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Year 2 RE > Ovarian Cysts- Benign and Malignant > Flashcards

Ovarian Cysts- Benign and Malignant Flashcards

1
Q

The peritoneum is a continuous membrane which lines the abdominal cavity and covers the abdominal organs (abdominal viscera). This folds over the uterus forming what ligament?

1 - broad ligament
2 - round ligament
3 - ovarian ligament
4 - suspensory ligament

A

1 - broad ligament

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2
Q

The peritoneum is a continuous membrane which lines the abdominal cavity and covers the abdominal organs (abdominal viscera). This folds over the uterus forming the broad ligament. This can be further divided into 3 mesenteries, which are folds of a membrane that attaches organs to the abdominal wall and holds it in place as well as allowing blood vessels, nerves and lymphatics to pass through. Label the 3 mesentaries of the broad ligament and what each covers using the labels below:

  • mesovarium
  • mesosalpinx
  • mesometrium
A 
1 = - mesosalpinx = uterine tubes 
2 = - mesometrium = uterus
3 = mesovarium = ovaries
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3
Q

Which ligament suspends the ovaries medially?

1 - broad ligament
2 - round ligament
3 - ovarian ligament
4 - utero-ovarian ligament

A

4 - utero-ovarian ligament

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4
Q

Which ligament connects the ovaries to the pelvic sidewall?

1 - broad ligament
2 - round ligament
3 -suspensory ligament
4 - utero-ovarian ligament

A

3 -suspensory ligament

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5
Q

Why is the suspensory ligament particularly important?

1 - provides important structural support to the side walls of the pelvis
2 - contains the all the pelvic lymph nodes
3 - contains the blood vessels and nerves of the ovaries
4 - contains the blood vessels and nerves of the uterus

A

3 - contains the blood vessels and nerves of the ovaries

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6
Q

Which artery is the primary blood source to the ovaries and what does this branch off?

1 - ovarian artery branches of common iliac artery
2 - ovarian artery branches directly from the external iliac artery
3 - ovarian artery branches directly from the aorta
4 - ovarian artery branches directly from the internal iliac artery

A

3 - ovarian artery branches directly from the aorta

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7
Q

What veins drain the blood from the ovaries?

A
  • right ovarian vein

- left ovarian vein

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8
Q

The right and left ovarian veins drain the ovaries. Where does each vein drain into?

A
  • left = drains into left renal vein

- right = drains into inferior vena cava

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9
Q

Label the ovary and all the aspects including follicles and oocytes using the labels below:

follicular fluid
mature graafin follicle
ovarian stroma
zona pellucida
mature ovum
primordial follicle
primary follicle
theca cells
vein
artery
antrum
corpus albicans
developing corpus luteum
corpus luteum
space filled with blood
A 
1 = primordial follicle
2 = primary follicle
3 = theca cells
4 = antrum
5 = follicular fluid
6 = mature ovum
7 = mature graafin follicle
8 = ovarian stroma
9 = zona pellucida
10 = artery
11 = vein
12 = developing corpus luteum
13 = space filled with blood
14 = corpus luteum
15 = corpus albicans
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10
Q

What can we see in the image below?

A
  • ovaries with follicle development
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11
Q

What is an ovarian cyst?

A
  • a fluid fill sac in the ovaries
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12
Q

Ovarian cysts are fluid fill sacs in the ovaries. There are 2 classes of them, which are?

A

1 - functional ovarian cyst

2 - neoplastic cysts

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13
Q

What is a functional ovarian cyst?

A
  • a physiological cyst formed during normal follicular/luteal stages of development
  • could be a dominant follicle that does not rupture in ovulation and continues to grow (could be no LH)
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14
Q

What is a an adnexal mass?

1 - mass in ovaries or fallopian tubes
2 - mass at the fundus of the uterus
3 - mass at the sides of the uterus
4 - mass at the cervix

A
  • 1 - mass in ovaries or fallopian tubes

- adnexal refers to appendages

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15
Q

What % of women develop at least one pelvic mass in their lifetime?

1 - 20%
2 - 40%
3 - 60%
4 - 80%

A

1 - 20%

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16
Q

How many different types of ovarian cysts are there?

A
  • > 30 types
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17
Q

When deciding on the management of an ovarian cyst what 3 things must we consider?

A 
1 = characteristics of the lesion
2 = age of the patient
3 = risk factors for malignancy
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18
Q

What happens to the majority of ovarian cysts?

A
  • benign and self resolve
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19
Q

The majority of ovarian cysts are benign and self-resolve. At what age are ovarian cysts more common?

