OVARIAN TUMORS

Question 1

UTZ cannot reliably differentiate benign from malignant BUT _________

Answer 1

it could assess malignant characteristics:
simplex vs complex cysts

echogenic structures protruding into the mass

solid lesions or cystic lesions with solid components

thick septations

Question 2

Rule out neoplasm if diameter of the cyst remains stable for more than ___ weeks or ____ months-ish

Answer 2

10 weeks or 3 months

Question 3

marker helpful in assessing adnexal mass in postmenopausal women

Answer 3

CA 125

Question 4

What are the indications of conservative management for follicular cysts

Answer 4

Simple cyst

not larger than 10 cm mass

Question 5

Why opt for conservative management on follicular cyst?

Answer 5

majority of cysts disappear spontaneously either via REABSORPTION of the cyst fluid or SILENT RUPTURE within 4-8 weeks

Question 6

What are the indications for surgical treatment

Answer 6

persistence of ovarian mass

CYSTECTOMY or OOPHORECTOMY

Question 7

What is the medical treatment for follicular cysts

Answer 7

OCPs may be given for 4 to 6 weeks in young women with adnexal mass in order to remove pituitary gonodatropin influence on cyst

Question 8

What are the indications of surgical management for follicular cysts

Answer 8

anything other than simple cyst

CA 125 is >35

Question 9

How long to observe simple follicular cysts

Answer 9

UTZ and CA-125 testing every 6 months for 2 years

Question 10

OPERATIVE MANAGEMENT for NONMALIGNANT CYSTS in PREMENOPAUSAL WOMEN

Answer 10

Oophorocystectomy (not oophorectomy)
-can be handled laparoscopically, but may have risk of spilling malignant cells into peritoneal cavity if the cyst is an early carcinoma

Question 11

OPERATIVE MANAGEMENT for NONMALIGNANT CYSTS in PREMENOPAUSAL WOMEN

Strict Pre-operative criteria should be

Answer 11

1. woman’s age (premenopausal)
2. Size of mass is RESECTABLE
3. Ultrasound characteristic: non-adherent, smooth, and thin-walled cysts without papillae or internal echoes (cystic)

Question 12

Ultrasound characteristic of a simple cyst:

Answer 12

non-adherent, smooth, and thin-walled cysts without papillae or internal echoes (cystic)

Question 13

Size of the cyst for it to be considered as corpus luteum cyst?

Answer 13

3 cm

Question 14

Corpus luteum cyst

When does it appear?
What hormone?
When does it disappear

Answer 14

appears on 2nd half of cycle due to Progesterone acts on corpus luteum
disappears after menstruation

Question 15

most common neoplasm in prepubertal girls

Answer 15

dermoid cyst

Question 16

When a patient comes in with abdominal pain, right side… and you are thinking of torsion… ask if it coincides with MENSES?

Answer 16

Pwede kasing corpus luteum cyst (more clinically important)

Question 17

consistency of dermoid cyst

Answer 17

doughy consistency

Question 18

Why do you need to request TSH levels when you are suspecting a dermoid cyst

Answer 18

Struma Ovarii -thyroid tissue can be found in benign teratoma

usually unilateral <10 cm in diameter

Thyrotoxicosis

Question 19

What predisposes the teratoma to torsion?

Answer 19

most frequent complication

free floating and movable
weight predisposes it to torsion, presence of sigmoid colon on the left
—> twisting

Question 20

What are the expected findings in an ovarian teratoma?

Answer 20

Large mass with regions of increased echogenicity representing fat and regions of decreased echogenicity representing fluid

Echogenic solid nodule protruding from the wall –> acoustic shadowing

(+) Dermoid mesh - tufts of hair

Question 21

Treatment for Dermoid Cyst

Answer 21

Laparoscopic cystectomy

Laparoscopic oophorecystectomy

Question 22

cut off for laparoscopic approach

Answer 22

10 cm

Question 23

Differentiate Pathologic ONG from Physiologic Ong in terms of age, size, cyclicity (in relation to menses), consistency and sonographic features

Answer 23

PHYSIOLOGIC: reproductive age, up to 6 cm, follicular/corpus luteum spontaneously regresses, cystic
(+) unilocular, THIN walled, hypoechoic, (-) color flow

PATHOLOGIC: post menopausal, usually >6 cm, No cyclicity and persistent, cystic or solid
(+) multilocular, thick-walled, mixed echogenicity within, may have PAPILLA, SEPTA, SOLID AREAS (+) color flow

Question 24

MEIG’S SYNDROME (Fibroma)

Answer 24

1. ascites - transudation of fluid from fibroma

2. hydrothorax - ascitic fluid flows into pleural space via DIAPHRAGM lymphatics