Ovarian Pathology Flashcards
T/F? Ovaries are covered by a single layer of cells called the peritoneum.
FALSE, germinal epithelium
This contains the ovarian follicles and corpus lutea.
cortex
This is composed of ovarian fibrous tissue and blood vessels.
medulla
T/F? An ovarian cyst is more than 3 cm long.
true
T/F? An ovarian follicle is less than 2 cm long.
FALSE, 3 cm
During the proliferative phase, many follicles increase in size until about day __ due to the stimulation by the __ hormones.
8 or 9, FSH and LH
If the fluid in one of the non-dominant follicles is not reabsorbed…
a follicular cyst develops.
The ovaries are bound __ by the umbilical artery.
anteriorly
The ovaries are bound __ by the ureter and the iliac vessels.
posteriorly
The fimbria of the fallopian tube lie __ to the ovary.
superior and lateral
T/F? The ovarian ligaments are rigid and do not allow the ovary to be mobile.
FALSE, flexible and very mobile
The right ovarian vein drains into the __.
IVC.
The left ovarian vein drains into the __.
left renal vein.
Three kinds of functional ovarian cysts…
- follicular
- corpus luteum
- theca-lutein
This is the most common cause of ovarian enlargement in young women.
functional ovarian cyst
Most functional cysts typically resolve within __ menstrual cycles.
1-2
Follow up of larger functional cysts is usually __ weeks later to show changed appearance or resolution.
6
This type of cyst can form when ovulation does not occur or when a mature follicle involutes.
follicular cyst
Follicular cysts range from __ in size.
3 cm - 8 cm
T/F? Follicular cysts are usually unilateral.
true
This type of functional ovarian cyst occurs after an egg has been released from the dominant follicle.
corpus luteal
These are less common than follicular cysts but tend to be larger and more symptomatic.
corpus luteal
What is the major symptom of a corpus luteal cyst?
pain
T/F? Corpus luteal cysts are usually unilateral.
true
The corpus luteum continues until what week of pregnancy?
16th
This hyperechoic structure results from the regression of a luteal structure from a previous cycle.
corpus albicans
Hemorrhage may occur in __ or __ cysts.
follicular, corpus luteum
The presence of __ helps confirm the diagnosis of a leaking or ruptured hemorrhagic cyst.
free fluid in the cul-de-sac
These are the largest of the functional ovarian cysts.
theca-lutein cysts
These ovarian cysts are associated with high levels of hCG.
theca-lutein cysts
These ovarian cysts typically occur in patients with GTD and infertility therapy.
theca-lutein cysts
Paraovarian cysts are also known as…
paratubal cysts.
These cysts are found in the broad ligament.
paraovarian cysts
These cysts are most common in the 3rd and 4th decades.
paraovarian cysts
These ovarian cysts occur predominantly in premenopausal women with a history of previous abdominal surgery or trauma.
peritoneal inclusion cysts
In patients with peritoneal adhesions fluid may accumulate and entrap the ovaries, resulting in…
a large adnexal mass.
__ are extra-ovarian and separate from the ovary whereas the ovary lies inside or in the wall of a __ cyst.
Paraovarian cysts and hydrosalpinx, peritoneal inclusion
The normal ovaries are usually identified __ to the anteflexed midline uterus.
laterally or posterolaterally
When the uterus lies to one side, the ipsilateral ovary lies …
superior to the uterine fundus.
In a retroverted uterus, the ovaries tend to be located…
laterally and superiorly near the uterine fundus.
When the uterus is enlarged, the ovaries tend to be…
displaced more superiorly and laterally.
When the uterus is removed, the ovaries tend to be…
more medially and directly superior to the vaginal cuff.
A corpus luteal cyst results from the failure of absorption of the __ or from excess __ into the corpus luteum.
dominant follicle, bleeding
This is the presence of functioning endometrial tissue outside the endometrium and myometrium.
endometriosis
T/F? Endometriosis can occur everywhere except the bladder and bowel.
