O&G Written - Ovarian disorders Flashcards
Rotterdam criteria for PCOS
Need 2/3 for Dx
Clinical or lab evidence of high androgens (LH>FSH)
Polycystic ovaries on USS
Clinical features - oligomenorrhoea for 6 months
Management options for PCOS (fertility desired)
Metformin
Clomifene
Gonadotrophins
Letrozole (not licensed)
Laparoscopic ovarian drilling - diathermy/laser therapy
Management options for PCOS (fertility not desired)
COCP
For hirsutism:
Cyproterone acetate (anti androgen)
Spironolactone
Eflornithine = topical anti androgen for facial hair
Metformin
Medical management of endometriosis
Non hormonal: Paracetamol +/- NSAIDs
Hormonal: COCP, implant, IUS
2nd line (or requiring fertility) = refer to secondary care for GnRH analogues e.g. leuprorelin
Surgical management of endometriosis
Laparoscopic ablation/excision
Laser Tx of endometriotic cysts
+ post-op hormonal Tx if not wanting fertility
Hysterectomy + bilateral sapling-oophorectomy (radical)
Types of physiological ovarian cyst
follicular - non rupture of dominant follicle or failure of atresia in non-dominant follicles
corpus luteum - failure of breakdown (after no fertilisation), becomes filled with blood/fluid
Cyst associated with pseudomyxoma peritonei
Mucinous cystadenoma
type of benign epithelial / surface derived cyst
USS features of complex cyst
Multi loculated
Containing solid mass
USS features of simple cyst
Thin walled
Non loculated
<5cm
Management of simple ovarian cyst
Reassurance
Repeat USS in 8 weeks (3 menstrual cycles)
Management of complex ovarian cyst
Tx as malignant until confirmed
Bloods - CA125, AFP, b-hCG (premenopausal women)
Cystectomy
Key features of malignant serous cystadenocarcinoma
Psammoma bodies (collection of calcium_ Often bilateral
Key features of Brenner tumour
Walthard cell rests (benign clusters of epithelial cells)
‘Coffee bean’ nuclei
Most common benign ovarian tumour
Overall = serous cystadenoma
<30yo = (mature cystic) teratoma / dermoid cyst
Key features of (malignant) Dysgerminoma
Secrete beta-hCG and LDH
Hypercalcaemia?
Associated with turner’s syndrome
Key features of (malignant) Dysgerminoma
Secrete beta-hCG and LDH
Hypercalcaemia?
Associated with turner’s syndrome
Key features of Yolk sac tumour
Secrete AFP
Schiller-Duval bodies on histology
Key features of Krukenberg tumour
Mucinous tumour (gastric mainly) metastasised to ovary
80% bilateral
Abdo/pelvic pain
Ascites
Poor appetite
Meig;s syndrome - associated tumour type?
Benign fibroma
Meig’s syndrome - key features
Benign ovarian tumour
Ascites
Pleural effusion
Tx = surgical removal of tumour, drain ascites + pleural effusion
Key features of granulosa cell tumour
Malignant
Produces oestrogen –> precocious puberty or PMB, endometrial hyperplasia
Histology: Call-Exner bodies
Key features of Sertoli-Leydig tumour
Benign
Produce androgens –> hirsutism, amenorrhoea
Associated with Peutz-Jegher syndrome
Initital work up for suspected ovarian cancer
CA-125 for any woman >50yo with many abdo Sx
TV (and TA?) USS
Referral to secondary care if ascites / mass on USS
Components of risk malignancy index
Menopause status
TV USS findings
CA-125