1 - as soon as they begin puberty
2 - from birth
3 - reproductive years
4 - menopause

A

3 - reproductive years

- ovarian cycles are most active in this time

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20
Q

The majority of ovarian cysts are benign and self-resolve and are most common during a woman’s reproductive years. If a post-menopausal women has a suspected cysts, what should she receive?

1 - estrogen
2 - progesterone
3 - follow up with a specialist
4 - ultrasound

A

3 - follow up with a specialist

- high risk of malignancy in post-menopausal women

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21
Q

Although ovarian cysts are generally benign, they can lead to complications. What are the 4 most common complications?

A

1 - pelvic pain
2 - cyst rupture
3 - blood loss
4 - ovarian torsion

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22
Q

Women can develop functional and non-functional cysts. Are they both dangerous?

A
  • functional = generally benign

- non-functional = can develop into malignancies and complications

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23
Q

What is the difference between a simple and mixed cyst?

A
  • simple = fluid filled cysts

- mixed = can be fluid and solid, or completely solid

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24
Q

Cysts can be simple or mixed cysts:

  • simple = fluid filled cysts
  • mixed = can be fluid and solid, or completely solid

Which is more dangerous?

A
  • mixed cysts are more likely to become malignant
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25
Q

What is the MOST important independent risk factor for developing ovarian cysts?

1 - age
2 - previous contraception
3 - ethnicity
4 - previous cysts

A

1 - age

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26
Q

What are some of the most common risk factors for developing ovarian cysts?

A
  • infertility treatment
  • tamoxifen
  • pregnancy
  • hypothyroidism
  • maternal gonadotropins
  • smoking
  • tubal ligation sterilizations
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27
Q

Infertility treatment is a known risk factors for developing ovarian cysts, why?

A
  • induces ovulations in an attempt to become pregnant

- any ovulation increases the risks of ovarian cysts

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28
Q

Why is it difficult to identify the prevalence of ovarian cysts?

A
  • most women don’t have any symptoms so don’t know they have them
  • normally a random finding in an examination
29
Q

In the follicular development of the menstrual cycle, which hormone is key for the development of follicles?

1 - LH
2 - FSH
3 - testosterone
4 - oestrogen

A

2 - FSH

- also drives the formation of the dominant follicle

30
Q

Which hormone is key for driving ovulation?

1 - LH
2 - FSH
3 - testosterone
4 - oestrogen

A

1 - LH

31
Q

There are functional and non-functional cysts. There are 3 types of functional cysts, what are they?

1 - follicular, corpus luteum, theca letein
2 - follicular, PCOS , theca letein
3 - chocolate, corpus luteum, theca letein
4 - follicular, corpus luteum, PCOS

A

1 - follicular, corpus luteum, theca letein

32
Q

Follicular cysts can grow and become >2.5cm in diameter. These follicular cysts contain granulosa cells. What do granulosa cells secrete which is able to decrease the frequency of menstruation (normal vaginal bleeding)?

A
  • estrogen
  • excess estrogen produced by follicular cells leads to decreased frequency of menstruation
  • decreased frequency of menstruation = increased risk of follicular cysts
33
Q

If pregnancy doesn’t occur, what is the general life span of the corpus luteum?

1 - 5 days
2 - 10 days
3 - 14 days
4 - 21 days

A

3 - 14 days

34
Q

If an egg is fertilised the corpus luteum will continue to produce progesterone for how long?

1 - 4 weeks
2 - 8 weeks
3 - 12 weeks
4 - 14 weeks

A

4 - 14 weeks

35
Q

Generally the following occurs with the corpus luteum:

  • fertilised egg = corpus luteum last up to 14 weeks
  • non fertilised egg = corpus luteum lasts 14 days

If the corpus luteum does not dissolve (disappear) what form of cyst can this form?

1 - follicular
2 - corpus luteal cyst
3 - theca letein
4 - chocolate

A

2 - corpus luteal cyst

36
Q

Corpus luteal cysts can grow to around 3cm, are they common?

A
  • yes
  • always occur in pregnancy, but resolve by 1st trimester
  • normally asymptomatic and resolve without treatment
37
Q

If there is an overproduction of human chorionic gonadotropin (hCG) levels, what kind of cyst can this lead to?

1 - follicular cyst
2 - theca lutein cyst
3 - haemorrhagic cyst
4 - paraovarian cyst

A

2 - theca lutein cyst

38
Q

If there is an overproduction of human chorionic gonadotropin (hCG) levels, a theca lutein cyst can form. Who is this most likely to occur in?

