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OBGYN 2 > M2: Ovarian Pathology > Flashcards

M2: Ovarian Pathology Flashcards

1
Q

What are the 2 categories of ovarian masses and their sub groups

A

cystic

  • simple
  • bilateral and multiple

ovarian tumors (the 3 types refer to the layer of the ovary that they arise from)

  • epithelial
  • germ cell
  • sex cord or stromal
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2
Q

describe follicular cysts

what do they develop into

A

normal cysts that develop as a result of stimulation from LH and FSH which cause the ovary to mature the oocyte

develop into corpus luteum after rupture

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3
Q

describe corpus luteal cysts

how do they appear on US

A

a follicular cyst after ovulation

complex appearance, often containing debris due to hemorrhage

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4
Q

when will corpus luteal cysts resolve w/o preg?

with preg?

A

w/o preg: about 8 wks if large

w/ preg: 12-15 wks

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5
Q

what are paraovarian cysts

are they surrounded by ovarian tissue

A

a remnant of embryonic ducts

never surrounded by ovarian tissue (don’t change size with cycle)

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6
Q

do paraovarian cysts produce symptoms

A

not usually

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7
Q

describe urachal cysts

where are they located

A

a remnant of the development of the bladder

located midline, anterior abdo wall b/w the belly button and the bladder

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8
Q

describe omental cysts

where are they located

A

found along the omentum

Usually located higher in the pelvis or abdo

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9
Q

describe theca lutean cysts

A

multiple bilateral cysts caused by excessive hCG

… can undergo hemorrhage, rupture or torsion

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10
Q

theca lutean cysts are associated with which risk factors

A 
multiple gestations
molar preg
choriocarcinoma
hyperstimulation syndrome
fertility drugs
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11
Q

describe PCOS syndrome

A

multiple cysts on the ovaries caused by unopposed estrogen w/ no surge of LH

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12
Q

does ovulation occur w/ PCOS

A

no, many immature follicles never mature or rupture

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13
Q

is there an increased androgen secretion from the ovarian stroma w/ PCOS

A

yes

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14
Q

another name for PCOS

A

stein-leventhal syndrome

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15
Q

symptoms of PCOS

A

obesity
hirsutism (abnorm. growth of hair on face and body)
infrequent menses (oligomenorrhea)
infertility

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16
Q

PCOS can be associated with what type of cancer

A

endo cancer

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17
Q

what is the most extreme form of PCOS called

A

hyperthecosis or thecosis

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18
Q

how is PCOS diagnosed

A

blood work (increased testosterone)

pelvic US are to investigate PCOS but can’t give a definitive diagnosis

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19
Q

how does PCOS appear on US

A

“string of pearls”

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20
Q

ovarian torsion is associated w/ what other pelvic pathology

A

ovarian masses…. is it rare in normal pelvises/ovaries

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21
Q

symptoms of ovarian torsion

A

acute sharp pain

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22
Q

what are the 2 types of ovarian torsion

A

incomplete

complete

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23
Q

describe the US appearance of incomplete ovarian torsion

A

large, edematous ovaries w/ multiple cysts (fluid retention due to congestion)

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24
Q

describe the US appearance of complete ovarian torsion

A

increased or decreased echotexture due to infarct or hemorrhage (depending on when the hemorrhages occurred)

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25
Q

how should you evaluate ovarian torsion

A

use colour and spectral doppler

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26
Q

3 types of neoplastic tumors

A

epithelial tumors
germ cell tumors
sec cord/stromal/connective tissue tumors

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27
Q

7 neoplastic epithelial tumors

A 
serous cystadenoma
serous cystadenocarcinoma
mucinous cystadenoma
mucinous cystadenocarcinoma
endometrioid carcinoma
clear cell carcinoma
brenner's tumor
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28
Q

describe a serous cystadenoma

A

simple cystic tumor, common and benign

may have multiple septations and produces serum (thin fluid)

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29
Q

in what age group does a serous cystadenoma occur

A

menstruating age grp

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30
Q

what is a serous cystadenocarcinoma

A

malignant tumor

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31
Q

what other pathology of the abdo is serous cystadenocarcinoma associated with

A

ascites and enlarged para-aortic lymph nodes

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32
Q

whats the most common malignant ovarian cancer

accounts for what % of ovarian cancers

A

serous cystadenocarcinoma (60%)

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33
Q

describe a mucinous cystadenoma

are they large?

