OB review- ovarian pathology Flashcards
indications for ovarian exam? (4)
- pelvic pain
- pelvic fullness
- palpable mass
- family history of ovarian or brest cancer
what is a functional cyst?,
means that the cyst is ovarian in orgin and responds to cyclic hormonal changes
when do functional cysts occur?
when a dominent follicle fails either to ovulate or regress
what are hemorrhagic cysts?
functional cysts bleeding inside
whats a theca lutein cyst?
functional cysts related to human chorionic honadotropin exposure
what are non-functional cysts?
- refer to cysts that do not respond to cyclic hormonal stimulation
examples of nonfunctional cysts? (3)
- endometriomas
- paraovarian cysts
- peritoneal inclusion cysts
where do paraovarian cysts originate?
from wolffian structures located in the broad ligament
paraovarian cysts usually occur in who? s/s?
- occur in all ages but mostly in mensturating women
- benign
- asymptomatic
- larger cysts may cause symptoms
follicular cyst
hemorrhagic cyst
paraovarian cyst
chocolate cyst refers to?
endometrioma
what type of cyst respond to cyclical hormone changes?
functional cyst
what cyst is caused by adhesions?
peritoneal inclusion
what cyst ruptures about the time of menstruation?
corpus luteal
what cyst contains a dominent follicle that fails to regress?
follicular
what is ovarian torsion?
- occurs when the ovary twist on its pedicle resulting in impaired blood flow to and from the ovary
- requires prompt surgical intervention
compromised arterial perfusion in ovarian torsion can cause what?
the ovary to infarct and necorse
lack of venous drainage in ovarian can cause the ovary to?
enlarge
when does ovarian torsion typicall occur?
in childhood or in reproductive years
what is ovarian torsion associated with?
- mobile adnexa or a preexisting ovarian cyst or mass
clinical symptoms- ovarian torsion? (4)
- severe pain
- nausea
- vomitting
- palpable mass
what is CA 125?
most widely used serum tumor marker for epithelial ovarian cancer is cancer antigen 125
what % of women with stage 1 epithelian ovarian cancer have elevated serum levels?
- 50-60%
benign conditions can elevate serum concentrations of CA 125 T or F?
true
who has the greatest risk of malignant ovarian neoplasm?
postmenopausal
ovarian neoplasms are classified by what?
type of ovarian tissue from which they arise
what are the 3 types of ovarian neoplasms?
- gem cell
- epithelial
- sex cord-stomal tumors
what type of ovarian neoplasm is most common?
germ cell tumors
what are the 2 most common types of ovarian neoplasms?
- benign cystic teratoma
- surface epithelial-serous cystadenoma
germ cell tumors are most commonly found in?
young women
epithelial tumors are more common in?
40-50s
what is a fourth source of ovarian neoplasms?
metastatic ovarian disease
benign cystic teratomas are also referred to as (3)?
- cystic teratomas
- dermoids
- dermoid cysts
what are benign cystic teratomas composed of? (3)
- ectoderm
- mesoderm
- endoderm
what is the most common component of benign cystic teratomas?
ectoderm
germ cells form what? (7)
- teeth
- bone
- skin
- fingernails
- hair
- fat
- sebum
a cystic teratoma commonly contains?
sebum with varying amounts of fat, hair, teeth, and bone fragments
benign cystic teratomas s/s?
- commonly asymptomatic
- abdominal swelling
- pain
- can be bilateral
- slow growth
benign cystic teratomas are prone to?
torsion or rupture
what is tip of the ice burg sign?
- fat/fluid level
- dermoid plug
- dermoid mesh
- obscures entire back wall of the mass because of attenuation
what is Rokitansky noduleordermoid plug ?
- solid protuberence projecting from an ovarian cyst, It often contains calcific, dental, adipose, hair and/or sebaceous components
tip of iceburg sign
what is an ovarian dysgerminoma?
- malignant tumor
- contribute 1%-2% of malignant ovarian tumors
- occur in 20-30 year old women
invasive malignant ovarian tumors discovered during pregnancy are typically what?
dysgerminoma
dysgerminoma s/s?
