Ovarian Pathology Flashcards
What are ovarian cysts?
Fluid-filled sacs in the ovaries
What are the types of ovarian cysts?
Follicular cysts
Corpus lutem cyst
Dermoid cyst
Serous cyst adenoma
What is the other name for dermoid cysts?
Mature cystic teratomas
What is the pathology of dermoid cysts?
Usually lined with epithelial tissue and may contain skin appendages, hair and teeth
What is the main complications of ovarian cysts?
Increase the risk of ovarian torsion
What can rupture of serous caystadenomas cause?
Pseudo-myxoedema peritonei - where cancer cells produce abundant mucin or gelatinous ascites
What are chocolate cysts?
Cysts on the ovaries in endometriosis
What is the presentation of ovarian cysts?
Can be asymptmoatic
Non-specific symptoms similar to ovarian cancer
What is the presentation of a ruptured ovarian cyst?
Sudden onset pelvic pain
Pain tends to subside after a few hours
Precipitated by intercourse or strenuous activity
Tender lower abdomen
What is the main investigation for ovarian cysts?
Ultrasound scan
What USS result shows a simple cyst?
Unilocular
What USS result shows a complex cyst?
Multilocular
What USS result shows a ruptured cyst?
Free fluid in the pelvic cavity
What is the next step in management for post-menopausal women with ovarian cysts?
Referral to gynaecology for assessment to exclude malignancy
What investigations are done to rule out malignancy in ovarian cysts?
FNA
Explorative laparoscopy
What is the management of small (<5cm) simple ovarian cysts in patients <35 years
Conservative approach
Repeat USS arranged for 8-12 weeks
Referral if persistent
What is the management of symptomatic ovarian cysts?
Cystectomy or oophorectomy
What are the types of ovarian cancer?
Serous Endometroid Mucinous Clear cell Transitional type Granulosa cell Theca/Leydig cell
What is the most common ovarian cancer?
Serous carcinoma
What is a Brenner tumour?
Transitional type tumour
Benign
Coffee-bean nucleus
What ovarian tumour is oestrogen producing?
Granulosa cell
What ovarian tumour is androgen producing?
Theca/Leydig cell
What are risk factors for ovarian cancer?
Increasing age - post-menopausal Nulliparous Increased number of menstrual cycles (early menarche, lat menopause, use of IUD) Obesity Family history Use of HRT
Which family history syndromes increase risk of ovarian cancer?
BRCA 1 and 2 Lynch syndrome (HNPCC)
What factors are protective against ovarian cancer?
COCP
Multiparity
Breastfeeding
Hysterectomy and tubal ligation
Which cancers commonly spread to the ovaries?
Breast
Pancreas
Stomach
GI
What is Krukenberg tumour?
Metastatic disease of the ovary that is gastric in origin and has signet ring cells
What is the presentation of ovarian cancer?
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
With what presentation should you be very suspicious of ovarian cancer?
IBS-like symptoms in a post-menopausal woman
What are the main investigations for ovarian cancer?
CA-125
Ultrasound
Diagnostic laparoscopy
What other factors cause a high CA-125?
Endometriosis
Menstruation
Benign ovarian cysts
What is the Risk of Malignancy Index?
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
What ultrasound features are indicative of ovarian cancer?
Multiloculated Solid areas Bilaterality Ascites Metastasis
What is the risk of ovarian cancer if RMI <30?
3%
What is the risk of ovarian cancer if RMI is >250?
Over 75%
Rever to gynae
What is the staging system for ovarian cancer?
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
What are some sites that ovarian cancer spreads to?
Liver
Lungs
What is the management of ovarian cancer?
If fit - surgery for maximal tumour debulking
If fertility required - unilateral sapling-oophorectomy
Stage 2+ - radiotherapy in addition to surgery
What is ovarian torsion?
Partial or complete torsion of the ovary on it’s supporting ligaments
Blood supply may become compromised
What is adnexal torsion?
If the fallopian tube is involved in ovarian torsion
What are risk factors for ovarian torsion?
Ovarian mass (90% of cases) Reproductive age Pregnancy Ovarian hypestimulation syndrome PCOS
What is the presentation of ovarian torsion?
Abdominal pain - sudden onset - deep-seated - colicky Vomoiting Distress, tachycardia Fever in the minority Adnexal tenderness of vaginal examination
What USS signs are indicative of ovarian torsion?
Whirlpool sign
Free fluid
What is the management of ovarian torsion?
Laparoscopy - diagnostic and therapeutic
What are the criteria for PCOS?
2 of:
Polycystic ovaries
Oligomenorrhea or amenorrhoea
Hyperandrogenism (acne, hirsutism, male pattern baldness)
What conditions are associated with PCOS?
Obesity
Hypertension
Hyperlipidaemia
Insulin resistance
What is the presentation of PCOS?
Menstrual disturbances Hyperandrogenism Obesity Acanthosis nigricans (due to insulin resistance/hyperinsulinemia) Subfertility Diabetes mellitus Thrombosis - stroke, TIA, coronary artery disease Obstructive sleep apnoea
What is the management for period irregularities in PCOS?
COCP
What is the management for fertility in PCOS?
BMI <35 Metformin Clomiphene citrate - stimulates ovulation Gonadotrophins IVF
What is the function of metformin in PCOS?
Improves insulin resistance
Improves ovulatory function
