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Spring 2014 - OB TEST 6 - OVARIES ✔️ > Pathology > Flashcards

Pathology Flashcards

0
Q

How are the ovaries positioned?

A

Varies in position

Influenced by uterine location and ligament attachments

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1
Q

What do the ovaries look like structurally?

A

Paired, almond shaped structures situated one on each side of the uterus close to the lateral pelvic wall

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2
Q

Where are the ovaries found in an anteflexed midline uterus?

A

Laterally or posterolaterally

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3
Q

What is the normal sonographic appearance of the ovaries?

A

Homogeneous echotexture
May exhibit central, more echogenic medulla
Small anechoic or cystic follicles - peripherally in cortex
Appearance varies with age and menstrual cycle

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4
Q

What are the 3 phases of the menstrual cycle?

A

Menstruation - Days 1 to 4
Proliferative - Days 5 to 14
Secretory or Luteal - Days 15 to 28

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5
Q

What happens during the proliferative phase?

A

Many follicles develop and increase in size until about day 8 or 9 of cycle due to stimulation by both FSH and LH

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6
Q

How many follicles become dominant per cycle and what is its measurement at time of ovulation?

A

One dominant follicle

Reaching 2.0-2.5 cm at time of ovulation

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7
Q

During the proliferative phase, what is Cumulus Oophorus?

A

An eccentrically located, cystic like, 1 mm internal mural protrusion

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8
Q

During the proliferative phase, what does visualization of a cumulus indicate?

A

A mature follicle and imminent ovulation

No reproducible sonographic sign reliable

Other follicles become atretic

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9
Q

During the late proliferative phase, what develops if fluid in the nondominant follicles do not reabsorb?

A

Follicular cyst

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10
Q

During the late proliferative phase, what happens to the dominant follicle?

A

Usually disappears immediately after rupture at ovulation

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11
Q

Describe what a follicle occasionally looks like during the late proliferative phase.

A

Follicle decreases in size and develops a wall that appears crenulated (scalloped)

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12
Q

When is fluid in the cul de sac commonly seen?

A

After ovulation and peaks in early luteal phase

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13
Q

What is commonly seen in a normal ovary?

A

Multiple small, punctuate, echogenic foci

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14
Q

Following menopause, what happens to the ovary and follicles?

A

The ovary atrophies and follicles disappear with increasing age

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15
Q

After a hysterectomy, what happens to the ovaries?

A

Ovaries can be difficult to visualize with ultrasound

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16
Q

What is the ovary volume of an adult menstruating female?

A

As large as 22 cc

Ovary volume of 9.8 plus or minus 5.8 cc

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17
Q

What ovary volume is considered abnormal for a postmenopausal patient?

A

More than 8 cc

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18
Q

When the ovary volume is _______ that of the opposite side! this should be considered abnormal, regardless of actual size.

A

Twice

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19
Q

What is the ovary’s function?

A

To mature oocytes until ovulation under influence of LH and FSH from the pituitary gland

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20
Q

What is the ovary synthesizing?

A

Androgens (male hormones) and converts them to estrogen (female hormones)

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21
Q

What is produced after ovulation occurs and how do this help a pregnant women?

A

Produces progesterone after ovulation to sustain early pregnancy until placenta can do so at 10-12 weeks of gestation

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22
Q

What size does the dominant follicle enlarge to about 10 days into the mid and late follicular phases of cycle?

A

Enlarges from 3 mm to 24 mm

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23
Q

What follows the enlargement of the one dominant follicle?

A

Ovulation

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24
Q

Ovulation causes what?

A

The corpus luteum or an abnormal unruptured follicle can persist as simple or complex cystic structure from 1-10 cm

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25
Q

When might surgical intervention be considered for a cyst?

A

If a cyst is greater than 6 cm for more than 8 weeks

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26
Q

What is the most common mass found in an ovary?

A

A simple follicular cyst - benign

VERY IMPORTANT

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27
Q

What is the criteria of a cyst?

A

Anechoic, well defined borders, thin smooth walls, round or oval, through transmission

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28
Q

Describe postmenopausal ovaries…

A

Small anechoic cysts may be seen

Can disappear or change in size over time

Surgery is recommended for postmenopausal cysts greater than 5 cm and for those contains internal septations and/or solid nodules

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29
Q

What are 7 common cystic or complex ovarian masses?

