Ovaries Flashcards
1
Q
Describe the sonographic appearance of a normal ovary
A
- Homogeneous parenchyma
- Hypoechoic to mildly echogenic cortex
- Paired, elliptical/ovoid/almond shaped
- Multiple small follicles may be seen
2
Q
Ovaries sonographic appearance changes based on ______ & _______ ________.
A
age
menstrual cycles (hormone levels).
-Depending on where the pt is in their menstrual cycle you may or may not see ovarian follicles
3
Q
Ovaries artery originates from the______ aspect of the _____.
A
lateral
aorta
4
Q
Right ovarian vein drains into the ____.
Left ovarian vein drains into the _____.
A
- IVC
- Left Renal Vein.
5
Q
a syndrome resulting from hyperstimulation of the ovaries by fertility drugs; results in the development of multiple, enlarged follicular ovarian cysts.
A
Ovarian Hyperstimulation Syndrome
6
Q
Frequency complication of ovulation induction (aka infertility treatments)
A
Ovarian Hyperstimulation Syndrome
7
Q
linked to ovulation induction and theca-lutein cysts
A
Ovarian Hyperstimulation syndrome (OHS)
8
Q
Ovarian Hyperstimulation Syndrome
- Mild form =
- Severe form =
A
- mild = pelvic discomfort w/ moderately enlarged ovaries
- severe = significant pelvic pain, abdominal distention, enlarged ovaries (>10cm)
- Can also have ascites, pleural effusion, & numerous large thin-walled cysts throughout ovary.
9
Q
SONO: Ovarian Hyperstimulation Syndrome
A
- Enlarged ovaries (5cm -12cm)
- Contain multiple large follicles known as theca-lutein cysts
- May see ascites / pleural effusions
- Similar SONO look to Theca- Lutein cysts. Key difference is that Ovarian hyperstimulation syndrome is caused by infertility treatment/ ovulation induction.
10
Q
Explain the link between OHS & theca lutein cysts.
A
hCG is administered as part of ovulation induction, & theca-lutein cysts occur as a result of high hCG levels.
Therefore, a person w/ OHS will appear with bilateral theca-lutein cysts on their ovaries.
11
Q
syndrome characterized by anovulatory cycles, infertility, hirsutism, amenorrhea, and obesity.
A
Polycystic Ovarian Syndrome (PCOS)
aka Stein Leventhal Syndrome
12
Q
Endocrinologic ovarian disorder linked with infertility
A
Polycystic Ovarian Syndrome (PCOS)
aka Stein Leventhal Syndrome
13
Q
What is the mc cause of hyperandrogenism?
A
Polycystic Ovarian Syndrome (PCOS)
aka Stein Leventhal Syndrome
14
Q
Hyperandrogenism
A
excess of androgens
15
Q
What is mc cause of androgen excess?
A
Polycystic Ovarian Syndrome (PCOS)
aka Stein Leventhal Syndrome
- Hyperandrogenism= androgen excess
16
Q
-
-
A
- Oligomenorrhea or amenorrhea
- Blood work indicative of hyperandrogenism
- Sonographic findings consistent w/ PCOS
17
Q
Pts can suffer from chronic anovulation due to hormonal imbalance
A
PCOS (aka Stein Leventhal Syndrome)
18
Q
PCOS is most often seen in what age range?
A
late teens - 20s
19
Q
may have an endocrine imbalance (Low LH or FSH)
A
PCOS (aka Stein Leventhal Syndrome)
20
Q
S/S of PCOS … (5)
A
- Amenorrhea or oligomenorrhea
- Hirsutism
- Infertility
- Obesity
- Possibly Acne
21
Q
linked to anovulatory cycles in obese women
A
PCOS (aka Stein Leventhal Syndrome)
22
Q
PCOS SONO…(3)
A
- Multiple small cysts along the periphery of the ovary (“string of pearls” sign)
- Or many small cysts throughout the ovary
- Ovaries may be normal in size or enlarged
23
Q
“string of pearls” sign
A
PCOS (aka Stein Leventhal Syndrome)
24
Q
T/F: PCOS diagnosis is not made with ultrasound alone; mostly based on blood work (LABs).
A
true
25
Functional , ectopic endometrial tissue located outside the uterus.
Endometriosis
26
Ectopic endometrial tissue seen in the presence of endometriosis undergoes physiologic changes as a result of stimulation by the _______ of the menstrual cycle.
hormones
27
T/F: Ectopic endometrial tissue seen in the presence of endometriosis undergoes physiologic changes as a result of stimulation by the hormones of the menstrual cycle.
- ectopic tissue responds to hormones and bleeds during menses; causes inflammation and adhesions
true
28
Endometriosis - age group?
Most common b/t 30 - 40 y/o
(penny 25-35 y/o)
29
T/F: w/ endometriosis, ectopic endo tissue can implant anywhere in the pelvis
true
(however ovaries are the mc site)
30
What is the mc site for ectopic endo tissue (endometriosis) to implant in the pelvis?
ovaries
31
Endometriosis S/S.. (4)
- Menometrorrhagia
- Significant cyclic pain (dysmenorrhea)
- Dyspareunia
- Infertility
32
What are the 2 types of Endometriosis?
