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OB/GYN Scanning > Ovarian Pathology > Flashcards

Ovarian Pathology Flashcards

1
Q

T/F? Ovaries are covered by a single layer of cells called the peritoneum.

A

FALSE, germinal epithelium

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2
Q

This contains the ovarian follicles and corpus lutea.

A

cortex

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3
Q

This is composed of ovarian fibrous tissue and blood vessels.

A

medulla

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4
Q

T/F? An ovarian cyst is more than 3 cm long.

A

true

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5
Q

T/F? An ovarian follicle is less than 2 cm long.

A

FALSE, 3 cm

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6
Q

During the proliferative phase, many follicles increase in size until about day __ due to the stimulation by the __ hormones.

A

8 or 9, FSH and LH

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7
Q

If the fluid in one of the non-dominant follicles is not reabsorbed…

A

a follicular cyst develops.

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8
Q

The ovaries are bound __ by the umbilical artery.

A

anteriorly

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9
Q

The ovaries are bound __ by the ureter and the iliac vessels.

A

posteriorly

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10
Q

The fimbria of the fallopian tube lie __ to the ovary.

A

superior and lateral

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11
Q

T/F? The ovarian ligaments are rigid and do not allow the ovary to be mobile.

A

FALSE, flexible and very mobile

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12
Q

The right ovarian vein drains into the __.

A

IVC.

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13
Q

The left ovarian vein drains into the __.

A

left renal vein.

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14
Q

Three kinds of functional ovarian cysts…

A
  1. follicular
  2. corpus luteum
  3. theca-lutein
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15
Q

This is the most common cause of ovarian enlargement in young women.

A

functional ovarian cyst

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16
Q

Most functional cysts typically resolve within __ menstrual cycles.

A

1-2

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17
Q

Follow up of larger functional cysts is usually __ weeks later to show changed appearance or resolution.

A

6

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18
Q

This type of cyst can form when ovulation does not occur or when a mature follicle involutes.

A

follicular cyst

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19
Q

Follicular cysts range from __ in size.

A

3 cm - 8 cm

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20
Q

T/F? Follicular cysts are usually unilateral.

A

true

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21
Q

This type of functional ovarian cyst occurs after an egg has been released from the dominant follicle.

A

corpus luteal

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22
Q

These are less common than follicular cysts but tend to be larger and more symptomatic.

A

corpus luteal

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23
Q

What is the major symptom of a corpus luteal cyst?

A

pain

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24
Q

T/F? Corpus luteal cysts are usually unilateral.

A

true

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25
Q

The corpus luteum continues until what week of pregnancy?

A

16th

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26
Q

This hyperechoic structure results from the regression of a luteal structure from a previous cycle.

A

corpus albicans

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27
Q

Hemorrhage may occur in __ or __ cysts.

A

follicular, corpus luteum

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28
Q

The presence of __ helps confirm the diagnosis of a leaking or ruptured hemorrhagic cyst.

A

free fluid in the cul-de-sac

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29
Q

These are the largest of the functional ovarian cysts.

A

theca-lutein cysts

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30
Q

These ovarian cysts are associated with high levels of hCG.

A

theca-lutein cysts

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31
Q

These ovarian cysts typically occur in patients with GTD and infertility therapy.

A

theca-lutein cysts

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32
Q

Paraovarian cysts are also known as…

A

paratubal cysts.

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33
Q

These cysts are found in the broad ligament.

A

paraovarian cysts

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34
Q

These cysts are most common in the 3rd and 4th decades.

A

paraovarian cysts

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35
Q

These ovarian cysts occur predominantly in premenopausal women with a history of previous abdominal surgery or trauma.

A

peritoneal inclusion cysts

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36
Q

In patients with peritoneal adhesions fluid may accumulate and entrap the ovaries, resulting in…

A

a large adnexal mass.

