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Female Pelvis > ovarian pathology ch 44 > Flashcards

ovarian pathology ch 44 Flashcards

1
Q

Normal Sonographic Appearance

A
  • Homogeneous echotexture
  • May exhibit central, more echogenic
    medulla.
  • Small anechoic or cystic follicles may be
    seen peripherally in cortex.
  • Appearance varies with age and menstrual
    cycle.
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2
Q

During early proliferative phase,

A

many follicles develop and increase in size until about day 8 or 9 of cycle due to stimulation by both follicle-stimulating hormone (FSH) and luteinizing hormone (LH).

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3
Q

At that time, one follicle becomes dominant,
reaching up to

A

2.0 to 2.5 cm at time of
ovulation.

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4
Q

Follicular cyst develops

A

if fluid in
nondominant follicles not reabsorbed

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5
Q

Dominant follicle usually

A

disappears
immediately after rupture at ovulation.

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6
Q

Occasionally follicle decreases in

A

size and develops a wall that appears crenulated (scalloped).

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7
Q

Following menopause,

A

ovary atrophies and follicles disappear with
increasing age.

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8
Q

Postmenopausal ovaries are difficult to visualize

A

sonographically because of smaller size and lack of discrete follicles.

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9
Q

Stationary loop of bowel may

A

mimic small shrunken ovary; look for
peristalsis in bowel.

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10
Q

After hysterectomy,

A

ovaries can be difficult to visualize with
ultrasound.

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11
Q

Ovarian Volume

A
  • In adult menstruating female, normal ovary may have volume as large as 22 cc, with mean ovarian volume of 9.8 ± 5.8 cc.
  • Volume of more than 8.0 cc considered abnormal for postmenopausal patient.
  • Volume of more than twice that of opposite side should also be considered abnormal, regardless of actual size.
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12
Q

Cystic Masses

A

Majority of ovarian masses simple
cysts, most of which are benign

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13
Q

Cystic Masses Sonographic Findings

A
  • thin smooth wall
  • anechoic contents
  • acoustic enhancement
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14
Q

Cystic masses are

A

mostly fluid-filled, may
have some echoes

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15
Q

Common Cystic Masses

A
  • Follicular cyst
  • Corpus luteum cyst of pregnancy
  • Cystic teratoma
  • Paraovarian cyst
  • Hydrosalpinx
  • Endometrioma (low-level echoes)
  • Hemorrhagic cyst
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16
Q

Complex masses may

A

have cystic and solid components, usually are cystic with many internal echoes or debris

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17
Q

common complex masses

A
  • Cystadenoma
  • Dermoid cyst
  • Tubo-ovarian abscess
  • Ectopic pregnancy
  • Granulosa cell tumor
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18
Q

Mixed solid to cystic ovarian masses typical of all

A

epithelial ovarian tumors

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19
Q

During peak fertile years,

A

only 1 in 15 malignant; ratio becomes 1 in 3 after age 40

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20
Q

sonographically complex the mass,

A

more likely to be malignant, especially
if associated with ascites

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21
Q

solid masses

A

large and often fill pelvic cavity

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22
Q

When solid mass found,

A

care taken to identify connection with uterus
to differentiate ovarian lesion from pedunculated fibroid

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23
Q

Color Doppler helpful with solid mass by

A

using color to identify vascular pedicle between uterus and mass, as can often be identified with pedunculation

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24
Q

Solid masses are usually

A

hypoechoic or hyperechoic with no fluid levels, may be heterogeneous

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25
Q

common solid masses

A
  • Solid teratoma
  • Adenocarcinoma
  • Arrhenoblastoma
  • Fibroma
  • Dysgerminoma
  • Torsion
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26
Q

Suspected cystic lesion: color Doppler helpful in

A

differentiating potential cyst from adjacent
vascular structures

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27
Q

Color can be used to

A

localize flow to further determine flow velocity with pulsed Doppler; can
be obtained on all ovarian masses

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28
Q

Pulsed Doppler interrogation of adnexal branch of uterine artery, ovarian artery, intratumoral flow performed to determine

A

resistive index or
pulsatility index

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29
Q

Largest study uses cutoff of

A

> 0.4 as normal RI in nonfunctioning ovary.

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30
Q

Other investigators use PI of

A

> 1 as normal.

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31
Q

Signs that may be worrisome for malignancy:

A
  • intratumoral vessels
  • low-resistance flow
  • absence of normal diastolic notch in Doppler waveform
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32
Q

Abnormal waveforms can be seen in

A

inflammatory masses, metabolically active
masses (including ectopic pregnancy), and corpus luteum cysts.

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33
Q

RI is not a sensitive indicator of

A

malignancy

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34
Q

Mass showing complete absence or minimal
diastolic flow (very elevated RI and PI values)
usually

A

benign.