Diffuse
Localized (aka Endometrioma)
33
What is the mc type of endometriosis?
Diffuse
34
What type of endometriosis is more difficult to diagnose/see with US?
Diffuse
35
Tiny implants of endometrial tissue scattered throughout the pelvis
Diffuse endometriosis
36
Blood collects chronically into a localized site (Endometrioma)
Localized endometriosis
37
Localized endometriosis is aka __________
an Endometrioma
38
Endometriomas are aka _________ cysts
Chocolate cysts
39
Diffuse Endometriosis SONO...(1)
-
- Diffuse endometriosis may not be visible with ultrasound
- Avascular nodular tissue along the periphery of the ovary or uterus
40
SONO: Localized Endometriosis (aka Endometrioma or chocolate cyst)...(4)
- Well-defined, unilocular or multilocular cystic structure
- Predominantly cystic with diffuse, homogeneous, low level echoes
- Low level echoes may be present throughout the mass (top image)
- Low level echoes may appear in the dependent portion, creating a fluid-to-fluid level or fluid-to-debris level. (bottom image)
41
Hemorrhage of the ectopic endometrial tissue often occurs, resulting in focal areas of bloody tumors known as_________.
endometriomas (aka chocolate cysts).
42
Endometriomas can be located anywhere in the pelvis but are mc in the _____.
ovaries.
43
an abnormality that results from the ovary twisting on its mesenteric connection, consequently cutting off the blood supply to the ovary
Ovarian torsion
44
Partial or complete rotation of the ovarian pedicle on its axis
Ovarian torsion
45
Ovarian torsion may also be refereed to as __________
Adnexal torsion
46
Ovarian torsion usually occurs secondary to a(n) __________.
ovarian mass/cyst
47
What is the mc cause of ovarian torsion?
ovarian mass/cyst
48
Ovarian torsion without the presence of a mass/cyst usually occurs in ______.
children
49
Results in the disruption of vascular outflow/inflow
-Ovaries become enlarged & edematous
- Loss of arterial perfusion to the ovary results in infarction
Ovarian torsion
50
Which ovary is most likely to torse?
Right ovary
- right is 3x more likely to torse than left
51
Ovarian Torsion (aka Adnexal Torsion) S/S...(5)
- Acute unilateral pelvic pain
or
- Intermittent pain
- Fever / Leukocytosis
- N/V
- Palpable mass (sometimes)
52
"Whirlpool" sign on color doppler
Ovarian torsion
53
In the presence of ovarian torsion, ______ flow is lost first, followed by ____ flow.
venous
arterial
- w/ ovarian torsion you may see arterial flow in the ovary but no venous flow
54
Adnexal/ ovarian torsion is associated with a ______ _____ ____ or resulting from ______ ______of adnexal structures.
large ovarian mass
excessive mobility
55
SONO Ovarian Torsion...(6)
- Loss of venous signal (arterial may or may not be present)
- Enlarged, edematous ovary (>4cm; penny says >5cm)
- Heterogeneous ovary
- Peripherally located ovarian follicles
- “Whirlpool” sign (color doppler)
- FF
56
What does the "Whirlpool" sign indicate in the presence of ovarian torsion?
Whirlpool sign is an indicator of the torsed ovarian pedicle adjacent to the ovary, appearing as a round mass with concentric hypo-hyperechoic rings that demonstrates a swirling of color doppler signal.
57
What pathology is the image associated with?
