Ovarian Pathology Flashcards
What are the sonographic findings of simple ovarian cysts?
- anechoic
- unilocular
- thin-walled
What percentage of ovarian cysts resolve spontaneously?
60%
Sonographic and clinical follow up is recommended when an ovarian cyst exceeds ___ cm.
3 cm
What are functional cysts? What do they result from?
- generic hormonally active cysts
- result from stimulation of released pituitary gonadotropins
What is the most common cause of ovarian enlargement in young women?
functional cysts
Name 3 types of functional cysts
- follicular cysts
- corpus luteal cysts
- theca lutein cysts
What are follicular cysts caused by? What happens after this?
- overstimulation of a follicle that fails to rupture or involute
- serous fluid distends the lumen of the follicle, creating a cyst
Most follicular cysts are ______ cm and are ________. What is the maximum measurement of a normal dominant follicle?
- 3-8cm
- unilocular
- 3cm
When do corpus luteal cysts occur?
following ovulation of the dominant follicle
In the absence of pregnancy, what happens to the CL cyst?
may continue to grow or hemorrhage into the lumen
CL cysts rarely exceed ___ cm and may contain ________.
- 4cm
- internal echoes
What do CL cysts secrete? When do they resolve by in pregnancy?
- progesterone
- resolve by 16 weeks
Name 4 sonographic findings of CL cysts.
- thick hyperechoic irregular walls
- usually echogenic internal content
- possible solid appearance
- low resistance flow along periphery
Which are the largest of the functional cysts?
theca lutein
Theca lutein cysts do not secrete ______.
hormones
Theca lutein cysts are ________ and _________. What do they result from?
- multilocular
- bilateral
result from overstimulation by high levels of hCG associated with gestational trophoblastic disease or hCG administration during infertility treatment
How long do theca lutein cysts persist? Do they resolve without surgery?
- may persist for days or weeks
- generally involute without surgery
What do hemorrhagic cysts result from?
- large size of ovarian cyst
- spontaneous rupture
- torsion
What do patients with hemorrhagic cysts present with?
sudden onset of pelvic pain
What are the sonographic findings of a hemorrhagic cyst? (4) Include an acute hemorrhage and subacute hemorrhage.
- typical cystic characteristic
- acute hemorrhage = hyperechoic (!!!), mimicking a solid mass but with posterior acoustic enhancement
- subacute hemorrhagic cyst = complex appearance with internal echoes, strands, rarely a fluid-fluid level
- sonographic appearance of hemorrhagic cyst will vary with time with clot lysis
What happens in ovarian torsion?
- there is partial or complete rotation of the ovarian pedicle on its axis
- lymphatic and venous drainage is compromised
- this causes congestion and edema of the ovary — leading to loss of arterial perfusion and resultant infarction
What is the clinical presentation of ovarian torsion?
sudden onset pelvic pain
What can right sided torsion mimic?
acute appendicitis
What are the 3 risk factors for ovarian torsion?
- pre-existing ovarian cyst or mass (usually benign)
- children and young females with mobile adnexa (ovary is usually normal)
- pregnancy
What are the sonographic findings of ovarian torsion?
- enlarged ovary, often with multiple follicles
- Doppler findings depend on degree and chronicity of torsion:
- –absent color and spectral Doppler
- –possible arterial Doppler flow but absent venous flow
- –dampened arterial flow (compare flow to both ovaries)
- “whirlpool” sign - twisted ovarian vessels
- possible adnexal mass
Which sonographic finding is more common in peds?
abdnormal/midline position of ovary
What is another name for PCOS?
Stein-Leventhal syndrome
What is PCOS?
an endocrinology disorder associated with chronic anovulation
When is PCOS usually diagnosed?
late teens, early 20’s
What is diagnosis based off of for PCOS?
clinical and serologic findings
What are the clinical signs of PCOS?
- infertility
- obesity
- amenorrhea
- hirsutism (hairy)
What are the serum laboratory findings for PCOS?
- FSH: decreased (or normal)
- LH: increased
- testosterone: increased
- AMH (anti-Mullerian Hormone): increased
Name 4 sonographic findings of PCOS.
- bilateral multiple cysts (< 1 cm) throughout sub capsular and stromal ovarian tissue (greater than or equal to 12-19 follicles per ovary– 19 is preferred now I guess)
- ovarian volume > 10cm cubed
- small symmetric cysts in the periphery - “string of pearls”
- always bilateral
Tumors arising from the surface epithelium account for ______% of all ovarian neoplasms and _____% of all ovarian malignancies.
- 65-75%
- 90%
Name the 5 categories of epithelial tumors, based on differentiation.
- serous
- mucinous
- endometroid
- clear cell
- transitional cell (Brenner)
What are the three categories of the proliferative changes of epithelial tumors?
- benign
- atypically proliferating (borderline)
- malignant
Serous tumors are _______, accounting for _____% of all ovarian neoplasms. _____% are benign, but serous cystadenocarcinomas account for 40-50% of all malignant ovarian neoplasms.
- common
- 25-30%
- 50-70%
- 40-50%
How often are benign serous tumors bilateral? Who do they most commonly occur in? What is another name for them?
- bilateral 12-20% of the time
- occur most commonly in women 40-50 years of age
- serous cystadenoma
How often are malignant serous tumors bilateral? Who do they most commonly occur in? What is another name for them?