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35
Q

Inflammatory masses, active endocrine tumors, and trophoblastic disease (ectopic pregnancies) may give low indices, mimicking

A

cancer.

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36
Q

Follicular Cysts occur when

A

dominant follicle does not succeed in ovulating and remains active though immature

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37
Q

Follicular Cysts usually

A

unilateral

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38
Q

Follicular Cysts

A

Thin-walled, translucent, have watery fluid; may project above or within
surface of ovary

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39
Q

Follicular Cysts may grow

A

1 to 8 cm

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40
Q

Follicular Cysts usually disappear

A

spontaneously by resorption or rupture

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41
Q

Clinical findings of follicular cyst

A

asymptomatic to dull, adnexal pressure and pain

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42
Q

Sonographic findings of follicular cyst

A

simple cyst

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43
Q

Corpus Luteum Cysts result from

A

hemorrhage within persistently mature
corpus luteum

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44
Q

Corpus Luteum Cysts is filled with

A

blood and cystic fluid

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45
Q

Corpus Luteum Cysts may grow

A

1 to 10 cm in size

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46
Q

Corpus Luteum Cysts may accompany

A

intrauterine pregnancy (IUP)

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47
Q

Corpus Luteum Cysts clinical findings:

A
  • irregular menstrual cycle
  • pain
  • mimic ectopic pregnancy
  • rupture
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48
Q

Corpus Luteum Cysts sonographic findings:

A

“cystic” type of lesion; may have internal echoes secondary to hemorrhage and increased color

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49
Q

Hemorrhagic Cysts internal hemorrhage may occur in

A

follicular cysts or, more commonly, in corpus luteal cysts.

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50
Q

Hemorrhagic Cysts patient may present with

A

acute onset of pelvic pain

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51
Q

acute hemorrhagic cyst usually

A

hyperechoic; may mimic solid mass.

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52
Q

Hemorrhagic Cysts usually has

A

smooth wall with posterior acoustic
enhancement indicating its cystic component

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53
Q

Hemorrhagic Cysts internal pattern becomes

A

more complex.

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54
Q

Theca-Lutein Cysts

A

large, bilateral, multiloculated cysts

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55
Q

Theca-Lutein Cysts associated with

A

high levels of human chorionic gonadotropin

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56
Q

Theca-Lutein Cysts seen in

A

30% of patients with trophoblastic disease

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57
Q

Theca-Lutein Cysts regress after

A

hCG levels diminish

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58
Q

Theca-Lutein Cysts clinical findings

A

nausea and vomiting

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59
Q

Theca-Lutein Cysts sonographic findings

A

multilocular cysts in both ovaries

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60
Q

Paraovarian Cysts located

A

adjacent to the ovary, but not attached

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61
Q

Paraovarian Cysts commonly arise from

A

fallopian tubes or broad ligaments

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62
Q

Paraovarian Cysts can range

A

in size and contribute to pelvic pain

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63
Q

Paraovarian Cysts may cause

A

ovarian torsion due to nature of cyst

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64
Q

Most common benign ovarian tumor

A

Cystic Teratoma (Dermoid)

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65
Q

Cystic Teratoma (Dermoid) Also is referred to as a

A

dermoid cyst

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66
Q

Cystic Teratoma(Dermoid)

A

Germ cell tumor

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67
Q

Cystic Teratoma (Dermoid) result from the

A

retention of an unfertilized
ovum

68
Q

Cystic Teratoma
(Dermoid) composed of the three germ cell layers

A
  • ectoderm
  • mesoderm
  • endoderm
69
Q

Cystic Teratoma (Dermoid) can contain

A

hair, teeth, bone, cartilage, etc.

70
Q

Cystic Teratoma (Dermoid) “Tip of the Iceberg” Sign due to

A

posterior shadowing of lesion

71
Q

Polycystic Ovary Syndrome
(PCOS) AKA

A

Stein-Leventhal Syndrome

72
Q

Polycystic Ovary Syndrome
(PCOS) bilaterally

A

enlarged polycystic ovaries

73
Q

Polycystic Ovary Syndrome
(PCOS) occurs in

A

late teens through 20s

74
Q

Polycystic Ovary Syndrome
(PCOS) may have

A

endocrine imbalance

75
Q

Polycystic Ovary Syndrome
(PCOS) spectrum of

A

sonographic appearances

76
Q

Polycystic Ovary Syndrome
(PCOS) clinical findings

A
  • amenorrhea
  • obesity
  • infertility
  • hirsutism
77
Q

Polycystic Ovary Syndrome
(PCOS) sonographic findings

A

multiple tiny cysts around periphery of ovary; ovary may be normal size or enlarged

78
Q

women undergoing ovulation induction by the administration of hormones are at
increased risk for

A

OHS

79
Q

Ovarian Hyperstimulation Syndrome Ovaries can become

A

enlarged and measure up to 12cm.