A

benign tumor

low level echoes (mucin) or can be complex…. very large

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34
Q

what is the risk w/ mucinous cystadenomas?

A

they can rupture due to large size

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35
Q

what is a mucinous cystadenocarcinoma

A

rare, malignant mass

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36
Q

what other pathology of the abdo is mucinous cystadenocarcinoma associated with

A

ascites

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37
Q

what is the risk w/ mucinous cystadenocarcinomas?

A

higher risk of rupture than mucinous cystadenomas

risk of pseudomyxoma peritonei which is a large adhesion from the mucin in the ascites

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38
Q

what is a endometrioid carcinoma

are they large

A

a mass that is usually malignant

large (10-15 cm),

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39
Q

in what age group is an endometrioid carcinoma most common

A

menopausal age grp, >60

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40
Q

endometrioid carcinoma is associated w/ what other pelvic cancer

A

endometrial cancer

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41
Q

describe clear cell carcinoma

A

malignant mass that is a variant of endometrioid carcinoma

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42
Q

clear cell carcinoma has an origin from which duct

A

mullerian duct

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43
Q

another name for clear cell carcinoma

A

mesonephroid

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44
Q

describe a Brenner’s tumor

what is its echotexture

A

benign, rare mass

solid

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45
Q

another name for Brenner’s tumor

A

transitional cell tumor

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46
Q

other names for paraovarian cysts

A

cysts of morgagni

paratubular serosal cysts

47
Q

which abdo pathology is commonly seen with hyperstimulation

A

ascited, because the ovaries are leaking fluid into the pelvis and abdomen…. this can cause shock

48
Q

why isnt it common to do aspirations of cystic ovarian masses

A

when the needle is removed, then the cancerous cells are introduced to the pelvis and can easily spread.

49
Q

most common symptom of ovarian cancer

A

bloating

50
Q

which 2 pathologies in the abdo and lungs are highly suspicious for ovarian cancer

A

pleural effusion

ascities

51
Q

why are theca lutean cysts associated w/ multiple gestations

A

more placental tissue, so more hCG

52
Q

is obesity a reliable symptom of PCOS

A

no

53
Q

4 types of germ cell tumors

A

cystic teratoma
solid teratoma
dysgerminoma
endodermal sinus tumor

54
Q

describe a cystic teratoma

what is its characteristic appearance

A

usually benign

containing fat, fluid, calcifications (teeth or hair)
tip of the iceberg appearance