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37
Q

__ are extra-ovarian and separate from the ovary whereas the ovary lies inside or in the wall of a __ cyst.

A

Paraovarian cysts and hydrosalpinx, peritoneal inclusion

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38
Q

The normal ovaries are usually identified __ to the anteflexed midline uterus.

A

laterally or posterolaterally

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39
Q

When the uterus lies to one side, the ipsilateral ovary lies …

A

superior to the uterine fundus.

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40
Q

In a retroverted uterus, the ovaries tend to be located…

A

laterally and superiorly near the uterine fundus.

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41
Q

When the uterus is enlarged, the ovaries tend to be…

A

displaced more superiorly and laterally.

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42
Q

When the uterus is removed, the ovaries tend to be…

A

more medially and directly superior to the vaginal cuff.

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43
Q

A corpus luteal cyst results from the failure of absorption of the __ or from excess __ into the corpus luteum.

A

dominant follicle, bleeding

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44
Q

This is the presence of functioning endometrial tissue outside the endometrium and myometrium.

A

endometriosis

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45
Q

T/F? Endometriosis can occur everywhere except the bladder and bowel.

A

FALSE, can occur anywhere

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46
Q

The clinical signs of endometriosis?

A
  1. chronic pain with menses
  2. infertility
  3. the 4 Ds
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47
Q

What are the 4 Ds?

A
  1. dysmenorrhea
  2. dyspareunia
  3. dysuria
  4. dyschezia
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48
Q

Localized endometriosis is also known as…

A

endometrioma or ‘chocolate cyst’.

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49
Q

T/F? Localized endometriosis is the most common type.

A

FALSE, diffuse

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50
Q

Diffuse endometriosis causes dys__, dys__, and __.

A

dysmenorrhea, dyspareunia, infertility

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51
Q

T/F? Localized endometriosis is asymptomatic and frequently multiple.

A

true

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52
Q

This is caused from bleeding from abnormally implanted endometrial tissue.

A

localized endometriosis

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53
Q

How is endometrioma different from a hemorrhagic cyst?

A

Hemorrhagic cysts will resolve over time.

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54
Q

The main endometriosis treatment is…

A

surgery.

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55
Q

PCOS is also known as…

A

Stein-Leventhal syndrome

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56
Q

This is an endocrinologic disorder associated with chronic anovulation.

A

PCOS

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57
Q

PCOS is most commonly found in __ women.

A

adolescent girls and young women

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58
Q

T/F? Sonography is essential to PCOS diagnosis.

A

FALSE, diagnosis is serologic

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59
Q

Clinically, PCOS presents with…

A
  1. hyperandrogenism
  2. oligoamenorrhea
  3. amenorrhea
  4. hirsuitism
  5. obesity,
  6. infertility
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60
Q

Sonographically, PCOS appears with __lateral multiple cysts in a string of pearls sign.

A

bilateral

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61
Q

The risk factors for torsion are…

A
  1. Pre-existing ovarian cyst or mass

2. Pregnancy

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62
Q

If the ovary is completely torsed, the Doppler will show…

A

All color flow will be absent.

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63
Q

If the ovary is partially torsed, the Doppler will show…

A

Absent venous flow and diminished arterial flow.

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64
Q

Whet happens to the size of the ovary during a torsion?

A

It becomes enlarged.

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65
Q

Name three clinical symptoms of ovarian torsion.

A
  1. Severe pelvic pain
  2. Nausea and vomiting
  3. Palpable mass (usually on the right) mimicking appendicitis
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66
Q

This is the fourth leading cause of cancer death among women.

A

Ovarian cancer

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67
Q

Ovarian cancer has the highest mortality rate as a result of…

A

Late diagnosis.

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68
Q

Ovarian cancer comprises __% of all gynecologic malignancies.

A

25%

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69
Q

Women with __ are at increased risk of ovarian cancer.

A

A family history of ovarian ca

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70
Q

Women who have __ are at a reduced risk of ovarian cancer.

