Ovary Flashcards
follicular cyst
graafian follicle does not rupture at ovulation, continues to grow
resolves spontaneously
Corpus luteum cyst
corpus luteum does not degenerate
filled w/ fluid
resolve spontaneously
frequently hemorrhagic
Theca-Lutein cyst
high hCG levels
multiple gestations, molar pregnancies
gestational trophoblastic dz
assistive reproduction techniques
B/L, multiple
Dermoid cyst
benign cystic teratoma
tissue of multiple germ layers
Hemorrhagic cyst
cyst w/ blood - any type
Endometroid cyst
endometriosis inside ovary
cyclic bleeding in ovary –> chocolate cyst
Ovarian torsion
twisting of supportive ligaments –> impaired vascular supply –> ischemia and necrosis
Risk increases with ovarian mass >5cm diameter
Acute onset of severe pelvic pain -sharp, stabbing
possible radiation to back or groin
+/- N/V
Dx: clinical, pelvic US
Tx: surgery
Clomiphene
first line SERM for infertility d/t anovulation
Hypothalamus:
Binds estrogen receptors –> blocked negative feedback of endogenous estrogens
–>increased LH, FSH –> follicle maturation and ovulation
SE: hot flashes ovarian enlargement multiple gestations Visual disturbances - blurred vision, scotomida, retinal toxicity
Evidence of ovulatory cycles
cyclic menses
Mittelschmerz - midcycle pelvic pain assoc w/ ovulation
LH surge: tested for by OTC ovulation prediction kits
Biphasic basal body temperature - 1/2 degree rise after ovulation
Infertility
inability to conceive after 1 year
1/3 of females
- PCOS - anovulation
- endometriosis
- uterine fibroids
- PID
- Turners
- Intrauterine adhesions
- Asherman Syndrome
Use hysterosalpingography to check abnormal anatomy
Symptoms of ovarian cancer
ascites abdominal distention abdominal pain Nausea early satiety vaginal bleeding urinary sx
Risks of ovarian cancer
Family Hx - BRCA1 or 2
Lynch Syndrome - HNPCC
-risk colon, ovarian, endometrial cancers
Uninterrupted ovulatory cycles
- nulliparity
- infertility
- early menache
- late menopause
CA125
elevated w/ anything causing peritoneal irritation
Can be used for ovarian cancer marker to monitor
4 main categories of ovarian tumors with origin
Surface epithelium –> epithelial tumors
Stroma –> sex-cord - stromal tumors
Primordial germ cell –> germ cell tumors
Metastatic
- Uterus, tubes, ovary
- Krukenberg tumors - gastric adenocarcinoma - met to ovaries b/l; signet ring cells - filled with mucin, nuclei pushed to peiphery
Epithelial tumors
“Serious Epithelial Malignancies are Clearly Bad”
Serous tumors Endometroid tumors Mucinous tumors Clear cell tumors Brenner tumor
40s-60s
often b/l
Poor prognosis
Germ cell tumors
Teratomas
Dysgerminoma
Yolk sac aka endodermal sinus tumors
Choriocarcinomas
teens-20s
u/l (15% teratomas b/l)
excellent prognosis, responsive to chemo
Sex Cord-Stromal tumors
Granulosa cell tumors
sertoli-Leydig tumors
Fibromas
Thecomas
All ages
u/l
good prognosis, found early
Serous tumors
originate in fallopian tubes
ciliated columnar epithelium
Psammoma bodies
Benign: serous cytoadenoma
Malignant: serous cystadenocarcinoma
Mucinous tumors
multiloculated
filled w/ mucin - to 50 lbs
can look like gastric or intestinal tissue
Benign: mucinous cystadenoma
Malignant: mucinous cystadenocarcinoma
Pseudomyoma peritonei
abundant mucinous ascites
primary cancer of appendix
Endometroid tumors
malignant
look like endometrium w/ tubular glands
assoc w/ endometriosis
30% coexist w/ endometrial cancer
Clear cell tumors
variant of endometroid cancer
clear cytoplasm
Brenner tumor
benign
urinary tract-like epithelium
Teratomas
tissue from all 3 germ layers
Benign: mature teratoma
Malignant: immature teratoma
neuroectoderm
Struma ovarii - functional thyroid tissue –> hyperthryoidism, ovarian mass
Dysgerminoma
seminoma in males
malignant
produce hCG and LDH
fried egg appearance
Yolk sac tumor
“Endodermal sinus tumors”
malignant
produce AFP
Schiller Duval bodies
Choriocarcinomas
malignant
produce hCG
mets to lung
Granulosa Cell tumors
potentially malignant
produce estrogen
Kids –> precocious puberty
Post meno –> abnl vaginal bleeding, post menopausal bleeding, endometrial hyperplasia/cancer
yellow - cholesteral laden
Call Exner body - rosette surrounding eosinophilic spaces
Sertoli-Leydig tumors
Potentially Malignant
resemble seminiferous tubules
produce androgens –> virilization
-hirsuitism, deepning voice, clitoromegaly
yellow
Fibromas
Benign
arise from fibroblasts - firm tumors
no hormones
Meigs syndrome: ovarian tumor + ascites + hydrothorax
Thecomas
Benign
arise from spindle cells
can be mixed w/ estrogen producing cells