A 
Follicular cyst
Corpus luteum cyst with pregnancy
Cystic teratoma
Paraovarian cyst
Hydrosalpinx
Endometrioma
Hemorrhagic cyst
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30
Q

What is a complex mass?

A

Any simple cyst that hemorrhages as it involutes

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31
Q

What are 3 classic differential considerations of complex adnexal masses?

A

Ectopic pregnancy
Endometriosis
Pelvic inflammatory disease (PID)

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32
Q

Name 5 specific complex masses…

A 
Cystadenoma
Dermoid cyst
Tubo-ovarian abscess
Ectopic pregnancy
Granulose cell tumor
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33
Q

What is typical of all epithelial ovarian tumors?

A

Mixed solid to cystic ovarian masses

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34
Q

What are the 2 most common serous types of solid tumors?

A

Cystadenoma

Cystadenocarcinoma

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35
Q

During peak fertile years, what ratio of solid tumors are malignant? How about the ratio after the age of 40?

A

Fertile years - 1 in 15

After age of 40 - 1 in 3

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36
Q

More sonographically ________ the tumor, more likely to be ________, especially if associated with ________.

A

Complex
Malignant
Ascites

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37
Q

What is the epithelium of serous tumors?

A

Tubal in type

May be one or multiple cysts

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38
Q

What fraction of solid tumors are bilateral?

A

1/4

Tumors are large and offer fill pelvic cavity

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39
Q

Solid tumors mostly occur in women over what age?

A

40

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40
Q

What is helpful in determining the pathology of an ovary?

A

Color Doppler

Ovarian lesion vs pedunculated fibroid

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41
Q

What are 6 common solid masses?

A 
Solid teratoma
Adenocarcinoma
Arrhenoblastoma
Fibromyalgia
Dysgerminoma
Torsion
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42
Q

What does Doppler of the ovary help to differentiate?

A

Potential cyst from adjacent vascular structures

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43
Q

How can RI and PI be determined for the adnexal branch of the uterine artery, the ovarian artery, and the intratumoral flow?

A

Pulse Doppler - localized flow

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44
Q

When should patients with normal menstrual cycles be scanned for best results?

A

First 10 days of the cycle

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45
Q

Why is it best to scan during the first 10 days of the cycle?

A

Avoids confusion with normal changes in intraovarian blood flow because high diastolic flow occurs in luteal phase

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46
Q

What is the value of RI in distinguishing between benign and malignant adnexal masses?

A

Greater than 0.4 as normal RI in nonfunctioning ovary

Greater than 1 as normal PI

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47
Q

What are some signs that may be worrisome for malignancy?

A

Intratumoral vessels, low resistance flow, and absence of normal diastolic notch in Doppler waveform

Malignancies will have a lot more flow

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48
Q

When can abnormal waveforms be seen?

A

Inflammatory masses, metabolically active masses (ectopic pregnancy), and corpus luteum cysts

Mimicks cancer

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49
Q

______ is not a sensitive indicator of malignancy.

A

RI

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50
Q

Formula for PI?

A 
      Mean velocity
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51
Q

Formula for RI?

A 
Systolic peak velocity
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52
Q

Increased diastolic flow suggests what?

A

Neovascularity and likelihood of a malignancy

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53
Q

Masses showing what are usually benign?

A

Complete absence or minimal diastolic flow

Very elevated RI and PI values

Diastolic notch in early diastole

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54
Q

What cysts result from normal function of ovary?

A

Functional cysts

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55
Q

Functional cysts cause what?

A

Ovarian enlargement in young women due to hormonal influences

MOST COMMON

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56
Q

Functional cysts include what?

A

Follicular
Corpus luteum
Hemorrhagic
Theca-lutein

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57
Q

Describe 5 things about functional cysts…

A

Occur when dominant follicle does not succeed in ovulating and remain active though immature

Unilateral

Thin walled, translucent, have watery fluid

Grow 1-8 cm

Usually disappear spontaneously by resorption or rupture

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58
Q

What are clinical findings of follicular cysts?

A

Asymptomatic to dull
Adnexal pressure and pain
Abnormal ovarian function
Torsion of ovary resulting in severe pain

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59
Q

Describe 4 things about corpus luteum cysts…

A

Result from hemorrhage within persistently mature corpus luteum

Filled with blood and cystic fluid

Grows 1-10 cm ; complex

May accompany intrauterine pregnancy (IUP)

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60
Q

What are clinical findings of corpus luteum cysts?