Ovarian torsion
58
Benign or Malignant
1. Endometrioma
2. Follicular cysts
3. Mucinous Cysadenocarcinoma
4. Dysgerminoma
5. Corpus Luteum cysts
1. B
2. B
3. M
4. M
5. B
59
Benign or Malignant
6.Serous Cystadenoma
7. Theca-Lutein cysts
8. Brenner (aka Transitional Cell tumor)
9. Serous Cystadenocarcinoma
10. Dermoid (aka Teratoma)
6. B
7. B
8. B (rarely M)
9. M
10. B (if become M it would be termed an immature teratoma)
60
Benign or Malignant
11. Yolk Sac tumor (aka Endodermal sinus tumor)
12. Thecoma
13. Mucinous cystadenoma
14. Endometrioid
15. Immature Teratoma
11. M
12. B
13. B
14. M (sometimes B)
15. M
61
Benign or Malignant
16. Mature Teratoma
17. Androblastoma (aka Sertoli-Leydig cell tumor)
18. Granulosa Cell tumor
19. Fibroma
20. Krukenberg tumor
21. Arrhenoblastoma
16. B
17. M
18. B (rarely M)
19. B
20. M
21. B (sometimes M)
62
Name the 8 malignant masses of the ovaries
- Mucinous Cysadenocarcinoma
- Serous Cystadenocarcinoma
- Dysgerminoma
- Yolk Sac tumor (aka Endodermal sinus tumor)
- Endometrioid (sometimes benign)
- Immature Teratoma
- Androblastoma (aka Sertoli-Leydig cell tumor)
- Krukenberg tumor
usually benign but sometimes malignant
- Brenner (aka Transitional Cell tumor)
- Granulosa Cell tumor
- Arrhenoblastoma
63
Name the 6 Epithelial tumors of the ovary
- Serous Cystadenoma
- Serous Cystadenocarcinoma
- Mucinous Cystadenoma
- Mucinous Cystadenocarcinoma
- Endometrioid
- Brenner (aka Transitional Cell Tumor)
64
Name the 4 Germ cell tumors of the ovary
- Dermoid (Teratoma)
- Immature & Mature Teratomas
- Dysgerminoma
- Yolk Sac tumor (Endodermal sinus tumor)
65
Name the 5 stromal (sex-cord) tumors of the ovary
- Thecoma
- Fibroma
- Granulosa Cell tumor
- Sertoli-Leydig Cell tumor (aka Androblastoma)
- Arrhenoblastoma
66
Stromal ovarian tumors are aka _______ tumors
sex-cord tumors
67
Name the 3 functional cysts of the ovaries
Follicular cysts
Corpus Luteum cysts
Theca-Lutein cysts
68
Which of the following is typically seen in younger pts?
a. Epithelial tumors
b. Germ cell tumors
c. Stromal tumors
b. Germ cell tumors
69
Which of the following is most likely to be seen in peds pts?
a. Epithelial tumors
b. Germ cell tumors
c. Stromal tumors
b. Germ cell tumors
70
Which of the following is the most common type of ovarian tumor?
a. Epithelial tumors
b. Germ cell tumors
c. Stromal tumors
a. Epithelial tumors
- most ovarian tumors are epithelial
71
Ovarian carcinoma is the ____ mc GYN malignancy
- ____ mc cancer in women
3rd
5th
72
Ovarian carcinoma associated findings ...(4)
Ascites
Pleural effusions
Obstructions
Hepatic mets
73
Most ovarian cancers occur in women ages ___ to ___ y/o
40-60 y/o
74
T/F: ovarian cancer is usually not detected until later stages. (silent killer)
true
75
Ovarian carcinoma risk factors... (7)
Previous hx of breast or colon cancer
Family hx of ovarian cancer
Increasing age (>50y/o)
Nulliparity
Infertility
Uninterrupted ovulation
Late menopause
76
Ovarian Carcinoma Staging
Stage 1: limited to _____
Stage 2: limited to _____
Stage 3: Limited to _______
Stage 4: ...
1. ovaries
2. pelvis
-Spread to another pelvic structure
3. abdomen
4. Distant Metastasis outside of abdominal cavity
77
_________ cysts result from the normal function of the ovary & respond to hormonal changes
functional (aka physiologic cysts)
78
Mc cause of ovarian enlargement in young women
functional cysts (aka physiologic cysts)
79
May have elevated CA-125
ovarian carcinomas
80
Should the Graafian follicle fail to ovulate, it could continue to enlarge and result in a _______ cyst
follicular cyst
81
ovarian cyst that forms as a result of the failure of the Graafian follicle to ovulate
follicular cyst
82
Follicular cysts measure __ cm or larger
3 cm
83
the surgical removal of an ovarian cyst.
Ovarian cystectomy
84
Follicular cysts that contain blood are referred to as _______ cysts.
hemorrhagic
85
SONO: simple cyst in ovary
follicular cyst
86
follicular cyst
87
Physiologic (functional) cyst that develops after ovulation has occurred.
corpus luteum cyst
88
the corpus luteum that is maintained during early pregnancy for the purpose of producing estrogen and primarily progesterone.
corpus luteum of pregnancy
89
T/F: corpus luteum cysts typically regress spontaneously
true
90
May mimic ectopic pregnancy
corpus lutuem cyst
- due to peripheral vascularity aka “ring of fire”
91
corpus luteum cyst
92
SONO: Corpus Luteum Cyst
- simple
- Hemorrhagic
- Rupture
- Color Doppler
- Simple = simple cyst in ovary (w/ peripheral vascularity)
- Hemorrhagic = complex cyst (may have septations/internal debris)
- Rupture = complex cyst (may have septations/internal debris) & FF in pelvis
- Color doppler = rim hypervascularity (“ring of fire” )
93
peripheral vascularity aka rim hypervascularity or “ring of fire”
corpus luteum cyst
94
Large, Bilateral, multiloculated cysts
correlated w/ high levels of estrogen & excessive amounts of hCG.
Theca-Lutein cysts
95
Theca-Lutein cysts are associated with high levels of ____ & _____.
estrogen
hCG
96
What pathology is associated with the following?
- Bilateral
- Large, multiloculated cysts
- high estrogen levels
- excessive amounts of hCG
- Associated with Gestational trophoblastic disease (molar pregnancy), Ovarian Hyperstimulation Syndrome, & multiple gestations.