FALSE, can occur anywhere
The clinical signs of endometriosis?
- chronic pain with menses
- infertility
- the 4 Ds
What are the 4 Ds?
- dysmenorrhea
- dyspareunia
- dysuria
- dyschezia
Localized endometriosis is also known as…
endometrioma or ‘chocolate cyst’.
T/F? Localized endometriosis is the most common type.
FALSE, diffuse
Diffuse endometriosis causes dys__, dys__, and __.
dysmenorrhea, dyspareunia, infertility
T/F? Localized endometriosis is asymptomatic and frequently multiple.
true
This is caused from bleeding from abnormally implanted endometrial tissue.
localized endometriosis
How is endometrioma different from a hemorrhagic cyst?
Hemorrhagic cysts will resolve over time.
The main endometriosis treatment is…
surgery.
PCOS is also known as…
Stein-Leventhal syndrome
This is an endocrinologic disorder associated with chronic anovulation.
PCOS
PCOS is most commonly found in __ women.
adolescent girls and young women
T/F? Sonography is essential to PCOS diagnosis.
FALSE, diagnosis is serologic
Clinically, PCOS presents with…
- hyperandrogenism
- oligoamenorrhea
- amenorrhea
- hirsuitism
- obesity,
- infertility
Sonographically, PCOS appears with __lateral multiple cysts in a string of pearls sign.
bilateral
The risk factors for torsion are…
- Pre-existing ovarian cyst or mass
2. Pregnancy
If the ovary is completely torsed, the Doppler will show…
All color flow will be absent.
If the ovary is partially torsed, the Doppler will show…
Absent venous flow and diminished arterial flow.
Whet happens to the size of the ovary during a torsion?
It becomes enlarged.
Name three clinical symptoms of ovarian torsion.
- Severe pelvic pain
- Nausea and vomiting
- Palpable mass (usually on the right) mimicking appendicitis
This is the fourth leading cause of cancer death among women.
Ovarian cancer
Ovarian cancer has the highest mortality rate as a result of…
Late diagnosis.
Ovarian cancer comprises __% of all gynecologic malignancies.
25%
Women with __ are at increased risk of ovarian cancer.
A family history of ovarian ca
Women who have __ are at a reduced risk of ovarian cancer.
Used oral contraceptives
This lab test is used to follow women with ovarian cancer.
CA 125
T/F? CA 125 is a screening tool for ovarian cancer.
FALSE, is not
CA 125 detects __% of first stage ovarian cancer.
Less than 50%
What would make you highly suspicious that an ovarian mass was carcinoma?
If it was in a post menopausal women with elevated CA 125.
Ovarian mass dopplers tend to yield __ resistance and __ velocities.
Low, high
Ovarian rumors are named for the __ and whether or not the tumor is __.
Kind of cells it started from, benign or malignant
Tumors that start from cells that cover the outer surface of the ovary are called…
Epithelial-stromal tumors
Tumors that start from cells that produce the ova are called…
Germ cell tumors
Tumors that start from the sex cords of the embryonic gonad are called…
Sex cord-stromal tumors
T/F? Most epithelial-stromal tumors are malignant.
FALSE, benign
Name the five types of epithelial-stromal tumors.
- serous cystadenoma
- mucinous cystadenoma
- endometrioid
- clear cell
- transitional cell (Brenner tumor)
These kinds of epithelial-stromal tumors are borderline malignant 10-15% of the time.
serous and mucinous cystadenoma
These tumors are common, accounting for 25-30% of all ovarian neoplasms.
serous tumors
Most serous tumors are benign, but serous cystadenocarcinomas account for __ of all malignant ovarian neoplasms.
40-50%
Benign serous tumors are bilateral __ of the time and occur in women __ yrs old.
12-20%, 40-50
Malignant serous tumors are bilateral __ of the time and occur in women who are__.