55
Q

in what age group are cystic teratomas more commonly seen

A

usually young females, but affect all age groups

56
Q

what are the risks of a cystic teratoma

A

may undergo torsion

2% may become malignant

57
Q

other names for cystic teratomas

A

mature teratoma

dermoid

58
Q

what is a rokitansky nodule

A

a hyperechoic, discrete and round protrusion w/in a dermoid

59
Q

describe a solid teratoma

A

mass that ranges from benign to highly malignant

60
Q

in what age group are solid teratomas more commonly seen

A

young children and young women

61
Q

another name for a solid teratoma

A

immature teratoma

62
Q

describe a dysgerminoma

A

a rare malignant and highly radio sensitive mass

63
Q

in what age group are dysgerminoma more commonly seen

A

young women

64
Q

what is the male counterpart of a dysgerminoma

A

seminoma

65
Q

dysgerminoma is associated w/ what other cancer

A

choriocarcinoma

66
Q

dysgerminoma produce which hormone

A

hCG

67
Q

what is a choriocarcinoma

A

the malignant form of persistent trophoblastic disease

68
Q

describe an endodermal sinus tumor

A

a malignant, rapid growing tumor

69
Q

w/ endodermal sinus tumors, which lab values will be elevated

A

AFP

70
Q

describe the prognosis and recurrence rate of endodermal sinus tumors

A

poor prognosis, high recurrence

71
Q

another name for endodermal sinus tumor

A

yolk sac tumor

72
Q

sex cord or stromal tumors are made out of what type of tissue

A

connective tissue

73
Q

3 types of sex cord/stromal tumors

A

granulosa cell tumor
sertoli-leydig cell tumor
fibroma and fibrosarcoma

74
Q

describe granulosa cell tumors

A

tumor that is usually benign and produces estrogen

75
Q

what are the symptoms of granulosa cell tumors

A

precocious puberty in children

irregular cycles in adults due estrogen

76
Q

what are the risks associated w/ granulosa cell tumors

A

increased risk of endo cancer

77
Q

describe sertoli-leydig cell tumors

A

usually benign but can become malignant

78
Q

what hormones do sertoli-leydig cell tumors produce

A

androgens

79
Q

symptoms of sertoli-leydig cell tumors

A

masculinization

80
Q

another name for sertoli-leydig cell tumors

A

androblastoma

81
Q

in what age group are sertoli-leydig cell tumors found

A

adolescence

82
Q

describe a fibroma

A

benign tumor

83
Q

in what age group do fibromas occur

A

postmenopausal

84
Q

name for the malignant form of fibromas

A

fibrosarcoma

85
Q

fibromas are associated w/ what syndrome

A

Meigs’ syndrome

86
Q

what is Meigs’ syndrome

A

hydrothorax and ascites w/ an ovarian mass… once the mass is removed the syndrome resolves

87
Q

describe secondary ovarian tumors

A

primary carcinoma of a different organ thats spread (mets) to the ovary

88
Q

are secondary ovarian tumors quite common

A

yes

89
Q

where do secondary ovarian tumors usually originate

A

GI or breast

90
Q

what is a krukenberg’s tumor

A

a bilateral metastatic ovarian tumors that produce mucin (thick ascites)

91
Q

which cancer is the 4th leading cause of death in women

A

ovarian cancer

92
Q

how do most patients w/ ovarian cancer present

A

lots of ascites and 75% present w/ advanced disease (silent killer)

93
Q

risk factors of ovarian cancer

A
  • > 50, specifically 60-70 yrs
  • nulliparous, low parity or delayed childbearing
  • early onset menses or late onset menopause
  • HRT over 10 yrs
  • fam. Hx of ovarian or breast cancer
94
Q

the risk for developing ovarian cancer is directly proportional to what

A

the number of years ovulating and epithelial ovarian cancer

95
Q

which 2 female cancers are strongly associated w/ one another

A

breast and ovarian

96
Q

how much of a higher risk do women who have breast cancer have of developing ovarian cancer

A

2X

97
Q

how much of a higher risk do women who have ovarian cancer have of developing breast cancer

A

3-4X

98
Q

the mutations of which genes increase the risk of breast an ovarian cancer

A

BRCA 1 and BRCA 2

99
Q

the mutations of which genes MAY increase the risk of colon cancer

A

MSH 2 and MLH 1

100
Q

which sonographic signs are more indicative of malignancy in an ovarian mass

A

irregular walls, thick septations, >5cm, ascites, distal mets… look for invasion of other organs, vascularity

101
Q

what antibody in the blood is used to detect ovarian cancer

A

Ca 125… can be helpful to detect recurrence

102
Q

Ca 125 is most sensitive for which types of ovarian tumors

A

nonmucinous tumors

103
Q

where is the epithelium found in the ovary

A

periphery

104
Q

where are the germ cells found in the ovary

A

cortex

105
Q

where is the c-tissue found in the ovary

A

stroma

106
Q

where is mucin usually produced in the body

A

intestinal lining

107
Q

in general, are solid tumors usually indicative of being benign or malignant?

A

malignant

108
Q

will dermoids/cystic teratomas have colour flow

A

no

109
Q

how large does an ovary have to become to increase the risk of torsion

A

4-5cm

110
Q

rokitansky nodules contain mostly which type of tissue

A

sebum

111
Q

which masses have a higher malignant potential, masses that are more or less differentiated?

A

less

112
Q

another name for fibroma

A

adenofibroma

113
Q

another name for granulosa cell tumor

A

thecoma or theca-luteal tumor

OBGYN 2 (15 decks)

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