Theca-Lutein cysts
97
Theca-Lutein cysts are associated with... (3)
- Molar pregnancy (Gestational trophoblastic disease)
- Ovarian Hyperstimulation Syndrome (Infertility drug therapy)
- Multiple gestations (high levels of hCG)
98
associated with Molar pregnancy (Gestational trophoblastic disease)
Theca-Lutein Cysts
99
Theca-Lutein SONO ...(4)
Bilateral
Large cysts within large ovaries
Multilocular (thin walls/septations)
Anechoic w/ posterior enhancement
100
seen bilaterally. What is the most likely diagnosis?
Theca-Lutein cysts
101
Acute hemorrhage usually appears sonographically as ________ and can mimic a ____ ____.
Hemorrhagic cysts appear _______
during resolution.
New blood = ______
Old blood = ______
hyperechoic, solid mass
complex
New blood = hyper-echogenic
Old = Hypo - anechoic
102
can mimic a solid mass
hemorrhagic cyst
- bc new blood appears hyperechoic to echogenic
103
Cyst adjacent to, but separate from ovary
paraovarian cyst
104
Where are paraovarian cysts located?
in the broad ligament
105
Large paraovarian cysts may cause ________.
ovarian torsion
106
SONO: simple cyst adjacent to ovary
paraovarian cyst
-If hemorrhaged the cyst will appear complex
107
paraovarian cyst
- If hemorrhaged the cyst will appear complex
108
Blood containing tumor that forms from the implantation of ectopic endometrial tissue
Endometrioma
109
Chocolate cyst
Endometrioma
110
Endometrioma
aka Localized endometriosis or chocolate cyst
111
SONO: Endometrioma
- Well-defined cystic structure
- Low-level echoes may be present throughout the mass (top image)
- Low-level echoes may appear in the dependent portion, creating a fluid to fluid level or fluid to debris level. (bottom image)
112
What type of ovarian tumor?
- older women
- typically large
- always level of cystic component
- arise from surface of ovary
Epithelial tumors
113
Epithelial tumors are mc in _____ women
older
(however can occur in women 20+ y/o)
114
Epithelial tumors are typically _____ in size and always have a level of ______ component
large
cystic
115
mc type of ovarian neoplasm & mc type of ovarian carcinoma
epithelial tumors
116
What is the mc epithelial tumor?
Serous cystadenoma
117
________ & _________ comprise most neoplasms of the ovary.
Serous cystadenoma & Dermoid (Teratoma)
118
Large, septated cyst w/ thin septations & irregular borders.
- May contain solid components and/or mural nodules.
- Benign
- usually bilateral
- Age group = 40s & 50s
Serous Cystadenoma
119
Large, septated cyst w/ thin septations & irregular borders.
- May contain solid components and/or mural nodules.
- internal echoes
- Benign
- unilateral
- Age group = 13-45y/o
Mucinous Cystadenoma
120
Compare / Contrast Serous cystadenoma & Mucinous Cystadenoma.
Similarities
- benign, epithelial tumors
- large, complex cystic structure (however, mucinous is typically larger)
Differences
- Serous = more common type
- Serous = more often bilateral
- Mucinous = usually larger
- Mucinous = often contains internal echoes
121
Which is more frequently see bilaterally in the ovaries?
a. Serous cystadenoma /cystadenocarcinoma
b. Mucinous cystadenoma/cystadenocarcinoma
a. Serous cystadenoma /cystadenocarcinoma
122
Both are very large tumors, however, which is typically larger?
a. Serous cystadenoma /cystadenocarcinoma
b. Mucinous cystadenoma/cystadenocarcinoma
b. Mucinous cystadenoma/cystadenocarcinoma
123
Which is more common?
a. Serous cystadenoma
b. Mucinous cystadenoma
c. Serous cystadenocarcinoma
d. Mucinous cystadenocarcinoma
a. Serous cystadenoma
124
Which is most likely to present sonographically with internal echoes?
a. Serous cystadenoma /cystadenocarcinoma
b. Mucinous cystadenoma/cystadenocarcinoma
b. Mucinous cystadenoma/cystadenocarcinoma
125
Which is most likely to present with papillary projections & thick septations?
a. Cystadenoma (Serous & Mucinous)
b. Cystadenocarcinoma (Serous & mucinous)
b. Cystadenocarcinoma (Serous & mucinous)
126
Compare / Contrast Serous Cystadenocarconoma & Mucinous Cystadenocarcinoma
Similarities
- Malignant, Epithelial tumors
- Large complex cystic structure
- may have papillary projections
- THICK walls/septations
- may have elevated CA-125
Differences
- Mucinous = Associated with Pseudomyxoma Peritonei.
- Serous = more common & more often bilateral
- SONO: Mucinous = Pseudomyxoma Peritonei (complex ascites) & internal echoes (mucoid material)
- SONO: Serous = ascites (simple?)