50%, peri-/postmenopausal
Sonographically, benign serous tumors are __ marginated, usually __locular, with __ septations.
sharply, uni-, thin-walled
Sonographically, malignant serous tumors have __ projections, __ septations, and __.
multiple papillary, thick, ascites
Benign mucinous cystadenoma are __ bilateral and more common in women __ yrs old.
rarely, 30-50
Malignant mucinous cystadenoma are bilateral __ of the time and more common in women __ yrs old.
15-20%, 40-70
Rupture of a malignant mucinous tumor capsule results in…
pseudomyxoma peritonei (malignant ascites)
What kind of echoes does malignant mucinous cystadenoma have?
fine, gravity-dependent echoes
How big is a benign mucinous cystadenoma?
up to 50 cm in diameter
How big is a malignant mucinous cystadenoma?
15-30 cm in diameter
80% of these ovarian tumors are malignant (but have a better prognosis than either serous or mucinous carcinomas).
endometrioid
These account for a quarter of all ovarian carcinomas.
endometrioid tumors
30% of patients with this tumor have associated…
endometrial adenocarcinoma.
Sonographically, endometrioid tumors are a cystic mass with…
papillary projections.
These ovarian tumors are nearly always malignant, but are only 5-10% of epithelial-stromal tumors.
clear cell
Clear cell tumors are bilateral __ of the time and occur in women __ yrs old.
20%, 50-70
How big is a clear cell tumor?
up to 30 cm
Sonographically, clear cell tumors appear…
as a complex cyst.
Transitional cell tumors are bilateral __ of the time and occur in women __ yrs old.
6-7%, 40-80
Transitional cell tumors are also known as…
Brenner tumors
T/F? Transitional cell tumors are almost always benign.
true
How big is a transitional cell tumor?
smaller then 2 cm in diameter
Sonographically, transitional cell tumors appear as…
a hypoechoic solid mass.
T/F? Most germ cell tumors are benign.
true
In children and adolescents, more than 60% of ovarian neoplasms are __ origin and __ of them are malignant.
germ cell, 1/3rd
The most common germ cell malignancies…
- teratomas
- dysgerminoma
- endodermal sinus tumors
- choriocarcinoma
Cystic teratoma is also known as…
dermoid tumor.
Cystic teratoma tumors are bilateral __ of the time and occur in women who are…
15%, in their active reproductive years
The most common complication of cystic teratoma is…
ovarian torsion.
This kind of dermoid presents predominantly cystic mass with an echogenic mural nodule which typically casts an acoustic shadow.
dermoid plug
This kind of dermoid presents as a highly echogenic mass that shadows and obscures the posterior wall of the lesion.
‘tip of the iceberg’ sign
This kind of dermoid presents as multiple echogenic linear interfaces floating within a cystic mass (hair fibers).
dermoid mesh
Half of sex cord-stromal tumors are __ while most of the others are __.
Fibromas, granulosa
Name four kinds of sex cord-stromal ovarian tumors.
- Fibroma
- Thecoma
- Granulosa
- Sertoli-Leydig
Fibroma tumors are bilateral __ of the time and occur in women who are…
Rarely, Middle Age
How big is a fibroma tumor?
Range from Microscopic to large
This refers to ascites and pleural effusion and associated with an ovarian fibroma.
Meig’s syndrome
Meig’s syndrome refers to __ and __ and is associated with __.
Ascites, pleural effusion, fibromas
T/F? Meig’s syndrome persists after the fibroma is excised.
FALSE, resolves
Sonographically, fibromas appear…
Like a fibroid.
Thecoma tumors occur in women who are __ and vary in size from __.
Post menopausal with signs of estrogen/androgen activity, tiny to 5-10 cm
Granulosa cell tumors occur in women who are __ and produce __.
50-55 yrs old, estrogen
Juvenile granulosa cell tumors result in…
Precocious puberty
Sertoli-Leydig is also known as…
Androblastoma
Sertoli-Leydig tumors are bilateral __ of the time and occur in women who are…
Rarely, under 30.
How big is a Sertili-Leydig tumor?