A

Used oral contraceptives

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71
Q

This lab test is used to follow women with ovarian cancer.

A

CA 125

72
Q

T/F? CA 125 is a screening tool for ovarian cancer.

A

FALSE, is not

73
Q

CA 125 detects __% of first stage ovarian cancer.

A

Less than 50%

74
Q

What would make you highly suspicious that an ovarian mass was carcinoma?

A

If it was in a post menopausal women with elevated CA 125.

75
Q

Ovarian mass dopplers tend to yield __ resistance and __ velocities.

A

Low, high

76
Q

Ovarian rumors are named for the __ and whether or not the tumor is __.

A

Kind of cells it started from, benign or malignant

77
Q

Tumors that start from cells that cover the outer surface of the ovary are called…

A

Epithelial-stromal tumors

78
Q

Tumors that start from cells that produce the ova are called…

A

Germ cell tumors

79
Q

Tumors that start from the sex cords of the embryonic gonad are called…

A

Sex cord-stromal tumors

80
Q

T/F? Most epithelial-stromal tumors are malignant.

A

FALSE, benign

81
Q

Name the five types of epithelial-stromal tumors.

A
  1. serous cystadenoma
  2. mucinous cystadenoma
  3. endometrioid
  4. clear cell
  5. transitional cell (Brenner tumor)
82
Q

These kinds of epithelial-stromal tumors are borderline malignant 10-15% of the time.

A

serous and mucinous cystadenoma

83
Q

These tumors are common, accounting for 25-30% of all ovarian neoplasms.

A

serous tumors

84
Q

Most serous tumors are benign, but serous cystadenocarcinomas account for __ of all malignant ovarian neoplasms.

A

40-50%

85
Q

Benign serous tumors are bilateral __ of the time and occur in women __ yrs old.

A

12-20%, 40-50

86
Q

Malignant serous tumors are bilateral __ of the time and occur in women who are__.

A

50%, peri-/postmenopausal

87
Q

Sonographically, benign serous tumors are __ marginated, usually __locular, with __ septations.

A

sharply, uni-, thin-walled

88
Q

Sonographically, malignant serous tumors have __ projections, __ septations, and __.

A

multiple papillary, thick, ascites

89
Q

Benign mucinous cystadenoma are __ bilateral and more common in women __ yrs old.

A

rarely, 30-50

90
Q

Malignant mucinous cystadenoma are bilateral __ of the time and more common in women __ yrs old.

A

15-20%, 40-70

91
Q

Rupture of a malignant mucinous tumor capsule results in…

A

pseudomyxoma peritonei (malignant ascites)

92
Q

What kind of echoes does malignant mucinous cystadenoma have?

A

fine, gravity-dependent echoes

93
Q

How big is a benign mucinous cystadenoma?

A

up to 50 cm in diameter

94
Q

How big is a malignant mucinous cystadenoma?

A

15-30 cm in diameter

95
Q

80% of these ovarian tumors are malignant (but have a better prognosis than either serous or mucinous carcinomas).

A

endometrioid

96
Q

These account for a quarter of all ovarian carcinomas.

A

endometrioid tumors

97
Q

30% of patients with this tumor have associated…

A

endometrial adenocarcinoma.

98
Q

Sonographically, endometrioid tumors are a cystic mass with…

A

papillary projections.

99
Q

These ovarian tumors are nearly always malignant, but are only 5-10% of epithelial-stromal tumors.

A

clear cell

100
Q

Clear cell tumors are bilateral __ of the time and occur in women __ yrs old.

A

20%, 50-70

101
Q

How big is a clear cell tumor?

A

up to 30 cm

102
Q

Sonographically, clear cell tumors appear…

A

as a complex cyst.

103
Q

Transitional cell tumors are bilateral __ of the time and occur in women __ yrs old.

A

6-7%, 40-80

104
Q

Transitional cell tumors are also known as…

A

Brenner tumors

105
Q

T/F? Transitional cell tumors are almost always benign.