127
Large, septated cyst w/ thick septations & irregular borders.
- may contain solid components/ mural nodules
- may have papillary projections
- Malignant
- ascites
- often bilateral
Serous Cystadenocarcinoma
128
Large, septated cyst w/ thick septations & irregular borders.
- may contain solid components/ mural nodules
- may have papillary projections
- Malignant
- Associated with Pseudomyxoma Peritonei (complex ascites)
- internal echoes
Mucinous Cystadenocarcinoma
129
Compare/Contrast Cystadenoma & Cystadenocarcinoma
Similarities
- Large, complex cystic structures
- Epithelial tumors
Difference
- Cystadenoma = benign
- Cystadenocarcinoma = Malignant
- Cystadenoma = THIN walls/septations
- Cystadenocarcinoma = THICK
walls/septations, papillary projections, & ascites.
- Cystadenocarcinoma = more likely to rupture
130
Which of the following is most likely the diagnosis in this benign ovarian tumor?
a. Serous cystadenoma
b. Mucinous cystadenoma
c. Serous Cystadenocarcinoma
d. Mucinous Cystadenocarcinoma
b. Mucinous cystadenoma
- bc of internal echoes & its benign
131
Which of the following is most likely the diagnosis in this benign ovarian tumor?
a. Serous cystadenoma
b. Mucinous cystadenoma
c. Serous Cystadenocarcinoma
d. Mucinous Cystadenocarcinoma
a. Serous cystadenoma
- bc it lacks internal echoes and is benign
132
The following tumor presents with complex ascites. What is the most likely the diagnosis in this malignant ovarian tumor?
a. Serous cystadenoma
b. Mucinous cystadenoma
c. Serous Cystadenocarcinoma
d. Mucinous Cystadenocarcinoma
d. Mucinous Cystadenocarcinoma
- bc of internal echoes, papillary projections, complex ascites & malignant
133
The following tumor presents with ascites. What is the most likely the diagnosis in this malignant ovarian tumor?
a. Serous cystadenoma
b. Mucinous cystadenoma
c. Serous Cystadenocarcinoma
d. Mucinous Cystadenocarcinoma
a. Serous cystadenoma
- bc lack of internal echoes
- has papillary projections
- ascites (simple?)
- is malignant
134
associated with Pseudomyxoma Peritonei (complex ascites)
Mucinous Cystadenocarcinoma
135
intraperitoneal extension of mucin-secreting cells that results from the rupture of a malignant mucinous ovarian tumor or possible a malignant tumor of the appendix.
Pseudomyxoma Peritonei
136
Pseudomyxoma Peritonei is caused by the rupture of mucinous cells from either a malignant ______ ____ or possibly a malignant tumor of the _____.
ovarian tumor
appendix
137
Intraperitoneal extension of mucin-secreting cells that results from the rupture of a mucinous tumor may be associated with ovarian carcinoma or cancer of the:
a. appendix
b. rectum
c. stomach
d. fallopian tube
a. appendix
(Penny ch 18 review question #15)
138
Brenner tumor is aka ...
Transitional cell tumor
139
Brenner tumor- age group?
40 - 70 y/o
140
Brenner tumor is associated with _____ syndrome
Meigs
141
describes a condition having a benign ovarian tumor with ascites and pleural effusion.
Meigs syndrome
142
Describe the 3 characteristics of Meigs Syndrome
- ovarian tumor
- ascites
- pleural effusions
143
Endometrioid - age group?
postmenopausal (50s & 60s)
144
associated with hx of endometrial carcinoma or hyperplasia & endometriosis.
Endometrioid
145
Mc cancer to originate within an endometrioma
Endometrioid
146
Endometrioid
1. benign or malignant?
2. associated w/...(3)
3. age group?
4. SONO:
1. M
2. endo carcinoma or hyperplasia, endometriosis
3. postmenopausal (50s & 60s)
4. (SONO simialr to cystadenocarcinoma)
- complex mass (solid & cystic components)
- may have papillary projections
147
What type of tumor is associated with high AFP & hCG and is often seen in younger pts (<30 y/o) ?
Germ cell tumor
148
Germ Cell tumors - age group
younger pts (< 30 y/o)
149
Germ cell tumors are associated with high levels of ____ & _____.
AFP & hCG
150
High AFP & hCG
Germ cell tumors
151
Mc benign ovarian tumor
- Mc ovarian neoplasm
Dermoid (aka Teratoma)
152
May contain bone, hair, teeth, sebum, fat, and/or cartilage.
Dermoid (aka Teratoma)
153
Dermoid is aka ... (3)
Teratoma
Dermoid cyst
Cystic Teratoma
154
Dermoid - age group?
reproductive/ childbearing years
(however can still be seen in postmenopausal women)
155
Rupture of a dermoid can lead to ______.
peritonitis.
