Ovaries

Question 1

Ovarian cysts - Ddx

Answer 1

• Benign ovarian ➤ functional cyst, endometriomas, serous cystadenoma, mucinous cystadenoma, mature teratoma
• Benign non-ovarian ➤ paratubal cyst, hydrosalpinges, tube-ovarian abscess, peritoneal pseudocyst, appendices abscess, diverticula abscess, pelvic kidney
• 1° malignant ovarian ➤ germ cell tumours, epithelial carcinoma, sex-cord tumour
• 2° malignant ovarian ➤ breast CA, GI CA

Question 2

Endometrioma = chocolate cyst - Infos

Answer 2

• Benign oestrogen dpt cyst - thick old blood
• 2-10 cm
• Precursors for endometrial or clear cell tumours
• Unilateral or bilateral
• Associated with endometriosis

Question 3

Endometrioma = chocolate cyst - S&S

Answer 3

asymptomatic
pelvic P
infertility 
dyspareunia
2° dysmenorrhoea

Question 4

Endometrioma = chocolate cyst - Tx

Answer 4

OCP
surgery - laparoscopy, ablation, aspiration
M - endometriosis
Nothing ➤ risk of rupture, not recommended if >4cm

Question 5

Endometrioma = chocolate cyst - Can affect what?

Answer 5

Fertility

Question 6

Dermoid cyst - types

Answer 6

Mature cystic teratoma + immature teratoma

Question 7

Mature cystic teratoma - germ layers?

Answer 7

ectoderm, mesoderm, endoderm

Question 8

Mature cystic teratoma - S&S

Answer 8

asymptomatic

➤ slow growing

Question 9

Mature cystic teratoma - Cx

Answer 9

torsion
rupture
infection
malignancy

Question 10

Mature cystic teratoma - Tx

Answer 10

➤ type & size dpt

• watch & wait
• surgery - laparoscopy, laparotomy
• age - menopausal

Question 11

Mature cystic teratoma - In pregnancy?

Answer 11

Operate >6cm in 2nd trimester

Question 12

Immature teratoma - infos

Answer 12

• Rare
• Young patient (20 yo++)
• 36% ➤ malignancy
• Often large (14-25 cm) ➤ solid masses
• Increase alpha-feto protein

Question 13

PCOS - What is it?

Answer 13

Polycystic ovarian syndrome

➤ endocrine disorder ➤ hyperandrogegism ovulatory dysfunction, polycystic ovarian morphology

Question 14

PCOS - S&S

Answer 14

menstrual disorder - amenorrhea, oligomenorrhoea
infertility
virilisation
acne, hirsutism, androgenic, alopecia
metabolic syndrome - obesity, insulin resistance

Question 15

PCOS - Dx

Answer 15

PCOM, chronic an ovulation, hyperandrogegism

Question 16

PCOS - Cx

Answer 16

• Infertility
• Ovarian abnormality ➤ change in vascularity, follicular fluid env, oocyte competence & quality
• Gestational diabetes
• Obstetric Cx ➤ obesity, IR, metabolic dysfunction, placental alterations, inflammation
• Increase pregnancy HT, pre-eclampsia

Question 17

PCOS - Long-term Cx

Answer 17

• CVS - HT, hyperlipidaemia, DM, increased CRP/TNF-alpha
• metabolic - increase obesity
• IR
• Oncology - increase breast, ovarian, endometrial CA
• Increase depression & anxiety

Question 18

PCOS - Causes

Answer 18

Unknown ➤ gen + env

Question 19

PCOS - Tx

Answer 19

Lifestyle - decrease weight
Drugs - clomiphene citrate, oestrogen modulator, aromatose inhibitor, metformin
Surgery - ovarian drilling

Question 20

Ovarian CA - Who?

Answer 20

> 50 yo ++

Question 21

Ovarian CA - S&S

Answer 21

persistent abdo distention (bloating) 
decrease of appetite
early satiety
pelvic / abdo P
increase urinary f. &/or urgency
ascites / pelvic or abdo mass

Question 22

Ovarian CA - Risk factors

Answer 22

nulliparous
IUD
early ovulation / late menopause
HRT
fertility Medications & Tx
obesity
BRCA 1 & 2
PCOS
endometriosis
env
white people
talc, alcohol, smoking

Question 23

Ovarian CA - What decreases risk?

Answer 23

OCP
breast feeding
aspirin

Question 24

Ovarian CA - Ix

Answer 24

CA125 ➤ if >35 iu/mL ➤ refer US
Gynae referral
Under 40 yo ➤ alpha-feto protein, beta-hCG

Question 25

Ovarian CA - Staging

Answer 25

T1: limited - 1 or both ovaries, rupture capsule, +ve peritoneum, tutor on ovarian surface
T2: pelvic extension - tubes/uterus/other pelvic organs, +ve cell in peritoneum
T3: extra pelvic extension: microscopic, macroscopic

N1: +ve LN

M1: distant mets

Question 26

Ovarian CA - Types

Answer 26

Epithelial:

• 90%
• Serous: ++ - 60-70%
• Mucinous: 5%
• Clear cell & endometroid - 15%
• Bordeline - small number, large masses but rarely metastasise

Germ cell

• uncommon
• younger patient
• arise from reproductive cell ovaries

Stromal cell

• arise from supporting tissue
• uncommon

Question 27

Ovarian CA - Tx

Answer 27

screening 
surgery
chemo
radio 
immuno, H
palliative care 

Complementary:

• high vits
• herbal & plant extracts
• boost immune
• increase qol
• decrease S&S

Question 28

Ovarian CA - Pattern of spread

Answer 28

diaphragm
liver
stomach 
lung lining implants
bowel lining implants
omentum 
LN
colon
pelvic peritoneal implants