80
Q

Ovarian Hyperstimulation Syndrome ovary will also contain

A

multiple large follicles that could turn into theca-lutein cysts due to the patient’s hCG levels

81
Q

Ovarian Hyperstimulation Syndrome clinical-

A

fertility treatment, electrolyte imbalance, nausea, vomiting, abdominal distension, ovarian enlargement, oliguria (low urine output)

82
Q

Ovarian Hyperstimulation Syndrome sono

A

cystic enlargement of ovaries >5cm, ascites, possible pleural effusion

83
Q

Sex cord-stromal tumors are

A

masses that arise from sex cords
of embryonic gonadal and/or ovarian
stroma.

84
Q

Thecoma

A

Sex cord-stromal tumor

85
Q

Thecoma often found in

A

postmenopausal women

86
Q

Thecoma may be associated with

A

Meigs syndrome (having abbenign ovarian tumor with ascites and pleural effusion)

87
Q

Thecoma is

A

estrogen-producing

88
Q

Thecoma clinical

A

Postmenopausal bleeding

89
Q

Thecoma sono:

A

hypoechoic, solid mass with posterior
attenuation

90
Q

Granulosa Cell Tumors most common

A

estrogenic tumor

91
Q

Granulosa Cell Tumors

A

Sex cord-stromal tumor

92
Q

Granulosa Cell Tumors is

A

estrogen-producing

93
Q

Granulosa Cell Tumors can be linked to

A

pseudoprecocious puberty

94
Q

Granulosa Cell Tumors ptential for

A

malignancy

95
Q

Granulosa Cell Tumors appearance can be

A

unpredictable

96
Q

Fibroma

A

Sex cord-stromal tumor

97
Q

Fibroma NOT associated with

A

estrogen production

98
Q

Fibroma can undergo

A

malignant degeneration

99
Q

Fibroma sono

A

hypoechoic, solid mass with posterior
attenuation

100
Q

Fibroma appearance

A

similar to thecoma

101
Q

Endometrioma (Chocolate Cyst)

A

Benign, blood-containing tumor

102
Q

Endometrioma (Chocolate Cyst) associated with

A

endometriosis

103
Q

Endometrioma (Chocolate Cyst) forms from

A

implantation of ectopic endometrial tissue

104
Q

Endometrioma (Chocolate Cyst) can be located

A

anywhere outside the endometrial cavity, including any other pelvic organ

105
Q

Endometrioma (Chocolate Cyst) most commonly found on the

A

ovary

106
Q

Endometrioma (Chocolate Cyst) sono

A

cystic mass with low level internal echoes, may have a fluid-fluid level

107
Q

Serous Cystadenoma

A

Epithelial tumor

108
Q

Serous Cystadenoma 50-70% are

A

benign

109
Q

Serous Cystadenoma often

A

large and bilateral

110
Q

Serous Cystadenoma sono

A

mostly anechoic that contains
septations or papillary projections

111
Q

Serous Cystadenoma clinical

A

Patients usually asymptomatic,
maybe pelvic pain

112
Q

Mucinous Cystadenoma

A

Epithelial tumor

113
Q

Mucinous Cystadenoma often

A

larger than serous

114
Q

Mucinous Cystadenoma also have

A

septations and/or projections

115
Q

Mucinous Cystadenoma not as often

A

bilateral

116
Q

Mucinous Cystadenoma sono

A

similar appearance to serous, but presence of
internal debris distinguishing factor between the two

117
Q

Mucinous Cystadenoma clinical

A

pelvic pressure and swelling due to large size

118
Q

Ovarian Torsion also referred to

A

adnexal torsion, since it can involve the fallopian tube as well

119
Q

Ovarian Torsion occurs most often on the

A

right side

120
Q

Ovarian Torsion can also be detected in the

A

fetus

121
Q

Ovarian Torsion

A

pedicle partially or completely rotates on its axis, compromising lymphatic and venous drainage

122
Q

Ovarian Torsion clinical

A

acute unilateral pain, nausea and vomiting, slight leukocytosis

123
Q

Ovarian Torsion sono

A

enlarged ovary, small peripherally located follicles, lack of or diminished
flow patterns in comparison to contralateral ovary, “whirlpool sign”, excessive free
fluid