156
T/F: Dermoids are capable of malignant degeneration (squamous cell carcinoma), however, this is rare.
true
157
Dermoid (aka Teratoma) SONO:
- Complex mass (solid & cystic components)
- Dermoid plug (produces posterior shadowing)
- “Tip of the iceberg” sign
- Dermoid mesh (hair)
- Fluid to Fluid level in which case there is a clear distinction between serous fluid and sebum.
- Fat -fluid levels
158
associated with "tip of the iceberg" sign
Dermoid (aka Teratoma)
159
Immature teratomas are ______ while mature teratomas are ______.
malignant
benign (so a dermoid is usually a mature teratoma?)
160
Immature teratoma - age group?
10-20 y/o
161
Imature teratomas
1. benign or malignant?
2. Age group?
3. predominantly _____
4. elevated _____ in 50% of cases
5. ______ _____
1. M
2. 10-20 y/o
3. solid
4. AFP
5. Rapid growth
162
Mc ovarian malignancy found in childhood
Dysgerminoma
163
Children with dysgerminoma present with… (3)
- Precocious puberty
- Elevated Serum Lactate Dehydrogenase (tumor marker for dysgerminoma)
- Possible Elevated hCG levels
164
Tumor marker for dysgerminoma
Serum Lactate Dehydrogenase
165
Dysgerminoma- age group?
younger women (<30y/o )
166
Dysgerminoma
1. Benign or Malignant?
2. Elevated _________ & possible elevated _____.
3. Age group?
4. associated w/ __________ in children
5. SONO (3)
1. malignant
2. Serum Lactate Dehydrogenase & possibly hCG
3. <30 y/o
4. Precocious puberty
5.
- Ovoid, solid mass in ovary
- Hyperechoic w/ areas of hemorrhage & necrosis
- Calcifications may be present
167
Yolk Sac tumor (Endodermal sinus tumor)
1. Benign or Malignant?
2. Elevated _________
3. Age group?
4. ______ ______
5. SONO (3)
- sonographically similar to _______
1. M
2. AFP
3. <20 y/o
4. Rapid growth
5. SONO: similar to Dysgerminoma
- Ovoid, solid mass in ovary
- Hyperechoic w/ areas of hemorrhage & necrosis
- Calcifications may be present
168
Yolk sac tumors (aka Endodermal Sinus tumor) is associated with elevated _____ & _______ growth.
AFP
rapid
169
Stromal (sex-cord tumors)
- typically _____ adnexal masses
- some are ______ producing.
- SONO: ________ (almost cystic) without through transmission
- occur at any age
- solid
- hypoechoic
- estrogen
170
Stromal tumor with an abundance of thecal cells
Thecoma
171
Thecomas are associated with ____ syndrome
Meigs syndrome
172
Thecoma
- B or M?
- ______ tumor.
- Age group?
- Frequently ______ producing. Therefore pts present with ____________.
- SONO: ... (2)
- Benign
- Stromal
- Postmenopausal
- estrogen, Postmenopausal bleeding
- SONO:
- hypoechoic solid mass ...
- w/ posterior attenuation
- (my appear similar to a pedunculated leiomyoma)
173
Feminizing neoplasm
Granulosa Cell tumor
174
Most common estrogenic tumor
- aka mc estrogen producing tumor?
Granulosa Cell tumor
175
Granulosa Cell tumor is associated with ______ ______ in children & ____________ in postmenopausal women.
precocious puberty
Postmenopausal bleeding
(bc it is an estrogen producing tumor?)
176
Granulosa Cell tumor
1. B or M?
2. mc _______ tumor
3. _________ neoplasm
4. associated with _______ in peds
5. associated with _______ in postmenopausal women.
6. SONO: (3)
1. B (M is rare)
2. estrogenic
3. Feminizing
4. precocious puberty
5. postmenopausal bleeding
6. SONO:
- solid
- hypoechoic
- large
177
Benign, stromal tumor with an abundance of fibrous tissue
Fibroma
178
T/F: fibromas are estrogen producing
FALSE
- Fibroms are NOT estrogen producing like some other stromal tumors
179
Fibromas are associated with _____ syndrome
Meigs
180
Fibroma
1. B or M?
2. _____ tumor
3. Age group?
4. associated w/ ____ syndrome
5. SONO:
6. NOT estrogen producing
1. B
2. stromal (sex-cord)
3. middle aged women
4. Meigs
5. SONO
- hypoechoic
- solid
- posterior attenuation
- may contain calcifications
- (may mimic pedunculated leiomyomas)
181
Sertoli-Leydig Cell tumor is aka ...
Androblastoma
182
Sertoli-Leydig Cell tumor (aka Androblastoma)
1. B or M?
2. ______ tumor.
3. Age group?
4. _____ producing
5. S/S = ________
6. SONO:
1. B (sometimes M 20% cases)
2. Stromal (sex-cord)
3. <30 y/o
4. estrogen (Lower estrogen in comparison to granulosa cell tumor & thecomas)
5. S/S = Virilization (Thus may present with abnormal menstruation & hirsutism bc of androgen production)
6. SONO
- solid
- hypoechoic
- may be partially cystic
183
Virilization
Sertoli-Leydig Cell tumor (aka Androblastoma)
184
changes within a female that are typically associated with males; caused by increased androgens and may lead to deepening of the voice and hirsutism.
