Module 2 : Ovarian Pathology Flashcards
two main categories for cystic ovarian masses
- simple
- bilateral and multiple
5 types of simple cystic ovarian masses
- follicular
- corpus lute
- paraovarian
- omental
- urachal
3 types of bilateral and multiple cystic ovarian masses
- theca lutean
- polycystic ovaries
- ovarian torsion
follicular cysts characteristics
- LH and FSH stimulates the ovary to mature the oocyte
- follicle grows a lot in 10 days
- normal
- evolve into corpus luteum after rupture
corpus luteum cysts characteristics
- term after ovulation
- odd shape
- 1 - 10 cm
- often debris within
- if large resolve in 8 weeks without pregnancy
- resolve 12-15 weeks with pregnancy
perisitent cysts
- follicular or corpus luteum
- may grow quite large before rupture
- may cause pain
paraovarian cysts characteristics
- remnants of embryonic ducts
- aka cysts of morgangi, para tubular, surosa cysts
- thin walls arising form mullerian wall
- NEVER SURROUNDED BY OVARIAN TISSUE
- do not change with cycle 1-4cm
- asymptomatic
urachal cyst characteristics
- located midline anterior and wall between umbilicus and bladder
- remnant of development of bladder
omental cysts characteristics
- located in higher pelvis or abdomen
- along the omentum
theca lutean cysts characteritics
- multiple bilateral cysts
- can be very large
- might undergo hemorrhage, rupture to torsion
4 other pathology associated with theca lutean cysts
- multiple gestation
- molar pregnancy
- choriocarcinoma
- hyperstimulation syndrome
which hormone causes theca lutean cyst to occur
- excessive amounts of HCG
polycystic ovarian syndrom PCOS
- steiqn-levinthal syndrome
- 20-30 years
- unopposed estrogen with no surge of LH
- increased androgen secretion from stroma
- many small immature follicles
- ovulation does not occur
PCOS symptoms
- obesity
- hirsutism
+ increased androgens - infrequent menses
+ oligomenorrhea - infertility
- pre cursor to type 2 diabetes
what other disease is PCOS associatied with
- endometrial cancer
what is the most extreme form of PCOS called
- hyperthecosis or thesis
PCOS diagnosis
- blood work
+ increased testosterone
PCOS sonographic appearance
- slightly enlarged ovaries with multiple SMALL cysts around periphery
- string of pearls
ovarian torsion symptoms
- acute sharp pain
- associate with ovarian masses
incomplete ovarian torsion
- large edematous ovaries
- multiple cysts
complete ovarian torsion
- increased or decreased echo texture due to infarct or hemorrhage
ovarian torsion ultrasound
- evaluate with color and spectral doppler
- early diagnosis could save ovary
3 types of neoplastic tumors
- epithelial tumors
- germ cell tumors
- connective tissue (stromal) tumors
7 types of epithelial tumors
- serous cystadenoma
- serous cystadenocarcinoma
- mucinous cystadenoma
- mucinous cystadenocarcinoma
- endometroid
- clear cell carcinoma
- brenners tumor
serous cystadenoma
- simple cystic tumor
- menstrauting age group
- common and BENIGN
- thin walls
- variable size
- may have septation
- serous means serum producing = thin fluid
serous cystadenocarcinoma
- may be cystic with irregular texture and walls
- ASCITES
- large >10cm
- look for paraaortic nodes
- MOST COMMON MALIGNANT OVARIAN CANCER
mucinous cystadenoma
- BENIGN
- unilateral cystic mass with low level echoes or complex
- very large
- may rupture
- comprised mostly of mucin producing cells
mucinous cystadenocarcinoma
- rare compared to benign
- MALIGNANT
- complex with AASCITES
- greater chance of rupture
- risk of PSEUDOMYXOMA PERITONEI
+ massive adhesions from mucin in the ascites
endometroid carcinoma
- usually MALIGNANT
- menopausal age
- large
- complex or solid
- associated with endometrial cancer
clear cell carcinoma
- aka mesonephroid, mullerian duct origin
- COMPLEX MASS
- MALIGNANT
- variant of endometroid carcinoma
brenners tumor
- akak transitional cell tumor
- rare
- BENIGN
- SOLID
- unilateral
4 types of germ cell tumors
- cystic teratoma (dermoid)
- solid teratoma
- dysgerminoma
- endodermal sinus tumor (yolk sac tumor)
cystic teratoma
- aka mature teratoma or dermoid
- usually BENIGN (can become malignant)
- predominantly complex with fat/fluid levels, calcifications (teeth or hair)
- tip of the ice berg appearance
- all ages
- may undergo torsion
- NO COLOR FLOW
rokitansky nodule
- very hyperechoic discrete rounded protuberance within the dermoid
solid teratoma
- aka immature teratoma
- increased risk of becoming malignant
- benign to HIGHLY MALIGNANT
- solid mass with complex internal echoes
dysgerminoma
- rare
- found in young women
- solid
- MALIGNANT AND RADIOSENSITVE
- male counterpart is seminoma
- associated with choriocarcinoma
- ## INCREASED HCG
endodermal sinus tumor
- also called yolk sac tumor
- MALIGNANT
- rapid growth
- solid
- poo prognosis with high recurrence
- INCREASED AFP
4 types connective cell tumors
- aka sex cord or stromal tumors
- granulosa cell tumor
+ theca luteal cell tumor
+ thecoma - sertoli-leydig cell
+ androblastoma or arrenoblastoma - fibroma and fibrosarcoma
granulosa cell tumor
- solid
- usually BENIGN
- produces ESTROGEN
- precocious (early) puberty in children
- irregular cycle in adults
- increased risk of endo cancer
sertoli - leydig tumor
- aka androblastoma
- adolesence
- produces ANDROGENS - masculine
- solid and unilateral
- small amount become MALIGNANT usually BENIGN
fibroma and fibrosarcoma
- BENIGN = fibroma MALIGNANT = fibrosarcoma
- unilateral
- postmenopausal
- solid like fibroud
- ASSOCIATED WITH MEIGS SYNDROME
meigs syndrome
- hydrothorax and ascites with an ovarian mass but once mass is removed syndrome resolves
secondary ovarian tumors
- primary carcinoma of different organ with mets to ovary
- common
- ## usually from GI or breast
krukenberg tumor
- bilateral metastatic ovarian tumors that produce mucin
- large complex masses
ovarian cancer facts
- 4th leading cause of death
- silent killer
- older age gourps
- increase when nulliparous or low parity
- delayed child bearing
- early onset of meses
- late menopause
- HRT
- family history
- direct relation to number of year and epithileal ovarian cancer
ovarian cancer and breast cancer
- strong association with each other
BRCA 1 and BRCA 2
- mutation of these genes increase risk of ovarian and breast cancer
MSH 2 and MLH1
- associated with colon cancer
ultrasound role with cancer
- if any pelvic abnormality seen you should to EV
- look for irregular walls, thick speciation, size (>5cm worrisome), ascites, distal mets
- check is mass is fixed or invading other organes
- doppler
blood work of cancer
- Ca125 antibody used to detect ovarian cancer
- helpful for detecting recurrance
- most sensitive are nonmucinous tumors
CHEETAH
- acronym for masses that look similar C - cystadenoma H - hemorrhagic cyst E - ectopic E - endometrioma T - teratoma A - abscess H - hydrosalpinx