A

true

106
Q

How big is a transitional cell tumor?

A

smaller then 2 cm in diameter

107
Q

Sonographically, transitional cell tumors appear as…

A

a hypoechoic solid mass.

108
Q

T/F? Most germ cell tumors are benign.

A

true

109
Q

In children and adolescents, more than 60% of ovarian neoplasms are __ origin and __ of them are malignant.

A

germ cell, 1/3rd

110
Q

The most common germ cell malignancies…

A
  1. teratomas
  2. dysgerminoma
  3. endodermal sinus tumors
  4. choriocarcinoma
111
Q

Cystic teratoma is also known as…

A

dermoid tumor.

112
Q

Cystic teratoma tumors are bilateral __ of the time and occur in women who are…

A

15%, in their active reproductive years

113
Q

The most common complication of cystic teratoma is…

A

ovarian torsion.

114
Q

This kind of dermoid presents predominantly cystic mass with an echogenic mural nodule which typically casts an acoustic shadow.

A

dermoid plug

115
Q

This kind of dermoid presents as a highly echogenic mass that shadows and obscures the posterior wall of the lesion.

A

‘tip of the iceberg’ sign

116
Q

This kind of dermoid presents as multiple echogenic linear interfaces floating within a cystic mass (hair fibers).

A

dermoid mesh

117
Q

Half of sex cord-stromal tumors are __ while most of the others are __.

A

Fibromas, granulosa

118
Q

Name four kinds of sex cord-stromal ovarian tumors.

A
  1. Fibroma
  2. Thecoma
  3. Granulosa
  4. Sertoli-Leydig
119
Q

Fibroma tumors are bilateral __ of the time and occur in women who are…

A

Rarely, Middle Age

120
Q

How big is a fibroma tumor?

A

Range from Microscopic to large

121
Q

This refers to ascites and pleural effusion and associated with an ovarian fibroma.

A

Meig’s syndrome

122
Q

Meig’s syndrome refers to __ and __ and is associated with __.

A

Ascites, pleural effusion, fibromas

123
Q

T/F? Meig’s syndrome persists after the fibroma is excised.

A

FALSE, resolves

124
Q

Sonographically, fibromas appear…

A

Like a fibroid.

125
Q

Thecoma tumors occur in women who are __ and vary in size from __.

A

Post menopausal with signs of estrogen/androgen activity, tiny to 5-10 cm

126
Q

Granulosa cell tumors occur in women who are __ and produce __.

A

50-55 yrs old, estrogen

127
Q

Juvenile granulosa cell tumors result in…

A

Precocious puberty

128
Q

Sertoli-Leydig is also known as…

A

Androblastoma

129
Q

Sertoli-Leydig tumors are bilateral __ of the time and occur in women who are…

A

Rarely, under 30.

130
Q

How big is a Sertili-Leydig tumor?

A

5-15 cm

131
Q

T/F? Sertili-Leydig tumors are very common.

A

FALSE, rare

132
Q

Sertili-Leydig patients present with symptoms of…

A

Masculinization

133
Q

The most common sites of ovarian mets are from the…

A

Breast and GI tract (stomach cancer)

134
Q

Metastatic tumors are bilateral __ of the time.

A

Most

135
Q

Dysgerminoma tumors are bilateral __ of the time and occur in women __ yrs old.

A

15%, under 30

136
Q

This malignant germ cell tumor comprises 3-5% of ovarian malignancies.

A

dysgerminoma

137
Q

This germ cell tumor is highly radiosensitive with a five year survival rate up to 90%.

A

dysgerminoma

138
Q

Sonographically, dysgerminoma appears as…

A

a multi-lobulated, solid, echogenic mass.

139
Q

Endodermal sinus tumor are also known as…

A

yolk sac tumor.

140
Q

Yolk sac tumors are bilateral __ of the time and occur in women __ yrs old.

