Ovarian Pathology Flashcards
What is the Rotterdam criteria in PCOS?
- Oligoovulation or anovulation
- Hyperandrogenism
- Polycystic ovaries on USS (or ovarian volume >10cm3)
2 out of 3 of the criteria = diagnosis, particularly the first 2.
What are the signs and symptoms of PCOS?
- Hyperandrogenism (Hirsuitism, male pattern balding, central obesity, acne)
- Subfertility/Infertility
- Oligo or amenorrhea
- Obesity (~70% of PCOS patients)
What are the potential complications of PCOS?
- Increased risk of T2DM
- Inferility/Subfertility
- Complications related to obesity/metabolic syndrome
- Acanthosis nigricans
- Depression/anxiety
- Endometrial hyperplasia/endometrial cancer
What is the expected LH:FSH ratio in a patient with PCOS?
Raised LH, thus a raised LH:FSH ratio
What is the management of PCOS?
- Weight loss (most important)
- Low glycaemic index diet
- Exercise
- Antihypertension and statins if indicated by QRISK >10%
- If not planning to get pregnant, consider COCP/Coil/etc to manage endometrial hyperplasia and hirsuitism
- Anti-androgens for hyperandrogenism
What are the main causes of ovarian torsion?
- Usually a mass - either a cyst or tumour
2. In girls before menarche, it can occur due to longer infundibulopelvic ligaments
How does ovarian torsion present?
Sudden onset severe unilateral pelvic pain
- Constant
- Progressively worsening
- Associated with nausea & vomiting
Examination:
- Localised tenderness
- Possibly a palpable mass
How is ovarian torsion diagnosed?
- Pelvic USS is initial investigation (TVUSS preferred):
- May show ‘whirlpool sign’ of free fluid in the pelvis
- May show ovarian oedema
- Doppler may show restricted blood flow - Diagnostic laparoscopy is definitive
What is the treatment of ovarian torsion?
Emergency laparoscopic surgery to either untwist the ovary or remove it
What are the complications of ovarian torsion?
Ischaemia > Necrosis > Infection > Rupture > Peritonitis > Death
What are ovarian cysts?
Fluid filled sacs in the ovaries
Functional ovarian cysts are related to the menstrual cycle and are extremely common in pre-menopausal women. Vast majority benign
Cysts in post-menopausal women are more concerning and warrant investigation.
Patients with multiple cysts or a ‘string of pearls’ finding on USS do not have PCOS unless they also fulfil another feature from the Rotterdam criteria
What are the signs and symptoms of ovarian cysts?
Majority asymptomatic, but may cause:
- Pelvic pain
- Bloating
- Abdominal fullness
- Palpable pelvic mass
What are the two types of functional ovarian cysts?
- Follicular cysts:
- Developing follicle that fails to rupture, leading to persistence of the cyst. Most common and usually resolve by next menstrual cycle. - Corpus luteum cysts:
- When the corpus luteum fails to break down and fills with fluid. May cause pelvic pain, discomfort or delayed menstruation. Common in early pregnancy.
What are the other types of ovarian cysts?
- Serous cystadenoma:
- Benign epithelial cell tumours - Mucinous cystadenoma:
- Benign epithelial cell tumours, often very large - Endometrioma:
- Lumps of endometrial tissue within the ovary; common in endometriosis - Dermoid cyst/Germ cell tumours:
- Weird usually benign tumours that contain germ cell tissue, also known as teratomas. Pure horror - Sex cord stromal tumours:
- Can be benign or malignant
- Arise from connective tissue or sex cords (follicular embryonic structures)
- Several types, including Sertoli-Leydig tumours and granulosa cell tumours
What are the presenting features of ovarian cancer?
Often insidious - known as ‘silent killer’, symptoms are usually late sign and indicate metastatic disease
- Persistent abdominal bloating (differentiate from digestive/IBS bloating by lack of variability)
- Reduced appetite/early satiety
- Unintentional weight loss
- Night sweats
- Urinary symptoms
- Pain
- Ascites
- Lymphadenopathy