Virilization
185
Masculinizing tumor
Arrhenoblastoma
186
Arrhenoblastoma
1. B or M?
2. Age group ?
3. S/S? (2)
4. SONO...
1. B (sometimes M 22% of cases)
2. 15-65 y/o (peak age = 25)
3. Amenorrhea & Infertility
4. solid mass with cystic components
187
Metastasis to the ovaries usually comes from... (3)
Common primaries include..
- GI
- Other pelvic organs
- Breasts
188
Malignant ovarian tumor that likely metastasized from the GI tract
Krukenberg
189
Presence of “signet-ring” cells
Krukenberg
190
Hx of gastric, colon, etc cancer
Krukenberg
191
Krukenberg SONO (6)
- Smooth walled
- Solid (may have cystic degeneration)
- hypoechoic or hyperechoic tumors
- often bilateral
- may present with ascites.
- “Moth-eaten” appearance in that it can be a solid mass containing scattered cystic spaces
192
SONO: “Moth-eaten” appearance
Krukenberg
193
add VCU test questions & Ch 18 review questions to brainscape
194
What formula is used to calculate volume of a mass?
L x W x H x 0.5233
195
a condition that is thought to result from the compression of the LRV at the origin of the superior mesenteric artery, a condition known as nutcracker syndrome.
Pelvic Congestion Syndrome (PCS)
196
Pelvic Congestion Syndrome results from _________ syndrome
Nutcracker
197
S/S: persistent lower abdominal/back pain after standing for long periods of time, dysparunia, dysmenorrhea, AUB, chronic fatigue, bowel issues.
Pelvic Congestion Syndrome (PCS)
198
_________ is the chosen imaging modality to confirm PCS.
Venography
199
PCS SONO: (2)
-
- (Spectral doppler)
- multiple tortuous and dilated venous structures adjacent to the uterus & ovaries that measure greater than 4-5 mm in diameter. (The ovarian vein itself typically exceeds 6 mm.)
- These dilated veins yield a slow flow velocity with spectral doppler.
200
W/ PCS veins adjacent to the uterus and ovaries measure greater than __to __ mm in diameter. The ovarian vein itself usually exceeds __ mm in diameter.
4 to 5 mm
6 mm
201
Which of the following would be least likely associated with PCS?
a. right renal vein entrapment
b. dysfunctional venous valves
c. AUB
d. fatigue
a. right renal vein entrapment
- bc with nutcracker syndrome (syndrome that causes PCS) the LRV is compressed (not the RRV).
(Penny ch 18 review question #1)
202
results from ovarian tissue being left behind following a salpingo-oophorectomy, thus leading to stimulation of that ovarian tissue by circulating hormones.
- a complication of bilateral-salpingo-oophorectomy
Ovarian Remnant Syndrome
203
Ovarian Remnant Syndrome is a complication of what pelvic procedure?
a complication of bilateral-salpingo-oophorectomy
204
Which of the following would be least likely associated with an increase for developing ovarian cancer?
a. Nulliparity
b. Late menarche
c. Delayed childbearing
d. Age over 50 y/o
b. Late menarche
(Penny ch 18 review question #3)
205
What mass would least likely appear as a solid adnexal mass?
a. Thecoma
b. Fibroma
c. Dermoid
d. Brenner tumor
c. Dermoid
(Penny ch 18 review question #6)
206
Which of the following would be associated with an elevated CA-125?
a. Fibroma
b. Thecoma
c. Dysgerminoma
d. PCS
c. Dysgerminoma
(Penny ch 18 review question #17)
207
Which of the following is not true concerning ovarian carcinoma?
a. Pts tend to have ovarian cancer familial incidence
b. Pts tend to have a hx of familial breast cancer
c. Pts tend to present early in the disease
d. Sonography does not serve as a best screening mechanism for ovarian cancer.
c. Pts tend to present early in the disease
(Penny ch 18 review question #18)
208
What germ cell tumor contains elements of the ectoderm, mesoderm, and endoderm?
a. Brenner tumor
b. Cystic Teratoma
c. Fibroma
d. Theca cell tumor
b. Cystic Teratoma
(Penny ch 18 review question #19)
209
An endometrioma most likely appears as a:
a. simple, anechoic mass with through transmission
b. complex mass with internal shadowing
c. mostly cystic mass with low-level echoes
d. solid, hypoechoic shadowing mass.
c. mostly cystic mass with low-level echoes
(Penny ch 18 review question #21)
210
With what ovarian tumor is Meigs Syndrome most likely associated?
a. Dysgerminoma
b. Cystic Teratoma
c. Fibroma
d. Yolk Sac tumor
c. Fibroma
(Penny ch 18 review question #22)
211
Sonographically, which of the following would most likely be confused for a pedunculated fibroid bc of its solid-appearing structure?