5-15 cm
T/F? Sertili-Leydig tumors are very common.
FALSE, rare
Sertili-Leydig patients present with symptoms of…
Masculinization
The most common sites of ovarian mets are from the…
Breast and GI tract (stomach cancer)
Metastatic tumors are bilateral __ of the time.
Most
Dysgerminoma tumors are bilateral __ of the time and occur in women __ yrs old.
15%, under 30
This malignant germ cell tumor comprises 3-5% of ovarian malignancies.
dysgerminoma
This germ cell tumor is highly radiosensitive with a five year survival rate up to 90%.
dysgerminoma
Sonographically, dysgerminoma appears as…
a multi-lobulated, solid, echogenic mass.
Endodermal sinus tumor are also known as…
yolk sac tumor.
Yolk sac tumors are bilateral __ of the time and occur in women __ yrs old.
almost never, 20-30
How big is a yolk sac tumor?
3-30 cm in diameter
This is the second most common malignant ovarian germ cell neoplasm.
yolk sac tumor
What lab value helps diagnose endodermal sinus tumors?
increased serum AFP
Sonographically, an endodermal sinus tumor appears…
like a dysgerminoma.
Half of these tumors are fibromas while most of the others are granulosa cell tumors.
sex cord-stromal tumors
Name four kinds of sex cord-stromal tumors.
- fibroma
- thecoma
- granulosa
- Sertoli-Leydig
Fibroma tumors are bilateral __ of the time and occur in women __ yrs old.
rarely, middle age
How big is a fibroma?
from microscopic to large
This refers to ascites and pleural effusion and associated with fibroma.
Meig’s syndrome
Meig’s syndrome refers to __ and __ and associated with __.
ascites, pleural effusion, fibroma
T/F? Meig’s syndrome persists after the removal of the tumor.
FALSE, resolves
Sonographically, fibromas appear…
like a fibroid (hypoechoic with posterior acoustic attenuation).
Thecoma tumors occur in women __ yrs old.
postmenopausal women who present with clinical signs of estrogen or androgen activity
How big is a thecoma?
tiny to 5-10 cm
Granulosa tumors occur in women __ yrs old.
50-55
How big is a granulosa?
small (and solid)
Granulosas produce…
estrogen.
Juvenile granulosa cell tumors result in…
precocious puberty.
Most granulosa cell tumors happen in…
adults.
Sertoli-Leydig tumors are also known as…
androblastoma.
Sertoli-Leydig tumors are bilateral __ of the time and occur in women __ yrs old.
rarely, under 30
T/F? Sertoli-Leydig tumors are very common.
FALSE, rare
Patients with Sertoli-Leydig may present with symptoms of…
masculinization.
How big is a Sertoli-Leydig tumor?
5-15 cm
The most common primary sites of ovarian mets are from the…
- breast
2. GI tract (stomach cancer)
How does a metatstatic tumor spread?
- direct invasion
- peritoneal fluid
- blood and lymphatics
This specific type of metastatic ovarian cancer most commonly arises from gastric carcinoma.
krukenberg tumor
Krukenberg tumors are bilateral __ of the time.
all
Sonographically, krukenberg tumors appear as…
solid ovarian masses with possible ascites.
These very rare tumors typically affect girls and young women, spreading rapidly, but sensitive to chemotherapy.
choriocarcinoma
T/F? Choriocarcinoma is more likely to start from the placenta than from the ovary.
true
Describe a stage one ovarian malignancy.
growth limited to one ovary, no ascites
Describe a stage two ovarian malignancy.
growth involving one or both ovaries with pelvic extension
Describe a stage three ovarian malignancy.
growth involving one or both ovaries with pelvic extension and/or retroperitoneal nodes, limited to the true pelvis
Describe a stage four ovarian malignancy.
growth involving one or both ovaries with distant mets, possible pleural effusion
Most ovarian cancer patients are diagnosed with…
advanced stage III or IV.
Ovarian cancer patients with stages I or II will…
develop a recurrence of the disease.