A

Irregular menstrual cycle
Pain
Mimic ectopic pregnancy
Rupture

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61
Q

What are sonographic findings of corpus luteum cysts?

A

“Cystic” type of lesion

May have internal echoes secondary to hemorrhage and increased color

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62
Q

What are hemorrhagic cysts?

A

Internal hemorrhage may occur in follicular cysts or, more commonly, in corpus luteal cysts

Will experience acute onset of pelvic pain

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63
Q

Septations in hemorrhagic cysts are caused by what?

A

Blood clotting

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64
Q

Describe 4 things about hemorrhagic cysts…

A

Hyperechoic; may mimic a solid mass
Smooth posterior wall and posterior acoustic enhancement
Diffuse low level echoes
Internal pattern becomes more complex

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65
Q

Theca-lutein cysts are…

A

Large
Bilateral
Multiloculated
Seen in 30% of patients with trophoblastic disease

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66
Q

What are theca-lutein cysts associated with?

A

High levels of hCG due to molar pregnancies

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67
Q

What are clinical and sonographical findings for theca-lutein cysts?

A

Clinical - nausea, vomiting

Sonographic - multilocular cysts in both ovaries

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68
Q

Name 3 ovarian syndromes…

A

Ovarian hylerstimulation
Polycystic ovarian
Ovarian remnant

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69
Q

Ovarian hyperstimulation syndrome is…

A

A frequent iatrogenic complication of ovulation induction

Ovaries enlarged - less than 5 cm

70
Q

Describe mild and severe symptoms of ovarian hyperstimulation syndrome…

A

Mild - pelvic discomfort, no significant weight gain

Severe - severe pelvic pain, ABD distention, notably enlarged ovaries greater than 10 cm

71
Q

Ovarian hyperstimulation syndrome is associated with what?

A

Ascites
Pleural effusion
Numerous THIN walled cysts throughout the periphery of ovary

72
Q

If ovarian hyperstimulation syndrome is treated…

A

Condition will resolve itself within 2-3 weeks

73
Q

Describe polycystic ovarian syndrome…

A 
Includes Stein-Leventhal Syndrome
Bilaterally enlarged polycystic ovaries
Occurs in late teens through 20's
Endocrine imbalance
Diagnosed through lab values
74
Q

Polycystic ovarian syndrome clinically and sonographically…

A

Clinical - amenorrhea, obesity, infertility, hirsutism

Sonographic - multiple tiny cysts around periphery, ovary may or may not be enlarged, “String of Pearls”

75
Q

Name 5 types of benign ovarian cysts…

A 
Peritoneal inclusion cysts
Paraovarian cysts
Fluid collections in adhesions
Benign cysts in fetus & adolescents
Simple cysts in postmenopausal women
76
Q

Name 2 nonfunctioning cysts…

A

Para ovarian cysts (sit adjacent to an ovary)

Endometrioma

77
Q

Describe paraovarian cysts…

A 
Simple
Can bleed or torse
Wolffian duct remnant
10% of all adnexal masses
Located in broad ligament
78
Q

Paraovarian cysts clinically & sonographically…

A

Clinical - asymptomatic

Sonographic - simple cyst adjacent to ovary

79
Q

Describe endometriosis…

A

Functioning endometrial tissue outside the uterus
Endometrial tissue cyclically bleeds and proliferates
May be found anywhere in the pelvis
Affects women in 3rd & 4th decades
DEPENDENT ON HORMONAL STIMULATION

80
Q

What 2 types of endometriosis is there?