A

almost never, 20-30

141
Q

How big is a yolk sac tumor?

A

3-30 cm in diameter

142
Q

This is the second most common malignant ovarian germ cell neoplasm.

A

yolk sac tumor

143
Q

What lab value helps diagnose endodermal sinus tumors?

A

increased serum AFP

144
Q

Sonographically, an endodermal sinus tumor appears…

A

like a dysgerminoma.

145
Q

Half of these tumors are fibromas while most of the others are granulosa cell tumors.

A

sex cord-stromal tumors

146
Q

Name four kinds of sex cord-stromal tumors.

A
  1. fibroma
  2. thecoma
  3. granulosa
  4. Sertoli-Leydig
147
Q

Fibroma tumors are bilateral __ of the time and occur in women __ yrs old.

A

rarely, middle age

148
Q

How big is a fibroma?

A

from microscopic to large

149
Q

This refers to ascites and pleural effusion and associated with fibroma.

A

Meig’s syndrome

150
Q

Meig’s syndrome refers to __ and __ and associated with __.

A

ascites, pleural effusion, fibroma

151
Q

T/F? Meig’s syndrome persists after the removal of the tumor.

A

FALSE, resolves

152
Q

Sonographically, fibromas appear…

A

like a fibroid (hypoechoic with posterior acoustic attenuation).

153
Q

Thecoma tumors occur in women __ yrs old.

A

postmenopausal women who present with clinical signs of estrogen or androgen activity

154
Q

How big is a thecoma?

A

tiny to 5-10 cm

155
Q

Granulosa tumors occur in women __ yrs old.

A

50-55

156
Q

How big is a granulosa?

A

small (and solid)

157
Q

Granulosas produce…

A

estrogen.

158
Q

Juvenile granulosa cell tumors result in…

A

precocious puberty.

159
Q

Most granulosa cell tumors happen in…

A

adults.

160
Q

Sertoli-Leydig tumors are also known as…

A

androblastoma.

161
Q

Sertoli-Leydig tumors are bilateral __ of the time and occur in women __ yrs old.

A

rarely, under 30

162
Q

T/F? Sertoli-Leydig tumors are very common.

A

FALSE, rare

163
Q

Patients with Sertoli-Leydig may present with symptoms of…

A

masculinization.

164
Q

How big is a Sertoli-Leydig tumor?

A

5-15 cm

165
Q

The most common primary sites of ovarian mets are from the…

A
  1. breast

2. GI tract (stomach cancer)

166
Q

How does a metatstatic tumor spread?

A
  1. direct invasion
  2. peritoneal fluid
  3. blood and lymphatics
167
Q

This specific type of metastatic ovarian cancer most commonly arises from gastric carcinoma.

A

krukenberg tumor

168
Q

Krukenberg tumors are bilateral __ of the time.

A

all

169
Q

Sonographically, krukenberg tumors appear as…

A

solid ovarian masses with possible ascites.

170
Q

These very rare tumors typically affect girls and young women, spreading rapidly, but sensitive to chemotherapy.

A

choriocarcinoma

171
Q

T/F? Choriocarcinoma is more likely to start from the placenta than from the ovary.

A

true

172
Q

Describe a stage one ovarian malignancy.

A

growth limited to one ovary, no ascites

173
Q

Describe a stage two ovarian malignancy.

A

growth involving one or both ovaries with pelvic extension

174
Q

Describe a stage three ovarian malignancy.

A

growth involving one or both ovaries with pelvic extension and/or retroperitoneal nodes, limited to the true pelvis

175
Q

Describe a stage four ovarian malignancy.

A

growth involving one or both ovaries with distant mets, possible pleural effusion

176
Q

Most ovarian cancer patients are diagnosed with…

A

advanced stage III or IV.

177
Q

Ovarian cancer patients with stages I or II will…

A

develop a recurrence of the disease.

OB/GYN Scanning (14 decks)

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