a. Serous cystadenoma
b. Mucinous cystadenoma
c. Fibroma
d. Theca lutein cyst
c. Fibroma
(Penny ch 18 review question #23)
212
During a pelvic sonogram, you see a small cyst located adjacent to the ovary. What is the most likely diagnosis?
a. Dermoid cyst
b. Ovarian cystadenoma
c. Endometrioma
d. Paraovarian cyst
d. Paraovarian cyst
(Penny ch 18 review question #24)
213
The most common benign ovarian tumor is the:
a. cystic teratoma
b. mucinous cystadenoma
c. fibroma
d. Sertoli-Leydig cell tumor
a. cystic teratoma
(Penny ch 18 review question #25)
214
The ovarian cysts that are most often bilateral and are associated with markedly elevated levels of hCG are the:
a. Corpus luteum cysts
b. Paraovarian cysts
c. Granulosa cell cysts
d. Theca lutein cysts
d. Theca lutein cysts
(Penny ch 18 review question #27)
215
The cystic mass commonly noted with a pregnancy is the:
a. Corpus luteum cysts
b. Dermoid cysts
c. Dysgerminoma
d. Serous cystadenoma
a. Corpus luteum cysts
(Penny ch 18 review question #28)
216
The sonographic appearance of an ovarian dermoid tumor in which the anterior elements of the mass can be seen, while the greater part of the mass is obscured by shadowing is consistent with:
a. Whirlpool sign
b. Tip of the iceberg sign
c. Dermoid mesh sign
d. Dermoid plug sign
b. Tip of the iceberg sign
(Penny ch 18 review question #29)
217
After the Graafian follicle rupture, the remaining structure is termed:
a. graafian remnant
b. corpus albicans
c. corpus luteum
d. medulla
c. corpus luteum
(Penny ch 18 review question #31)
218
Which of the following sonographic findings would NOT increase the liklihood of an ovarian malignancy?
a. septation measuring greater than 3 mm in thickness
b. irregular borders
c. solid wall nodule
d. anechoic components with acoustic enhancement
d. anechoic components with acoustic enhancement
(Penny ch 18 review question #33)
219
Normal ovarian flow is said to be:
a. low resistant during menstruation and high resistant during proliferative phase
b. high resistant during menstruation and low resistant at time of ovulation.
c. low resistant
d. high resistant
b. high resistant during menstruation and low resistant at time of ovulation.
(Penny ch 18 review question #34)
220
What would be a predisposing condition that would increase the risk for suffering from ovarian torsion?
a. Hirsutism
b. Excessive exercise
c. Ovarian mass
d. Sonohysterography
c. Ovarian mass
(Penny ch 18 review question #35)
221
The malignant ovarian tumor with gastrointestinal origin is the:
a. Brenner tumor
b. Krukenberg tumor
c. Yolk sac tumor
d. Granulosa cell tumor
b. Krukenberg tumor
(Penny ch 18 review question #36)
222
The malignant ovarian mass that is associated with pseudomyxoma peritonei is the:
a. Dysgerminoma
b. Sertoli-Leydig cell tumor
c. Serous cystadenocarcinoma
d. mucinous cystadenocarcinoma
d. mucinous cystadenocarcinoma
(Penny ch 18 review question #37)
223
All of the following adnexal masses may appear sonographically similar to a uterine leiomyoma except:
a. Thecoma
b. Paraovarian cyst
c. Fibroma
d. Granulosa cell tumor
b. Paraovarian cyst
(Penny ch 18 review question #38)
224
What ovarian mass is associated with virilization?
a. Krukenberg tumor
b. Cystic teratoma
c. Serous cystadenoma
d. Sertoli-Leydig cell tumor
d. Sertoli-Leydig cell tumor
(Penny ch 18 review question #42)
225
Which of the following is an estrogen producing ovarian tumor?
a. Cystic teratoma
b. Fibroma
c. Thecoma
d. Endoemetrioma
c. Thecoma
(Penny ch 18 review question #44)
226
A 55 y/o pt present to the ER with a history of pelvic pressure, abdominal swelling, & AUB. A pelvic sonogram reveals a large, multiloculated cystic mass with papillary projections. What is the most likely diagnosis?
a. Serous cystadenocarcinoma
b. Cystic teratoma
c. Androblastoma
d. Dysgerminoma
a. Serous cystadenocarcinoma
(Penny ch 18 review question #46)
227
A pt with an ovarian mass presents with an elevated serum AFP. Which of the following would be the most likely diagnosis?
a. Ovarian fibroma
b. Ovarian thecoma
c. Cystic teratoma
d. Yolk sac tumor
d. Yolk sac tumor
(Penny ch 18 review question #47)
228
Which of the following is the mc malignancy of the ovary?
a. Cystic teratoma
b. Serous cystadenocarcinoma
c. Krukenberg tumor
d. Sertoli-Leydig cell tumor
b. Serous cystadenocarcinoma
(Penny ch 18 review question #50)