A

Diffused

Localized (endometrioma)

81
Q

Describe diffused endometriosis…

A

More common
Endometrial plantings within endometrium
Rarely diagnosed through US
Disorganization of pelvic anatomy

82
Q

Describe localized endometriosis…

A 
Discrete mass (endometrioma, Sampson's cyst, chocolate cyst)
May be found in multiple sites
External/indirect form of endometriosis
83
Q

2 possible causes of endometriosis…

A

Retrograde menstruation into Fallopian tubes and peritoneum

Pelvic structures covered by tissue which responds to inflammation or hormonal stimulation

84
Q

Endometriosis clinical symptoms…

A

Severe dysmenorrhea
Chronic pelvic pain from peritoneal adhesions
Dyspareuria

85
Q

Endometriosis sonographically…

A

Ovaries most common organ involved (2/3)

Frequently bilateral

Ovarian cysts with patterns ranging from hypoechoic to solid depending on amount of blood

Ovaries may be adherent to posterior wall of uterus or stuck in cul de sac

86
Q

Describe endometrioma…

A

Well defined
Uni or multilocular
Predominantly cystic mass with low level internal echoes
Fluid may be seen

87
Q

Endometriosis often diagnosed how?

A

Based on history of symptoms and characteristic findings on internal exam

Normal pelvic US does not exclude the presence of endometriosis

88
Q

What causes ovarian torsion?

A

Partial or complete rotation of ovarian pedicle on its axis

Compromises lymphatic and VENOUS drainage

89
Q

Appearance of an ovarian torsion…

A

Enlarged edematous ovary greater than 4 cm

Classical - multiple tiny follicles around hypoechoic mass to completely solid adnexal mass

90
Q

What % accounts for gyne operative emergencies?

A

3%

Acute ABD condition requiring prompt diagnosis & surgery

91
Q

What other part of the pelvis is affected by an variant torsion?

A

Fallopian tubes

92
Q

Once torsion occurs, what % increased incidence of torsion occurring in contralateral adnexa?

A

10%

93
Q

Who do ovarian torsions usually occur in?

A

Children and younger females with mobile adnexa, preexisting ovarian cyst or mass, or pregnancy

94
Q

Basic ovarian torsion description?

A 
Usually associated with a mass
Hypoechoic enlarged ovary w/ or w/o periphery follicles
Absent blood flow on Doppler
Free fluid in cul de sac
Surgical emergency
95
Q

Clinical symptoms of ovarian torsions…

A

Acute severe unilateral pain
Fever
Nausea
Vomiting
Palpable mass felt in more than 50% of patients
RIGHT IS MORE 3x MORE LIKELY TO TORSE THAN LEFT

96
Q

Describe torsed masses…

A 
Greater than 4 cm
Cystic to solid
Varies in echogenicity
Possible palpable mass
MORE FREQUENT ON FIGHT SIDE
May mimic acute appendicitis
97
Q

Only ____% of ovarian cysts less than _____ cm are malignant

A

3%

5 cm

98
Q

What size cysts are recommended for removal?

A

Greater than 5 cm

99
Q

Ovarian neoplasms in postmenopausal women…

A

Ovaries enlarged

May be mixed texture to solid with papillae within

100
Q

Sonographic evaluation of ovarian neoplasms…

A

Well defined anechoic lesions, unilocular or THINLY septated cysts - benign

Lesions with irregular walls, THICK irregular septations, mural nodules, & solid echogenic elements - malignant

Low resistive flow

Malignant ascites possible

Evaluate omentum, pertioneum, and liver for metastases

101
Q

Any change in ovarian echogenicity or volume of more than _____ ml should be considered suspicious

A

20 ml

102
Q

Describe a postmenopausal woman’s ovaries normally, on HRT, & if there is a problem.

A

Normally - atrophic and no follicles

HRT - normal sized ovaries

Abnormal - enlarged & echogenic - malignant

103
Q

What kills more women than cancer of uterine cervix and body and is the _____ the leading cause of cancer deaths?

A

Ovarian CA

4th leading cause of cancer death

104
Q

Approx _____ in _____ women develop ovarian CA.

A

1 in 70

105
Q

____% of ovarian malignancies occur in women between ____ & ____ years of age

A

60%

40-60

106
Q

When is ovarian CA found?

A

Commonly not detected until advanced - has spread beyond capsule but still within pelvis (stage II) into ABD (stage III)

70% seen in advanced stages

107
Q

What blood chemistry test is done to screen for ovarian CA? Is it reliable?

A

CA 125

Has a lot of false neg/pos results

Elevated levels found in 50% of stage III patients

108
Q

Ovarian CA sonographically…

A

Complex, cystic, or solid mass

More likely predominantly cystic

20% bilateral

109
Q

Differential diagnoses for ovarian CA are…

A 
Endometriosis
Hemorrhagic ovarian cyst
Ovarian torsion
PID
Benign ovarian neoplasms
110
Q

Ovarian mass size that means benign…

A

Less than 5 cm

111
Q

Ovarian mass size that means malignant…

A

Greater than 10 cm

112
Q

Increasing patient _____ correlates with increased incidence of ________.

