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MRCOG Gynaecology Part 2 Revision - Hay > Management in ovarian cysts in children and adolescents TOG 2020 > Flashcards

Management in ovarian cysts in children and adolescents TOG 2020 Flashcards

1
Q

What are ovarian cyst common in 1st year of life?

A

Fetal gonadotrophins, material estrogen, placental hCG - follicles produced in ovary.

Most regress spontaneously
Conservative management

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2
Q

What is the most common cause of ovarian cyst in children and adolescents?

A

Simple cyst - 60%
Follicles forms corpus lutum, will resolve spontaneously.

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3
Q

Most common complex cyst in children and adolescents?

Risks associated

A

Mature cystic teratoma (dermoids) 10% BL
- 15% pain/torision
- 1% spont ruptures
- 1.7% risk malignancy transformation

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4
Q

What is a gonadoblastoma? Risk?

A

mixed germ cell tumour that characteristically develops in gonadal dysgenesis, when there is presence of a Y chromosome.

Although benign, it can evolve into a dysgerminoma with malignant features.

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5
Q

Most common malignant ovarian tumour in children and adolescents?

A

Juvenile granulose cell tumours 50% age 6-13yrs.
- 95% unilateral
- >90% survival with surgical resection alone

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6
Q

Common presenting symptoms of Juvenile granulose cell tumours

A

Pseudoprecious puberty - pigmentation breast areola, breast enlargement, vaginal discharge, public hair

  • Secrete oestrogen or androgens
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7
Q

When do malignant
ovarian germ cell tumours present?

A

Mostly 1st 2 decade’s of life. 1.5% all ovarian cancers
(1/3 dysgerminomas, 1/3 immature teratoma, others embryonal tumour, endodermal sinus tumour, choriocarcinoma.

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8
Q

Treatment for malignant
ovarian germ cell (MOGCTs)

A

Multiagent chemotherapy high cure rate
3% risk POF

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9
Q

What is the most common presenting symptoms of ovarian cyst in children and adolescents?

A

Pain (30%)

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10
Q

What is the incidence of ovarian torsion in children and adolescents diagnosed with an ovarian cyst?

A

10.5%

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11
Q

Differentials for abdominal pain in neonates

A

Urinary tract infection

Hirschprung’s enterocolitis

Incarcerated hernia

Intussusception

Meckel’s diverticulum

Volvulus

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12
Q

Differential for abdominal pain in children

A

Appendicitis

Gastroenteritis

Mesenteric adenitis

Ovarian pathology

Pneumonia

Constipation

Urinary tract infection

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13
Q

Which types of cysts can present with Meig’s syndrome?

A

Fibroma
Thecoma
Granulose cell tumour

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14
Q

1st imaging for children and adolescents? 2nd line?

A

Transabdominal USS (if adolescent sexually active can have TVUS)

MRI - but young children require sedation

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15
Q

Sensitivity and specificity of IOTA rules?

A

95% sensitivity
91% specificity

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16
Q

B rules

A

Unilocular
Solid <7mm
Prescence acoustic shadowing
Multilocular tumour <100m
Blood flow absent

17
Q

M rules

A

Irregular solid
ascites
+4 papillary structures
Irregular multilocular solid tumour >100mm
Very strong blood flow

18
Q

What other test to Ix cyst in child/adolescent

A

FBC, CRO
Tumour: AFP, LDH, CA124
Urine supstick (sterile pyuria seen in torsion)
+/- endocervical swan

If precocious puberty - FSH, LH, estradiol, TSH

19
Q

Which ovarian neoplasms can cause a raised AFP?

A

Immature teratoma
Sertoli-Leydig Cell
Yolk Sac tumour
Embryonal carcinoma

20
Q

Which ovarian neoplasms can cause a HCG AFP?

A

Dysgerminoma
Embryonal carcinoma

21
Q

Which ovarian neoplasms can cause a raised LDH?

A

Dysgerminoma
Immature teratoma

22
Q

Which ovarian neoplasms can cause a raised CA125?

A

Epithelial tumour

23
Q

Which ovarian neoplasms can cause a raised CEA?

A

Epithelial tumour

24
Q

Which ovarian neoplasms can cause a raised estradiol?

A

Juvenile granulosa cell tumour?

25
Q

Which ovarian neoplasms can cause a raised testosterone?

A

Sertoli-Leydig Cell tumours

26
Q

Flow diagram for management of ovarian cyst

A
27
Q

Simple ovarian cysts under which size, is not further investigations?

A

<3cm

28
Q

If a cyst is 3-7cm and patient is asymptomatic when should a repeat scan be offered?

A

3 months

29
Q

If a cyst is 3-7cm and patient is symptomatic what additional test should be considered?

A

MRI and tumour markers

30
Q

How much do mature cystic teratomas grow per year?

A

1.8mm/year
If <5cm can be conservatively managed

31
Q

Where is the bladder located in children?

A

Intraperitoneal - care with suprapubic ports

32
Q

What levels should the pneumoperitoneum be kept whilst operating?

A

12-15mmHg for thin adolescents, 8-10mmhg for younger children

33
Q

What is the risk of currency after surgical removal of a mature cystic teratoma

A

10%

34
Q

In torsion, should oophorectomy be performed if the ovary appears necrotic?

A

No - ovarian function has been proven to return in detorsion of blue black ovary

MRCOG Gynaecology Part 2 Revision - Hay (44 decks)

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