A
  • Pregnant women
  • Gestational trophoblastic disease
  • Multiple gestation
  • Ovarian hyperstimulation
39
Q

What are neoplastic cysts?

A
  • cysts arising from inappropriate overgrowth of cells within the ovary
  • can be malignant or benign, but more likely to be malignant
40
Q

There are 3 types of benign neoplastic cysts, what are they?

1 - serous, mucinous, PCOS
2 - PCOS, mucinous, cystadenomas
3 - serous, mucinous, cystadenomas
4 - serous, PCOS, cystadenomas

A

3 - serous, mucinous, cystadenomas

41
Q

There are 3 types of benign neoplastic cysts, serous, mucinous, cystadenomas. Malignant cysts are able to arise from all ovarian subtypes, but mostly from surface epithelium. Once of these is a teratoma cyst. What is this?

A
42
Q

There are 3 types of benign neoplastic cysts, what are they?

1 - serous, mucinous, PCOS
2 - PCOS, mucinous, cystadenomas
3 - serous, mucinous, cystadenomas
4 - serous, PCOS, cystadenomas

A

3 - serous, mucinous, cystadenomas

43
Q

What is a teratoma, also called a dermoid cysts?

A
  • a rare type of germ cell tumour
  • may contain immature or fully formed tissue, including teeth, hair, bone and muscle
  • generally includes tissue from each of the trilaminer germ disc layers
44
Q

A teratoma, also called a dermoid cyst, is a rare type of germ cell tumour. It may contain immature or fully formed tissue, including teeth, hair, bone and muscle. What is a teratoma cyst?

A
  • cyst that forms containing a teratoma

- can contain all 3 layers of trilaminar disc

45
Q

A teratoma also called a dermoid cyst, is a rare type of germ cell tumour. It may contain immature or fully formed tissue, including teeth, hair, bone and muscle. A teratoma cyst is a cyst that forms containing a teratoma and can contain all 3 layers of trilaminar disc. What is a struma ovarii?

A
  • specialised teratoma cyst containing mainly thyroid tissue
46
Q

Dermoid cysts are generally benign, what % can become malignant?

A
  • 1-2%
47
Q

What is polycystic ovary syndrome?

A
  • lower than normal FSH and increased LH
  • increased LH causes theca cells to express too much androstenedione
  • androstenedione moves into adipocytes and is converted to estrone and then estradiol
  • excessive unopposed estrogen stimulates follicles and no LH surge, so no ovulation
48
Q

Polycystic ovary syndrome (PCOS) is a dysfunction in the hypothalamic-pituitary-ovarian axis. This causes infrequent or prolonged menstrual periods or excess male hormone (androgen) levels. The ovaries may develop numerous small collections of fluid (follicles) and fail to regularly release eggs. What is the incidence of PCOS?

A
  • 5-10% of women in reproductive age
49
Q

What are 2 diseases that are heavily associated with polycystic ovary syndrome?

1 - diabetes mellitus and CKD
2 - diabetes and CVD
3 - CVD and CKD
4 - CVD and lung cancer

A

2 - diabetes and CVD

50
Q

Endometriosis is a condition where tissue similar to the lining of the womb starts to grow in other places, such as the ovaries and fallopian tubes. Can this lead to the formation of ovarian cysts?

A
  • yes one of the most common sites is the ovaries

- can form endometriomas (chocolate cysts)

51
Q

Endometriosis is a condition where tissue similar to the lining of the womb starts to grow in other places, such as the ovaries and fallopian tubes. This lead to the formation of endometriomas in the ovaries, more commonly known as chocolate cysts. Why are they called chocolate cysts?

1 - fill with old dark blood products
2 - just old cysts
3 - poor blood supply so become ischaemic

A

1 - fill with old dark blood products

52
Q

Ovarian cysts can be symptomatic or asymptomatic. If a patient becomes symptomatic, what are the most common symptoms?

1 - unilateral pain in lower abdomen, intermittent or constant sharp or dull pain
2 - bilateral pain in lower abdomen, intermittent or constant sharp or dull pain
3 - unilateral pain in upper abdomen, constant sharp pain
4 - bilateral pain in upper abdomen, constant sharp pain

A

1 - unilateral pain in lower abdomen, intermittent or constant sharp or dull pain

  • unilateral pain or pressure in the lower abdomen (sharp or dull)
  • rupture or ovarian torsion (acute severe pain and nausea)
  • irregular menstrual cycle (abnormal vaginal bleed)
53
Q

Ovarian cysts can be symptomatic or asymptomatic. If a patient becomes symptomatic, the most common symptoms are unilateral pain in lower abdomen, intermittent or constant sharp or dull pain. In addition, what effects can ovarian cysts have on menstrual cycles and bleeding?