A

Age

Malignancy

113
Q

Incidence of ovarian CA greatly increased in women who have had _____ & _____ cancer.

A

Breast & colon cancer

114
Q

Risk factors of ovarian CA…

A 
Increasing age
Nulliparity
Infertility
Uninterrupted ovulation
Late menopause
115
Q

Clinical symptoms of ovarian CA…

A 
Vague ABD pain
Swelling
Frequent urination
Constipation
Weight change (ascites)
116
Q

How many stages of ovarian CA are there?

A

4

117
Q

Name the stages of ovarian CA…

A

Stage I - limited to ovary
Stage II - limited to pelvis
Stage III - limited to ABD
Stage IV - hematogenous disease

118
Q

Describe ovarian CA stage I: limited to ovary…

A

Limited to 1 ovary
Limited to 2 ovaries
Positive peritoneal lavage (ascites)

119
Q

Describe ovarian CA stage II: limited to pelvis…

A

Involvement of uterus/Fallopian tubes
Extension to other pelvic tissues
Positive peritoneal lavage (ascites)

120
Q

Describe ovarian CA stage III: limited to ABD…

A

Intraabdominal extension outside pelvis/retroperitoneal nodes/extension to small bowel/omentum

121
Q

Describe ovarian CA stage IV: hematogenous disease…

A

Spread beyond the ABD - liver parenchyma affected

122
Q

Name 4 ovarian neoplasms…

A

Surface epithelium - MOST COMMON
Germ cell
Sex cord stroma
Metastatic

123
Q

Gynecologic tumors that arise from surface epithelium and cover ovary and underlying stroma are called what?

A

Surface epithelial-stromal tumors

124
Q

Epithelial tumors are ____% to ____% of all ovarian neoplasms

A

65%-75%

125
Q

Epithelial tumors are ____% to ____% of all ovarian malignancies

A

80%-90%

126
Q

2 most common types of epithelial tumors are…

A

Serous tumors - MOST COMMON, 30% of all ovarian neoplasm

Mucinous tumors - 20%-25% of ovarian neoplasms

127
Q 
Adenomas = ??
Adenocarcinoma = ??
A 
Adenoma = benign
Adenocarcinoma = malignant
128
Q

What tumors are less frequently bilateral, serous or mucinous?

A

Mucinous tumors

129
Q

Metastatic epithelial tumors spread primarily where?

A

Intraperitoneal

Direct extension to surrounding structures and lymphatic not uncommon

130
Q

Describe mucinous cystadenoma…

A 
In endocervix & bowel
80%-85% mucinous tumors benign
Women 13-45 yrs old
Large - 15 to 30 cm, more than 100 lbs
MOST COMMON CYSTIC TUMOR
Unilateral, multilocular
131
Q

Mucinous cystadenoma sonographically…

A

75% of patients show simple or septate thin walled multilocular cysts

Contain internal echoes with compartments differing in echogenicity caused by mucoid material

132
Q

Mucinous cystadenoma clinically…

A

Pressure
Pain
Increased ABD girth

133
Q

Describe mucinous cystadenocarcinoma…

A

Women 40-79 yrs old
10% occur in menopausal women
5%-10% of all primary malignant ovarian neoplasms
15%-20% bilateral when malignant
Causes lo ulster ascites with mass effect (rupture if benign)

134
Q

Mucinous cystadenocarcinoma sonographically…

A

Ascites appears as hypoechoic fluid with bright punctate echoes
THICK irregular walls & septations

135
Q

Describe serous cystadenoma…

A

Usually unilateral
Smaller than mucinous cysts
Multilocular cysts with septations
MOST COMMON BENIGN TUMOR OF OVARY (after dermoid)

136
Q

Serous cystadenoma sonographically…

A

Multilocular cyst
May have nodules
THIN septations

137
Q

Serous cystadenoma clinically…

A

Pelvic pressure

Bloating

138
Q

Describe serous cystadenocarcinoma…

A

60%-80% of all ovarian carcinomas
Over half bilateral
Calcification
Metastases to omentum, nodes, liver, lungs

