
Q

What is the treatment for mature cystic teratoma?

A

watch and wait (aka dermoid cyst)

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15
Q

Cystadenoma

A

serous and mucinous (typically unilateral)

thin walled –> can initially look similar to simple cyst

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16
Q

What are the different ways to manage a benign cyst?

A

symptomatic treatment
- most cysts resolve spontaneoulsy (within 1-2 menstrual cycles)
NSAIDs, heat

Hormonal treatment
OCP for simple cyst and endometriomas –> prevent new cysts from forming (controversial as to whether or not they will “shrink” the existing cyst)

Surgical management
cyst aspiration
can be accompanied by methotrexate injection (reduce fluid production and recurrence)
laparoscopy –> cysts typically >4-5 cm and causing refractory pain

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17
Q

What are concerning findings of ovarian cysts?

A

high suspicion of malignancy:

  • solid component
  • irregularly thick septations
  • blood flow in solid component (internal blood flow)
  • ascites
  • peritoneal masses, enlarged lymph notes, matted bowel

obtain pelvic MRI and CA-125

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18
Q

70% of malignant ovarian tumors present how?

A

multiocular with solid components

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19
Q

CA-125

A

blood test used to indicate malignancy (biomarker)
expressed in 80% of epithelial cell tumors

does NOT indicate severity of disease

more concerning in postmenopausal women

slight elevations in premenopausal might be nothing, unless its elevated by like 200 –thats a red flag

20
Q

What is the number one gyn malignancy?

A

endometrial cancer

21
Q

What is the second most common gyn malignancy?

A

ovarian cancer
most common cause of cancer death

likely because late stage at diagnosis

22
Q

What is the average age at dx of ovarian cancer?

A

60 y/o

23
Q

Are there any reliable screening tests for ovarian cancer?

A

no

24
Q

Ovarian cancer is a common location for which metastisized cancers?

A

endometrial
breast
colon

25
Q

What causes an increased risk of ovarian cancer?

A 
family hx 
genetic predisposition 
-lynch syndrome 
-BRCA 1/2
delayed childbearing/nulliparous 
early menarche
late menopause
endometriosis
obesity 
E2 replacement for > 5 years
26
Q

What puts you at decreased risk for ovarian cancer?

A 
breastfeeding >18 months 
multiparity 
late menarche 
early menopause
OCP use (5+ year use reduces risk by 40-50%) 
Tubal ligation/hysterectomy
27
Q

What are signs and sxs of ovarian cancer?

A 
abdominal fullness
backpain
constipation
diarrhea
early satiety
fatigue
nausea
pelvic pain 
pelvic mass 
inguinal lymphadenopathy 
weight loss
28
Q

What is the most common type of ovarian cancer?

A

Epithelial cell –85-95%

most common >50yo

29
Q

Stroma cell

A

5-8% of ovarian cancer

2 types:
Granulosa-theca
Sertoli-Leydig –common in adolescence –seen masculinizing d/t elevated testosterone

30
Q

Which type of ovarian cancers are more common in pediatric populations?

A

germ cell tumors

3-5% of all ovarian tumors

31
Q

Ovarian torsion

A

one of the most common gyn emergencies

impede blood supply

sx: SEVERE pain (sharp, stabbing/clociky, radiation)
N/V
low grade fever

Risk factors:
childbearing age –> ovarian cysts (generally >5cm), neoplasms, pregnancy

RIGHT side MC affected

32
Q

What are the sxs of ovarian torsion?

A

SEVERE pain (sharp, stabbing/clociky, radiation)
N/V
low grade fever

33
Q

What are risk factors of ovarian torsion?

A

childbearing age –> ovarian cysts (generally >5cm), neoplasms, pregnancy

34
Q

Which ovary is most likely to be involved in torsion?

A

RIGHT

35
Q

What is the work up for ovarian torsion?

A

HCG, CBC, CMP, TAUS/TVUS with doppler

36
Q

“String of pearls”

A

“string of pears” = multiple small peripheral follicles seen in PCOS

37
Q

What is the treatment for ovarian torsion?

A

de-torsion and ovarian conservation, possibly ovarian cystectomy, possible oopherectomy

rare that you’re able to treat or restore

38
Q

PCOS

A

polycystic ovarian syndrome
aka Stein-Leventhal Sydnrome

6.5-8% of women
MC cause of infertility

ligelong dx

common comorbidities:
obesity 
CV disease
DM2
dyslipidemia
OSA
endometrial carcinoma 
depression/anxiety
39
Q

What is the most common cause of infertility?

A

PCOS

40
Q

Do women with PCOS have high incidences of ovarian cysts?

A

NO

these women do NOT ovulate so they usually do not have ovarian cysts

41
Q

What do you see on US with a pt who has PCOS?

A

not cysts surprisingly

you see an increased number of antral follicles

42
Q

Rotterdam Criteria

A

dx criteria for PCOS

at least 2 needed for dx:
Oligo- and/or anovulation (d/t low progesterone)
Clincial and/or biochemical signs of hyperandrogenism
polycystic ovaries - “string of pearls”

43
Q

What is the treatment for PCOS?

A

goal: help prevent endometrial cancer by putting them on progesterone to shed the lining

Global progesterone keeps their lining thin

Endometrial protection: OCPs, IUD, metformin

Acne:
spironolactone

Hirsuitism:
low androgen OCP, spironolactone

Infertility:
weight loss, metformin, Clomid, ovarian drilling

Insulins resistance and/or hyperandrogenism:
weight loss, metformin

44
Q

A 29y/o G1P1 with regular, 28 day cycles present for scan on cycle day 13. The sonography sends you the images. What hormone levels should you check?

A

Estrogen and LH

since 13th day is right around the time for ovulation

45
Q

A 19yo G0 presents with dull midline/right sided cramping x 1 week. Her menses started 3 days ago and bleeding is light, as usual. She hasn’t tried any OTC analgesics because they usually don’t alleviate her symptoms. She is in a monogamous relationship with 1 partner and occasionally uses barrier contraception, but takes the Plan B morning-after pill the same day if needed. She’s currently not taking any medication and has NKDA. What should be your next step?

A

Pelvic exam and swab for STI and Urine HCG

46
Q

What is the most common type of ovarian cancer?

A

epithelial cell

Clin Med - Repro (18 decks)

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