A
  • irregular menstrual cycles

- abnormal vaginal bleeding

54
Q

Ovarian cysts can be symptomatic or asymptomatic. If a patient becomes symptomatic, the most common symptoms are unilateral pain in lower abdomen, intermittent or constant sharp or dull pain. In addition, what dangerous effects can ovarian cysts have?

1 - haemorrhage and loss of blood
2- cause ovarian torsion, sudden onset of sharp pain, nausea and vomiting
3 - sciatica pain
4 - inguinal hernia

A

2- cause ovarian torsion, sudden onset of sharp pain, nausea and vomiting

55
Q

Can a physical examination (bimanual) of a females ovaries be useful?

A
  • it can help identify the location, shape, size and tenderness of ovaries
  • BUT not diagnose the type of ovarian cyst
56
Q

The management of ovarian cysts depends on what 2 key factors”

A

1 - age

2 - if woman is post-menopausal

57
Q

In the management of ovarian cysts a woman needs to be confirmed as non pregnant, what 2 tests could be performed?

1 - ultrasound and serum hCG
2 - ultrasound and urine pregnancy test
3 - urine pregnancy test and hCG
4 - urine pregnancy test and ultrasound

A

3 - urine pregnancy test and hCG

58
Q

In the management of ovarian cysts if a woman has been confirmed as non pregnant, what would be the next evaluation?

1 - ultrasound
2 - MRI
3 - CT scan
4 - X-ray

A

1 - ultrasound

- MRI and CT are generally not used initially

59
Q

In the management of ovarian cysts if a woman has been confirmed as non pregnant and had an imaging scan. What further analysis could be performed?

A
  • full blood count
  • urinalysis (rule out urinary tract infection and kidney stones)
  • endocervical swabs (assess for pelvic inflammatory disease)
  • cancer antigen 125 (CA125)
60
Q

Cancer antigen 125 (CA125) can be used to assess the risk of ovarian cancer. What is this marker?

A
  • protein present on the cell membranes of healthy ovarian and cancerous tissue
61
Q

What type of ultrasound is used to assess ovarian cysts?

A
  • Transvaginal Ultrasonography

- abdominal ultrasound may be useful

62
Q

If a patient presents with ovarian cysts up to the size of 10cm, but she is asymptomatic, what would treatment involve?

1 - monitor the patient with serial transvaginal ultrasound
2 - open surgery to remove the cyst
3 - give synthetic LH as a treatment
4 - MRI

A

1 - monitor the patient with serial transvaginal ultrasound

63
Q

If a patient presents with ovarian cysts that do not resolve after several menstrual cycles or if the patient has symptoms what would the treatment involve?

1 - monitor the patient with serial transvaginal ultrasound
2 - open surgery to remove the cyst
3 - give synthetic LH as a treatment
4 - monitored using sonograms and surgery if required

A

4 - monitored using sonograms and surgery if required

64
Q

What are the 4 main indications for surgery in ovarian cysts?

A

1 - suspected ovarian torsion
2 - persistent adnexal mass
3 - acute abdominal pain
4 - suspected malignancy

65
Q

In all patients who have surgery for ovarian cysts, in addition to ensuring any malignancies are removed, what is another key aim following the surgery?

A
  • to maintain fertility for the patient
66
Q

What % of follicular ovarian cysts resolve spontaneously?

A
  • 70-80%
67
Q

What is ovarian torsion?

A
  • twisting of the ovary and/or fallopian tube on its vascular and ligamentous supports
  • suspensory ligament contains blood vessels and nerves
  • blocks adequate blood flow to the ovary
68
Q

Ovarian torsion is a twisting of the ovary and/or fallopian tube on its vascular and ligamentous support that blocks adequate blood flow to the ovary. is this dangerous?

A
  • yes if more than 3 hours ovaries become necrotic

- medical emergency

69
Q

If a patient is suspected of having an endometrioma, do they require any special follow up?

1 - only if they present with symptoms
2 - all ages get yearly transvaginal ultrasounds
3 - all ages receive follow up with sonogram at 6-12 week, yearly then surgery if it remains
4 - older women receive follow up with sonogram at 6-12 week, yearly then surgery if it remains

A

3 - all ages receive follow up with sonogram at 6-12 week, yearly then surgery if it remains

Year 2 RE (53 decks)

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