124
Q

Most common malignancy of the ovary

A

Serous Cystadenocarcinoma

125
Q

Serous Cystadenocarcinoma frequently

A

bilateral

126
Q

resembles the serous cystadenoma, but

A

has more prominent projections and thicker
septations

127
Q

Serous Cystadenocarcinoma clinical

A

weight loss, pelvic pressure, abnormal
vaginal bleeding, gastrointestinal issues

128
Q

Mucinous Cystadenocarcinoma less often

A

bilateral

129
Q

Mucinous Cystadenocarcinoma associated with

A

pseudomyxoma peritonei (intraperitoneal extension of mucin-secreting cells resulting from rupture of mucinous tumor, fluid from mass resembles ascites)

130
Q

Mucinous Cystadenocarcinoma clinical

A

similar to serous counterpart

131
Q

Krukenberg Tumor that most likely metastasized from

A

gastrointestinal tract

132
Q

Krukenberg Tumor most frequent origin is

A

the stomach (gastric cancer)

133
Q

Krukenberg Tumor often

A

bilateral

134
Q

Krukenberg Tumor sono

A

smooth-walled, hypoechoic or
hyperechoic

135
Q

Krukenberg Tumor clinical

A

asymptomatic, hx of gastric
cancer, possible weight loss, pelvic pain

136
Q

Sertoli-Leydig Cell Tumor (Androblastoma)

A

Sex cord-stromal tumor

137
Q

Sertoli-Leydig Cell Tumor (Androblastoma) found more often in women

A

younger than 30.

138
Q

Sertoli-Leydig Cell Tumor (Androblastoma) sono

A

solid hypoechoic mass, or complex mass

139
Q

Sertoli-Leydig Cell Tumor (Androblastoma) clinical

A

virilization (development of male characteristics), abnormal menstruation, hirsutism

140
Q

Ovarian cancer accounts for more

A

deaths than any other of the female
reproductive system.

141
Q

Most common malignant germ cell tumor of
ovary

A

Dysgerminoma

142
Q

Dysgerminoma most likely found in patients

A

under 30

143
Q

Dysgerminoma most frequent ovarian malignancy found in

A

childhood

144
Q

Dysgerminoma sono

A

ovoid, solid, echogenic mass, may have
cystic components

145
Q

Dysgerminoma clinical

A

pseudoprecocious puberty (children), elevated serum lactate dehydrogenase,
possible elevated hCG

146
Q

Yolk Sac Tumor AKA

A

endodermal sinus tumor

147
Q

Yolk Sac Tumor

A

Germ cell tumor

148
Q

Yolk Sac Tumor is

A

rapid growth, highly malignant

149
Q

Yolk Sac Tumor occurs in

A

females younger than 20 yrs

150
Q

Yolk Sac Tumor has a

A

Poor prognosis

151
Q

Yolk Sac Tumor sono

A

homogeneous echogenic mass, varying
appearances

152
Q

Yolk Sac Tumor clinical

A

Serum AFP (alpha- fetoprotein) elevated

153
Q

Endometrioid Tumor (Endometrioid Carcinoma) high incidence of

A

malignancy

154
Q

Endometrioid Tumor (Endometrioid Carcinoma) often seen in women during

A

their fifth and sixth decade of life

155
Q

Endometrioid Tumor (Endometrioid Carcinoma) associated with

A

hx of endometrial cancer or endometriosis

156
Q

Endometrioid Tumor (Endometrioid Carcinoma) Sono

A

complex mass with solid components or cystic mass with papillary projections

157
Q

Ovarian Cancer STAGE I:

A
  • Limited to ovary
  • Limited to 1 ovary
  • Limited to 2 ovaries
  • Positive peritoneal lavage (ascites)
158
Q

Ovarian Cancer STAGE II:

A
  • Limited to pelvis
  • Involvement of uterus/fallopian tubes
  • Extension to other pelvic tissues
  • Positive peritoneal lavage (ascites)
159
Q

Ovarian Cancer STAGE III:

A

Limited to abdomen: intraabdominal extension outside pelvis/retroperitoneal nodes/extension to small bowel/omentum

160
Q

Ovarian Cancer STAGE IV:

A

Hematogenous disease (liver parenchyma)/spread beyond abdomen

161
Q

Carcinoma of the Fallopian Tube

A

Least common (<1%) of all gynecologic malignancies

162
Q

Carcinoma of the Fallopian Tube Adenocarcinoma is the most common

A

histological finding

163
Q

Carcinoma of the Fallopian Tube occurs most frequently in

A

postmenopausal women with pain, vaginal bleeding, pelvic mass

164
Q

Carcinoma of the Fallopian Tube usually involves

A

distal end; may involve entire length
of tube

165
Q

Carcinoma of the Fallopian Tube sono

A

sausage-shaped, complex mass with cystic and solid components, often with papillary projections

166
Q

Carcinoma of the Fallopian Tube clinical

A

similar to ovarian carcinoma

Female Pelvis (5 decks)

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