- abdominal enlargment
- palpable mass
- pain
- mestrual abnormalities
prognosis if dysgerminoma is found early?
- 95% 5-year survival
dysgerminoma
most common ovarian tumor among women 50 years or older?
Epithelial ovarian neoplasms
most common types of spithelial neoplasms?
- serous cystadenoma
- mucinous cystadenoma
- cystadenocarcinoma
- borderline ovarian tumors
- endometrioid tumors
- clear cell tumors
- brenner tumors
- trasitional cell tumors
mose common type of epithelial neoplasm?
- serous tumor
- 50-70% being benign
the benign form of serous cystadenoma occur most frequently in?
40-50 year old
the malignant form of serous cystadenocarcinoma occurs most commonly in?
- perimenopausal or postmenopausal women
serous cyctadenocarcinoma accounts for what % of all malignant neoplasms?
50%
serous cystadenoma
serous cystadenocarcioma on u/s
- exhibit internal papillary projections with thick septations producing multiple locules
what is the most predictable sono feature for malignancy?
cystic mass that contains a solid area with detectable flow on doppler
mucinous tumors vs. serous tumors?
- less common and are usually benign
what is psedomyoxoma peritonei?
Rupture of the tumor capsule may cause spillage of the gelatinous contents into the abdomen
mucinous cystadenoma
endometroid tumor occur mostly in who?
women in their 50’s-60’s
what are endometroid tumors associated with?
- endometrial adenocarcinoma and endometriosis
what % of endometroid tumors are malignant?
80%
what is the seconf most malignant epithelial tumor?
endometrioid tumor
what has a better prognosis endometroid tumors or serous tumors or mucinous cystadenocarcinomas?
endometrioid
brenner tumor aka?
transitional cell tumor
what are brenner tumors?
- benign
- dense fibrous tumors
brenners tumour size?
<2cm diameter
- rarely exceed 10cm
what are brenners tumors associated with?
- ipsilateral cystic neoplasm
- cystadenoma
- teratoma
brenners tumor s/s?
- asymptomatic
- found incidently
Sex cord-stromal tumors arise from?
- sex cords of the embryonic gonad and from the ovarian stroma
Sex cord-stromal tumors on u/s?
solid masses and are hormonally active
most common Sex cord-stromal tumors? (4)
Granulosa cell tumor
Sertoli-Leydig cell tumor (androblastoma)
Fibroma
Thecoma
Granulosa cell tumor function?
- low-grade malignant tumor
- secrete estrogen- thickened endometrium
Granulosa cell tumor occur in?
Occur predominantly in postmenopausal women but can occur in patients younger than 30 years and in children
what can granulosa cell tumors cause?
- excess estrogen
- endometrial carcinomama
- precocious puberty or premature breast development
Sertoli-Leydig tumors aka?
androblastomas
what is a Sertoli-Leydig tumors?
- rare ovarian neoplasm occurring predominantly in menstruating women
Sertoli-Leydig tumors may be?
- hormonally active, producing the androgen testosterone, which results in virilization in about 30% of patients
- occasionally produce estrogen
what is virilization?
development of male physical characteristics
whats a fibroma?
- Fibromas occur most often in perimenopausal and postmenopausal women
- Fibromas consist of fibrous tissue, are not usually hormonally active, and tend to be asymptomatic
what is a thecoma?
- Thecomas contain a variable combination of thecal and fibrous tissue
- Thecomas may show clinical signs of estrogen production
Meig’s syndrome is characterized by?
presence of ascites and a pleural effusion
what is meigs syndrome?
a benign solid ovarian mass, of which fibroma is the most common, causes Meigs’ syndrome
fibroma
thecoma
the most common tumors to metastisize to the ovary are tumors of the?
breast and GI tract
metastatic ovarian neoplasms are usuallr uni or bilateral?
bilateral
metastatic ovarian tumors on u/s?
- complex
- large
- predominantly cystic
- ascites
Krukenberg tumor?
erroneously used as synonymous with any metastatic tumor to the ovary
what is a Krukenberg tumor?
best reserved for tumors containing mucin-secreting signet ring cells, which usually arise from the gastrointestinal tract
metastatic ovarian tumor
