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Y3 - Repro > Ovarian Pathology > Flashcards

Ovarian Pathology Flashcards

1
Q

What are ovarian cysts?

A

Fluid-filled sacs in the ovaries

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2
Q

What are the types of ovarian cysts?

A

Follicular cysts
Corpus lutem cyst
Dermoid cyst
Serous cyst adenoma

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3
Q

What is the other name for dermoid cysts?

A

Mature cystic teratomas

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4
Q

What is the pathology of dermoid cysts?

A

Usually lined with epithelial tissue and may contain skin appendages, hair and teeth

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5
Q

What is the main complications of ovarian cysts?

A

Increase the risk of ovarian torsion

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6
Q

What can rupture of serous caystadenomas cause?

A

Pseudo-myxoedema peritonei - where cancer cells produce abundant mucin or gelatinous ascites

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7
Q

What are chocolate cysts?

A

Cysts on the ovaries in endometriosis

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8
Q

What is the presentation of ovarian cysts?

A

Can be asymptmoatic

Non-specific symptoms similar to ovarian cancer

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9
Q

What is the presentation of a ruptured ovarian cyst?

A

Sudden onset pelvic pain
Pain tends to subside after a few hours
Precipitated by intercourse or strenuous activity
Tender lower abdomen

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10
Q

What is the main investigation for ovarian cysts?

A

Ultrasound scan

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11
Q

What USS result shows a simple cyst?

A

Unilocular

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12
Q

What USS result shows a complex cyst?

A

Multilocular

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13
Q

What USS result shows a ruptured cyst?

A

Free fluid in the pelvic cavity

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14
Q

What is the next step in management for post-menopausal women with ovarian cysts?

A

Referral to gynaecology for assessment to exclude malignancy

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15
Q

What investigations are done to rule out malignancy in ovarian cysts?

A

FNA

Explorative laparoscopy

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16
Q

What is the management of small (<5cm) simple ovarian cysts in patients <35 years

A

Conservative approach
Repeat USS arranged for 8-12 weeks
Referral if persistent

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17
Q

What is the management of symptomatic ovarian cysts?

A

Cystectomy or oophorectomy

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18
Q

What are the types of ovarian cancer?

A 
Serous
Endometroid
Mucinous
Clear cell 
Transitional type
Granulosa cell
Theca/Leydig cell
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19
Q

What is the most common ovarian cancer?

A

Serous carcinoma

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20
Q

What is a Brenner tumour?

A

Transitional type tumour
Benign
Coffee-bean nucleus

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21
Q

What ovarian tumour is oestrogen producing?

A

Granulosa cell

22
Q

What ovarian tumour is androgen producing?

A

Theca/Leydig cell

23
Q

What are risk factors for ovarian cancer?

A 
Increasing age - post-menopausal
Nulliparous
Increased number of menstrual cycles (early menarche, lat menopause, use of IUD)
Obesity
Family history
Use of HRT
24
Q

Which family history syndromes increase risk of ovarian cancer?

A 
BRCA 1 and 2
Lynch syndrome (HNPCC)
25
Q

What factors are protective against ovarian cancer?

A

COCP
Multiparity
Breastfeeding
Hysterectomy and tubal ligation

26
Q

Which cancers commonly spread to the ovaries?

A

Breast
Pancreas
Stomach
GI

27
Q

What is Krukenberg tumour?

A

Metastatic disease of the ovary that is gastric in origin and has signet ring cells

28
Q

What is the presentation of ovarian cancer?

A

Mass - swelling, bloating, abdominal distension
Pressure symptoms - bladder urgency, frequency
Irregular bleeding
Pelvic pain
GI disturbance
leg oedema
DVT
SOB (pleural effusion)
Non-specific - fatigue, malaise, weight loss, decreased appetite

29
Q

With what presentation should you be very suspicious of ovarian cancer?

A

IBS-like symptoms in a post-menopausal woman

30
Q

What are the main investigations for ovarian cancer?

A

CA-125
Ultrasound
Diagnostic laparoscopy

31
Q

What other factors cause a high CA-125?

A

Endometriosis
Menstruation
Benign ovarian cysts

32
Q

What is the Risk of Malignancy Index?

A 
Menopausal status x ultrasound features x CA-125
Premenopausal = 1
Postmenopausal = 3
No ultrasound features = 0
One US feature = 1
>1 US features = 3
Absolute level of Ca-125
33
Q

What ultrasound features are indicative of ovarian cancer?

A 
Multiloculated
Solid areas
Bilaterality
Ascites
Metastasis
34
Q

What is the risk of ovarian cancer if RMI <30?

A

3%

35
Q

What is the risk of ovarian cancer if RMI is >250?

A

Over 75%

Rever to gynae

36
Q

What is the staging system for ovarian cancer?

A

Figo Staging
1 - limited to the ovaries
2 - spread to pelvic organs but limited to the pelvis
3 - spread beyond pelvis but confined to abdominal peritoneum
4 - distant metastases

37
Q

What are some sites that ovarian cancer spreads to?

A

Liver

Lungs

38
Q

What is the management of ovarian cancer?

A

If fit - surgery for maximal tumour debulking
If fertility required - unilateral sapling-oophorectomy
Stage 2+ - radiotherapy in addition to surgery

39
Q

What is ovarian torsion?

A

Partial or complete torsion of the ovary on it’s supporting ligaments
Blood supply may become compromised

40
Q

What is adnexal torsion?

A

If the fallopian tube is involved in ovarian torsion

41
Q

What are risk factors for ovarian torsion?

A 
Ovarian mass (90% of cases)
Reproductive age 
Pregnancy
Ovarian hypestimulation syndrome
PCOS
42
Q

What is the presentation of ovarian torsion?

A 
Abdominal pain 
- sudden onset
- deep-seated
- colicky
Vomoiting
Distress, tachycardia
Fever in the minority
Adnexal tenderness of vaginal examination
43
Q

What USS signs are indicative of ovarian torsion?

A

Whirlpool sign

Free fluid

44
Q

What is the management of ovarian torsion?

A

Laparoscopy - diagnostic and therapeutic

45
Q

What are the criteria for PCOS?

A

2 of:
Polycystic ovaries
Oligomenorrhea or amenorrhoea
Hyperandrogenism (acne, hirsutism, male pattern baldness)

46
Q

What conditions are associated with PCOS?

A

Obesity
Hypertension
Hyperlipidaemia
Insulin resistance

47
Q

What is the presentation of PCOS?

A 
Menstrual disturbances
Hyperandrogenism 
Obesity
Acanthosis nigricans (due to insulin resistance/hyperinsulinemia)
Subfertility
Diabetes mellitus
Thrombosis - stroke, TIA, coronary artery disease
Obstructive sleep apnoea
48
Q

What is the management for period irregularities in PCOS?

A

COCP

49
Q

What is the management for fertility in PCOS?

A 
BMI <35
Metformin
Clomiphene citrate - stimulates ovulation
Gonadotrophins
IVF
50
Q

What is the function of metformin in PCOS?

A

Improves insulin resistance

Improves ovulatory function

Y3 - Repro (13 decks)

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