Ovaries Flashcards
Mobile
Cystic
Smooth
Unilateral
Benign
Ben’s Smooth Mobile UniCycle was Repossessed
Fixed
Solid
Irregular
Bilateral
Malign
Mali ang mag Fix ng Solid Irregular Bill ng Old, young and taking OCPs
Size differentiating Benign from Malignant
8
<8 Benign
>8 Malignant
Benign or Malignant ovarian mass: associated with calcifications
Benign
Benign or Malignant ovarian mass: associated with ascites and lymphadenopathy
Malignant
Benign or Malignant ovarian mass: nodular and papillary on UTZ
Malignant
Benign or Malignant ovarian mass: multilocular and multicystic on UTZ
Malignant
Comprise 75% of ovarian masses in women in reproductive age
Most common cause of simple cystic adenexal mass in the reproductive age
Functional Cyst
Most common cause of complex adnexal mass
Benign cystic teratoma
Most common cause of pelvic mass
Pregnancy
Benign cyst that can rupture and can cause mild-moderate intraperitoneal bleeding
Corpus Luteum
Benign cyst that can become very large and cause adnexal/ovarian torsion and massive bleeding
Theca lutein cyst
Functional ovarian cyst that results from the persistence of a dominant follicle (failure of a follicle to rupture during the follicular maturation phase)
Functional cyst
Functional ovarian cyst that results from the failure of the corpus luteum cyst to regress during the luteal phase
Corpus luteum cyst
Spotting with delay in menses
Unilateral pelvic pain
Small, tender adnexal mass (CL cyst)
Halban’s Triad
Functional ovarian cyst that results from prolonged or excessive stimulation by endo/exogenous gonadotropins (hCG)
Theca lutein cyst
Functional ovarian cyst with honeycomb appearance and (+) straw colored fluid grossly
Theca lutein cyst
Functional ovarian cyst that is translucent and thin walled
Functional cyst
Functional ovarian cyst: multicystic and bilateral
Theca lutein cyst
Functional ovarian cyst: regresses after pregnancy
Theca lutein cyst
Adnexal Torsion management
Exploratory laparotomy
Adnexal mass management: Premenarchal < 2 cm
Exploratory laparotomy
Adnexal mass management: Reproductive <6 cm
Observe -> repeat UTZ
Adnexal mass management: Reproductive 6-8 cm
UTZ -> (Observe if Unilocular, Exlap if Multilocular)
Adnexal mass management: Reproductive > 8 cm
Ex lap
Adnexal mass management: Post mens, palpable
Ex Lap
WHO classification of Ovarian tumors
Epithelial
Sex Cord
Germ Cell
M/C classification of Ovarian tumors
Epithelial
Most frequent ovarian epithelial tumor
Ovarian epithelial tumor that resembles fallopian tubes
Serous cystadenoma
Ovarian epithelial tumor that resembles endocervix/GIT
Ovarian epithelial tumor that is multilocular with mucoid substance within and can reach enormous size
Mucinous cystadenoma
Ovarian epithelial tumor that resembles the transitional cells of the urinary bladder
Ovarian epithelial tumor that has epithelial cells with “coffee-bean” appearing nucleus
Brenner’s Tumor
Ovarian epithelial tumor with cells resembling the endometrium
Endometroid
Most common neoplasm in prepubertal females
Dermoid Cyst/ Mature Teratoma
80% Occur in reproductive life
Benign cystic teratoma
Most common benign solid tumor of the ovary
Whorled pattern in cross section
Fibroma
Meig Syndrome
HAFi
Hydrothorax
Ascites
Fibroma
Ovarian stromal tumor that is extremely slow growing and unilateral
Fibroma
Tumor markers for Ovarian Epithelial tumors
CA - 125
CEA
Tumor markers for Germ cell tumors
LDH
hCG
AFP
Tumor markers for Sex cord tumors
Estrogen
Testosterone
Stage of Ovarian Tumors: Confined to the ovaries or Fallopian tubes
1
Stage of Ovarian Tumors: with pelvic extension (below brim) or primary peritoneal cancer
2
Stage of Ovarian Tumors: spread to peritoneum outside the pelvis and/or mets to retroperitoneal LN
3
Stage of Ovarian Tumors: Distant metastases excluding peritoneal surfaces
4
Ovarian epithelial tumor containing cells with abundant glycogen (Hobnail cells)
Clear Cell
Ovarian epithelial tumor associated with DES exposure
Clear Cell
Analogous to seminoma of the testes
Dysgerminoma
Tumor marker for Dysgerminoma
LDH
Most common malignant germ cell tumor
Dysgerminoma
Primary tool for evaluation of Pelvic mass
Pelvic Ultrasound
Pelvis and abdomen to assess the spread of the disease
MRI/ CT Scan
Distinguishes primary or secondary ovarian CA
Barium Enema and Intravenous Pyelogram
Tx for Ovarian CA
Desires pregnancy - USO/BSO + Completes Surgical Staging
Uterus not Needed - TAHBSO + Completes Surgical Staging
Stage IC-IV = + Chemo Tx (Paclitaxel + Carbaplatin)
St. IV = (-) Surgical Staging, (+) Surgical debulking
Most common ovarian malignancy in women <30 y/o
Germ Cell Ovarian Tumor
Germ cell stroma infiltrated with lymphocytes
TM: LDH
Analogous to Seminoma
Dysgerminoma
Schiller Duval Bodies
TM: AFP
Endometrial sinus Tumor/ Yolk Sac Tumor
Highly malignant cytotrophoblast and syncitiotrophoblast
TM: hCG
Choriocarcinoma
Immature embryonic structures mixed with mature elements
TM: AFP
Immature teratoma
Call Exner bodies (cells w/ coffee-bean nuclei arranged in small clusters around a central cavity)
Ovarian tumor that is functionally estrogenic
Ovarian tumor that may manifest with precocious puberty in children
Granulosa Theca Cell
Gran torino’s Ex coffee is precious to children
Nipple projections in dermoids
Tubercle of Rokitansky
Ovarian tumor that is functionally testosterogenic
Resembles Fetal Testes
Sertoli Leydig Cell Tumor
Most common tumor in less than 30 y/o
Dermoid cyst
Schiller Duval Bodies
Yolk Sac Tumor
Call Exner Bodies
Granuloma Theca Tumor
Nipple projection in dermoids
Tubercle of Rokitansky
Presents as virilization
Sertoli Leydig tumor
Presents as Hyaline Droplets
Schiller Duval of Yolk Sac Tumor
Presence of Thyroid tissue in the ovary
Struma ovarii
Presents as Vagina Bleeding in Adults
Sertoli Leydic
Eosinophilic Bodies surrounded by Granulosa cells
Granulos Theca