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MFSRH part 1 > Ovarian cysts > Flashcards

Ovarian cysts Flashcards

1
Q

in post-menopausal women when is a cyst size considered significant and should be reported on imaging?

A

a cyst >= 1cm should be reported anything below this level is considered insignificant and does not need reporting

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2
Q

Describe how the RMI is calculated

A

RMI = risk of malignancy index

RMI = U * M * Ca-125

U= USS score ( 1 feature = 1 score, 2 or more features = 3 points )
M = menopausal status ( pre-menopausal = 1, post menopausal = 3 points)
Ca-125 = level of serum CA-125 level

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3
Q

list the USS features that are used to calculate the RMI score

A

USS features:
1. ascites
2. metastases
3. bilateral
4. multilobulated
5. solid areas

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4
Q

what is the RMI level governed by NICE that suggest high risk of ovarian cancer?

A

> 250

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5
Q

what is the RMI level governed by RCOG that suggests high risk of malignancy?

A

> 200

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6
Q

what is the sensitivity and specificity of RMI at 200

A

78% sensitivity and 87% specificity

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7
Q

what is the sensitivity and specificity of RMI at 250

A

sensitivity = 70% and specificity = 90%

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8
Q

CA-125 considered a highly sensitive and specific test? True or false

A

false - sensitivity and specificity is only 78% (is only raised in epithelial ovarian cancers)

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9
Q

what is CA-125

A

CA-125 is a tumour marker used for epithelial ovarian cancers.
It is an antigen that is derived from epithelial and coelomic and mullerian epithelium

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10
Q

what other conditions can raise Ca-125

A

any condition that irritates the peritoneal lining e.g. TB, ascites, hepatitis, cirrhosis, pancreatitis
peritoneal primary cancers
cancers including lung/ breast and colon cancers
endometriosis, fibroids, PID, acute ovarian torsion or haemorrhage

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11
Q

what can cause decreased levels of CA-125

A

caffeine, hysterectomy, smoking

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12
Q

what is the pooled sensitivity and specificity of CA-125 in differentiating benign from malignant tumours in PMW

A

78% (this is considered low)

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13
Q

in post-menopausal women presenting with an ovarian cyst what tumour markers should be measured?

A

just Ca-125 (no evidence to check LDH, AFP and HCG - these are for germ cell tumours in women <40 years)

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14
Q

describe the IOTA benign rules

A

benign (b) rules are 5 in total:-
1. acoustic shadowing
2. no blood supply
3. unilocular cyst of any size
4. multilocular cyst < 100mm
5. if a solid mass is present <7mm

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15
Q

describe the IOTA malignant rules

A

5 in total:
1. irregular, multilocular cyst > 100mm
2. solid component >7mm
3. at least 4 papillary structures
4. good blood flow
5. ascites

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16
Q

what are the majority of cysts in pre-menopausal women (benign or malignant)

A

benign

17
Q

what does the risk of malignancy cyst increase to as age increases?

A

1 in 1000 aged 30 to 3 in 1000 aged 50

18
Q

describe the appearance of a follicular cyst

A

often unilateral
must be >3cm to be called a cyst, can reach 8-10cm
lined with granulose and theca cells

19
Q

what factors increase the risk of follicular cysts developing

A

linked with more ovulations
- ovulatory induction e.g. tamoxifen
- early menarche/ late menopause
-nuliparity
- GNRH analogues

20
Q

USS imaging describes a unilateral cyst that is thicked wall with a ring of vascularity surrounding the cyst

what type of cyst is being described?
1. follicular cyst
2. granulose cell cyst
3. dermoid cyst
4. corpus luteal cyst

A

4- corpus luteal cyst (with its characteristic ring of fire surrounding it)

21
Q

a 35 year old lady has an USS scan due to experiencing cyclical pelvic pain. The USS describes multiple thick walled homogenous cysts with a ground glass appearance. there is no solid component to the cysts.

what type of cysts are being described?
A- FOLLICULAR CYST
B- DERMOID CYST
C- ENDOMETRIOMAS
D- YOLK SAC CYST

A

c - Endometriomas

22
Q

what is the most common type of cyst that develops in molar pregnancy

A

theca lutein cyst

23
Q

what are the difference between serous cystadenomas and mutinous cystadenomas

A

serous cystadenomas are usually unilocular, can be bilateral in up to 30% of cases

mucous cystadenomas are usually multi-locular, unilateral and grow extremely large

24
Q

what type of epithelium is found in a brenner tumour

A

transitional epithelium

25
Q

USS demonstrates a yellow-grey and white solid tumour . Histology demonstrates the presence of transitional epithelium.

What type of cyst does this demonstrate?

A- FOLLICULAR CYST
B- MATURE TERATOMA (DERMOID CYST)
C- GERM CELL TUMOUR
D- BRENNER TUMOUR

A

Brenner tumour

26
Q

what is the most common type of germ cell tumour

A

mature teratoma (dermoid cyst)

27
Q

describe the appearance of a mature teratoma (dermoid cyst)

A

This is often a benign cyst
- can consist of all three embryological layers e.g. ectoderm, mesoderm and endoderm
- USS appearance - calcification can be visible, fluid level, distal acoustic shadowing, distinct nodule called Rokitansky nodule (represents hair in fluid)

28
Q

what age group do mature teratomas (dermoid cysts) often present in?

what is a concern with their presence?

A

reproductive age group, high risk of torsion

29
Q

what is the most common type of malignant germ cell tumour?

A- MATURE TERATOMA (DERMOID CYST)
B -DYSGERMINOMA
C-IMMATURE TERATOMA
D- ENDODERMAL SINUS TYMOURS

A

b - dysgerminoma (this is an undifferentiated type of GCT)

30
Q

how can germ cell tumours be classified

A

differentiated and undifferentiated

  • most of GCT are differentiated
  • dysgerminoma is undifferentiated
31
Q

what blood tests should be done to rule out a GCT

A

hCG, alpha fetaprotein, LDH (note LDH recommended in US guidelines but not UK)

32
Q

name the types of differentiated GCT

A
  1. mature teratoma (dermoid cyst) - most common benign GCT
  2. endodermal sinus tumours (previously called yolk sac tumour)
  3. choriocarcinoma
  4. immature teratoma
33
Q

USS scan describes a vary large, vascular lobulated adnexal mass with irregular internal echogenicity.

The patient is 20 years old. bloods demonstrate raised hCG and LDH.

Histology demonstrates sheets of nests uniform cells with clear or eosinophilic cytoplasm and distinct cell membranes

what type of cyst is being described?

A

dysgerminoma

MFSRH part 1 (20 decks)

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