ovarian cysts and PCOS

Question 1

what is the functional unit of the ovary? remember basic structure

Answer 1

oocyte surrounded by granulosa cells. then theca cells around that. LH hits theca cells- they make androgens. FSH allows androgens to be converted to estadiol, which bathes the oocyte.

Question 2

What is a hemorrhagic cyst?

Answer 2

hemorrhage into the corpus luteum. benign. cyst grows with increased blood retention. usually self-resolves.

Question 3

follicular cysts

Answer 3

distention of an unruptured graafian follicle. common and benign, but may be associated with hyperestrogenism and endometrial hyperplasia. most common ovarian mass in young women.

Question 4

PCOS: what is it? what is the pathophysiology?

Answer 4

multiple follicular cysts due to a hormone imbalance.
characterized by an increased LH and a low FSH. LH:FSH ratio > 2. incr LH –> theca cells make androgen. androgen goes to blood and cause hirsutism and go to adipose tissue, where it is converted to estrone. pts often obese and make lots of estrone. estrone will feedback to the pituitary and shut down FSH production. without FSH, granulosa cells don’t make estrogen, so follicle degenerates and becomes cystic –> polycystic ovary.
note that sex hormone binding protein will also be low (estrogen wants it to be high, but high insulin and testosterone levels oppose that). some pts have insulin resistance.

Question 5

treatment of PCOS infertility

Answer 5

clomiphene citrate (blocks negative feedback of circulating estrogen, decreases FSL and LH); metformin ( to incr. insulin sensitivity and decrease insulin levels; decr. testosterone will enable LH surge)

Question 6

theca-lutein cyst: presentation, cause, association

Answer 6

often bilateral/multiple. due to gonadotropin stimulation. associated with choriocarcinoma and moles

Question 7

dermoid cyst

Answer 7

mature teratoma: cyst is filled with tissues like fat, hair, teeth, bone, cartilage

Question 8

endometriod cyst

Answer 8

endometriosis within the ovary, with cyst formation. varies with menstrual cycle.

Question 9

describe a schematic for understaning ovarian tumors

Answer 9

3 types of ovarian cells
oocytes: germ cell tumors
support cells (granulosa, theca, fibroblasts): sex cord stromal tumors
sufrace epithelium: surface epithelial tumors
most common adenexal mass in women > 55.