Ovarian D/O and Infertility Flashcards
what are benign functional ovarian d/o
FYI CARDS, just know these are functional and the rest are non-functional
Follicular cyst
Corpus luteum cyst
Theca lutein cyst
what benign non-functional ovarian d/o
MORE FYI CARDS
Cystadenoma (mucinous or serous) Tubo-ovarian abscess (TOA) Endometrioma (chocolate cyst) Mature Teratoma (Dermoid) Paraovarian cyst or fibroid Polycystic ovary Ovarian/Adnexal Torsion
what are malignant ovarian d/o
Epithelial
Non-epithelial
Germ cell/Sex Cord Stromal tumor
___ are the most frequent cystic structure in normal ovary and usually effects ____ (age group)
Follicular Cyst
reproductive = ovulatory women
a follicular cyst occurs with persistent (unovulated, mature) follicle fills with ____ or immature follicle failing to undergo ___
fluid
atresia
what are s/s of follicular cysts
asymptomatic
large = heavy feeling, dull pain
delay menses
what may severe pain with a follicilar cyst indicate
hemorrhage
rupture
torsion
how do you dx follicular cysts
pelic exam
transvag. U/S
what exam finding indicate a benign ovarian cyst
2-8 cm
unilateral
mobile
mild/ no pain
What U/S findings suggest a benign ovarian cyst
<8 cm
unilocular
simple fluid flled
thin walls, no nodules
how can you treat ovarian disorders
expectant
OCP
surgery
____ are Less common than follicular cysts and results from intrafollicular bleeding after ovulation. They are Associated with normal endocrine function or prolonged secretion of P*
Corpus Luteum Cyst
Corpus Luteum Cyst are usually ___-___ cm and have the same sxs and complications as follicular cysts
3-10
_____ are the Least common physiologic ovarian cyst they are (Almost/Never) always bilateral*
Can be massive, up to __-__ cm with multiple cysts
Arise from prolonged or excess stimulation of ovaries by endogenous or exogenous Gn**
Theca Lutein Cysts
Always
20-30
Theca Lutein Cysts; Symptoms? Ultrasound findings? Complications:? Management:?
Symptoms: pelvic pressure
Ultrasound findings: multiple thin-walled cysts bilaterally
Complications: rare incidence of torsion/rupture*
Management: conservative, spontaneously regress
___ are Benign tumor of ovarian surface epithelium, lined by simple epithelium that is serous or mucinous. they are the MOST COMMON benign ovarian neoplasms
Cystadenoma: Serous or Mucinous
___ are filled with pale yellow serous fluid, usually unilocular
Serous cystadenoma:
___ are filled with sticky mucin, tend to be multiloculated
Mucinous Cystadenoma
how do you dx Cystadenoma: Serous or Mucinous
U/S
how do you tx Cystadenoma: Serous or Mucinous
surgical removal w/ staging
appendectomy
___ are Infectious disorder of the upper genital tract (PID) creating an inflammatory mass involving the fallopian tube and ovary
Often bilateral due to ascending infection
Tubo-ovarian abscess
Tubo-ovarian abscess s/s
Symptoms of PID
Adnexal pain and mass
complication of Tubo-ovarian abscess
sepsis rupture tubal occlusion infertility ectopic pregnancy chronic pelvic pain due to adhesions
how do you tx Tubo-ovarian abscess?
IV abx
___ is a an ovarian cystic mass arising from growth of ectopic endometrial tissue within the ovary. Typically contain thick brown tar-like fluid (“chocolate cyst”) and are often densely adherent to surrounding structures.
Endometrioma (Chocolate Cyst)
what are s/s of Endometrioma (Chocolate Cyst)
asymptomatic
pelvic pain
dysmenorrhea
dyspareunia
what are complications of Endometrioma (Chocolate Cyst)
infertility
rupture
how do you tx Endometrioma (Chocolate Cyst)?
observation
surgical
___ are a benign neoplasm containing tissue from all three germ layers ie:
Ectoderm (skin, appendages: hair, teeth, sebaceous material), Mesoderm And Endoderm
Mature Cystic Teratoma (Dermoid)
Mature Cystic Teratoma (Dermoid)* are the most common benign neoplasm in women ____ (age group)
__-__% bilateral
< 35 y/o including adolescents
10-15% b/l
how do you tx a Mature Cystic Teratoma (Dermoid)
surgery
____ are Ovaries with multiple cysts associated with PCOS. The most common cause of hyperandrogenism and chronic anovulation.
Polycystic ovary
Polycystic ovary occurs in __-__% of reproductive age females
4-12%
what are sxs related to?
HYPERANDROGENEMIA
- acne, hirsutism, alopecia
REPRODUCTIVE D/O
- irregular menses, anovulation, infertility, endometrial hyperplasia
METABOLIC DISTURBANCES
- obesity, insulin resistance, hyperinsulinemia
what re the dx criteria for Polycystic ovary
(need 2 out of 3 criteria):
- Oligoovulation or anovulation
- Hyperandrogenemia
- Polycystic ovaries diagnosed by ultrasound
how do you treat Polycystic ovary
OCP
Metformin
progesterone
mechanical hair removal for hirsutism
__ is a simple epithelial-lined cyst (rarely complex) or benign fibroid adjacent to the ovary, usually within the broad ligament
Incidence: approx. 10% of benign adnexal cysts, most common ___-___ year old
Paraovarian cyst or fibroid
30-50y.o.
how do you tx Paraovarian cyst or fibroid
observe if small
surgery to remove
____ is the rotation of the ovary or the ovary and FT to such a degree as to occlude the vascular supply (can be partial/intermittent or complete resulting in necrosis)
Ovarian (Adnexal)Torsion
what age group is Ovarian (Adnexal)Torsionmost common?
reproductive aged women
what are sx of Ovarian (Adnexal)Torsion
severe unilateral pain
N/V
T/F: Ovarian (Adnexal)Torsion can be dx using a TUS with Doppler flow studies
T
how do you tx Ovarian (Adnexal)Torsion
emergent surgery
what are U/S findings that suggest a malignant adnexal mass?
- Thick septations
- Papillary projections or nodules into the lumen of a cyst
- Cystic and solid components
- Increased overall volume of the ovary
- Increased Doppler measurement of blood flow
what are serum tumor markers in ovarian d/o
CA 125
HE4
these descriptions fit which ovarian tumor marker?
Decreased specificity especially in premenopausal women
Increased in many benign conditions including endometriosis, leiomyoma, PID and pregnancy
CA 125
these descriptions fit which ovarian tumor marker?
Has improved specificity over CA 125
Not elevated in endometriosis or other benign conditions
HE4
what does ROMA or RMI stand for?
Risk of ovarian malignancy algorithm
Risk of Malignancy Index
what clinical characteristics require a woman to be referred to a GYN oncologist
Elevated CA 125 level
- > 35 in postmenopausal woman
- > 200 in premenopausal woman
Ascites
Nodular or fixed pelvic mass
Evidence of abdominal or distant metastasis
FHx of one or more first-degree relatives with ovarian or breast cancer