- bilateral 50% of the time
- occur most commonly in peri- and postmenopausal women
- serous cystuadenocarcinoma
What is the most common type of ovarian cancer?
serous cystadenocarcinoma
Typically, serous tumors are _______ in size than mucinous tumors.
smaller
Name 4 sonographic findings of benign serous cystadenomas.
- sharply marginated
- anechoic
- large, but usually unilocular
- possibly internal thin-walled septations
Name 5 sonographic findings of serous cystadenocarcinoma.
- multilocular
- multiple papillary projections/septations
- occasional echogenic material within
- possible multiple echogenic foci
- ascites
Benign mucinous tumors comprise _____% of all benign ovarian neoplasms. What ages are these most common in? Are they commonly bilateral? What is another name for them?
- 20-25%
- women 30-50 years old
- very rarely bilateral
- AKA mucinous cystadenomas
Malignant mucinous tumors account for _____% of all malignant primary neoplasms. What ages are these most common in? What percentage are bilateral?
- 5-10%
- women 40-70 years old
- 15-20% bilateral
How does pseudomyxoma peritonei occur?
penetration of the tumor capsule (in mucinous tumors) or rupture may spread mucin-secreting cells into the peritoneal cavity, filling it with gelatinous material.
Does pseudomyxoma peritonei occur with benign or malignant tumors? What is it’s sonographic appearance similar to?
- both - benign or malignant
- similar to ascites, possibly with multiple septations
Name 3 sonographic findings of benign mucinous cystadenoma.
- multiloculated, with thicker and more numerous septations
- fine, gravity-dependent echoes
- up to 50cm in diameter
Name 3 sonographic findings of mucinous cystadenocarcinoma.
- multiloculated cystic lesions measuring 15-30cm in diameter
- contain echogenic material and papillary excrescences
What percentage of endometroid tumors are malignant?
80%
Which have a better prognosis, serous/mucinous carcinomas or endometroid tumors?
endometroid tumors
Endometroid tumors account for _____% of all ovarian carcinomas.
20-25%
What are endometroid carcinomas identical to?
endometroid adenocarcinoma
What are the sonographic findings for endometroid tumors? (3)
- mixed cystic and solid mass
- in some cases, there may be a predominantly solid mass, possibly with areas of hemorrhage or necrosis
- may have associated endometrial abnormality
What percentage of germ cell tumors account for all ovarian neoplasms?
20%
In adults, most germ cell tumors are ______, with 95% being __________.
- benign
- cystic teratomas
In children and adolescents, more than ____% of ovarian neoplasms are of germ cell origin and _____ of them are malignant.
- 60%
- 1/3
What are the three types of germ cell tumors?
- benign cystic teratoma
- dysgerminoma
- endodermal sinus tumor
What is the most common germ cell tumor of the ovary?
benign cystic teratoma
Benign cystic teratoma’s (BCT) account for ______% of ovarian neoplasms.
15-25%
BCTs are usually found in women of _______________.
active reproductive years
What are the layers of BCT’s?
- endoderm
- mesoderm
- ectoderm
What is another name for benign cystic teratoma’s? Which layer does this contain?
- dermoid cyst
- ectoderm
What percentage of of BCTs are bilateral?
up to 15%
What are the symptoms of benign cystic teratomas?
- usually asymptomatic
symptoms may include: - abdominal pain (especially with torsion)
- abdominal mass or swelling
What is the most common complication of benign cystic teratomas? What about less commonly?
most common: ovarian torsion
less commonly: rupture
What are immature teratomas called?
teratocarcinoma
What are immature teratomas? When do they most commonly occur?
very rare, rapidly growing solid malignant tumors
most commonly occur in first 2 decades of life
What is a dermoid plug?
predominantly cystic mass with an echogenic mural nodule
typically casts acoustic shadow
What is a dermoid mesh?
multiple echogenic linear interfaces floating within a cystic mass (hair fibers)
Describe the sonographic features of a teratoma.
- predominantly cystic adnexal mass
- complex mass with calcifications
- fat-fluid level (changes with patient position)
- diffusely echogenic
What are homologous to testicular seminomas?
dysgerminoma
What is a dysgerminoma? Who do they occur in?
malignant germ cell tumor
women under 30 years of age
Sonographic findings of dysgerminomas
- multilobulated solid mass, size variable
- may be bilateral
What is the second most common germ cell tumor? What is the most common germ cell tumor?
second most - endodermal sinus (YS) tumor
most common - dysgerminoma?
What ages get YS tumors?
ages 20-30 years old
Are YS tumors unilateral or bilateral? What lab values are increased with these? What are the sonographic findings?
- unilateral
- increased AFP/LDH/hCG
- predominantly solid mass with necrosis
What percentage of ovarian tumors are sex cord stromal?
8%
Half of sex cord stromal tumors are what?
fibromas
What percentage of fibromas account for all ovarian pathology?
4%
Fibromas are benign or malignant? Occur at what age? Unilateral or bilateral?
- benign
- all ages, frequently 40s-50s
- unilateral
What is Meig’s syndrome associated with?
- ascites
- pleural effusions
- fibromas
What are the sonographic findings of a fibroma?
- similar to pedunculated fibroid or Brenner tumor
- homogeneous, hypoechoic mass with posterior acoustic shadowing (highly attenuating mass)
- rarely focal or diffuse calcifications
What percentage of ovarian tumors do thecomas account for?
1%
Thecomas are _______ producing. Who do they most commonly occur in?
estrogen
postmenopausal women
Sonographic findings of thecomas
- solid hypoechoic
- posterior shadowing
- possibly abnormally thick endometrium due to hormonal stimulation
- similar to fibromas