139
Q

Serous cystadenocarcinoma sonographically…

A

Cystic structure with THICK septations and/or projections
Internal/external papillomas usually present
Ascites

140
Q

Serous cystadenocarcinoma clinically…

A

Pelvic fullness

Bloating

141
Q

Describe endometroid carcinoma…

A 
Epithelial tumor
Bilateral
1/3 associated w/ endometrial CA
Malignant
Postmenopausal
142
Q

Describe clear cell tumors (mesonephroid)…

A 
Epithelial tumor
Malignant
Müllerian duct origin
Bilateral
Postmenopausal
143
Q

Describe brenner tumor (transitional cell)…

A 
Epithelial tumor
Benign
Unilateral
40-70 yrs of age
Uncommon
Associated w/ cystic neoplasms in ipsilateral ovary
144
Q

Describe germ cell tumors…

A

Derive from primitive germ cells of embryonic gonad

Benign cystic teratomas approx 95%

Rare-MOST COMMON ovarian malignancy in adolescents

Associated w/ alpha fetoprotein & hCG

Unilateral

145
Q

Germ cells clinically…

A

Pelvic and/or ABD pain

Palpable mass

146
Q

5 types of germ cells…

A 
Teratomas - cystic, solid, malignant
Dysgerminoma
Embryonal cell carcinoma
Choriocarcinoma
Endodermal sinus tumor - yolk sac
147
Q

Describe teratoma: dermoid tumors…

A

Small to 40 cm
Unilateral
Round or oval mass
Contains fatty, sebaceous material, hair, teeth, bone
MOST COMMON OVARIAN NEOPLASM - 80% in childbearing yrs

148
Q

Teratoma: dermoid tumors clinically…

A

Asymptomatic to ABD pain
Enlargement & pressure
Pedunculated
Subject to torsion

149
Q

Teratoma: dermoid tumors sonographically…

A

Cystic, complex, solid mass
Echogenic components
Acoustic

150
Q

Describe dysgerminoma…

A

Rare malignant tumor

Bilateral

Women less than 30 yrs old

Sono - hyperechoic solid mass w/ areas of hemorrhage & necrosis, speckled pattern of calc

151
Q

What are the 2 most common ovarian neoplasms seen in pregnancy?

A

Dysgerminoma

Serous cystadenoma

152
Q

Describe endodermal sinus tumor…

A 
Known as "yolk sac" tumor
Women less than 20 yrs old
Unilateral
Increased serum AFP
Poor prognosis
2nd most common
Sono - looks like a dysgerminoma
153
Q

Describe sex cord stroma tumors…

A

Solid adnexal masses that arise from embryonic gonadal and/or ovarian stroma

Functional & feminizing = granulosa cell tumor, thecoma, fibroma

Masculinization = sertoli-leydig cell tumors (androblastoma), arrhenoblastoma

Hyperechoic & appear cystic, but NO THROUGH TRANSMISSION

154
Q

What tumors arise from ovarian stroma?

A

Fibromas & thecomas

155
Q

Thecomas are made up of what?

Fibromas are made up of what?

A

Thecoma = thecal cells

Fibroma = fibrous tissue

156
Q

Fibromas & thecomas show signs of what kind of production?

A

Estrogen

157
Q

Describe Fibromas…

A 
Rare
Postmenopausal 
Asymptomatic until larger
Symptoms - increasing pressure & pain
Ascites with Fibromas greater than 5 cm
Referred to as MEIGS SYNDROME
158
Q

Describe Meigs Syndrome…

A 
Ascites
Pleural effusion
Ovarian tumor
Removal is the cure
Associated w/ Fibromas & thecomas
159
Q

Meigs Syndrome sonographically…

A

Unilateral

Small to melon size

Hypoechoic mass w/ posterior attenuation seen from homogeneous fibrous tissue

Lager tumors pedunculated & prone to torsion, edema, & cystic degeneration

160
Q

Describe granulosa…

A

Feminizing neoplasm
MOST COMMIN HORMONE - active estrogenic tumor of ovary
Menopausal (50%), reproductive ages (45%), adolescents (5%)
Leads to Meigs Syndrome if torsed/ruptured

161
Q

Granulosa clinically…

A

Precocious puberty- Vaginal bleeding & full breasts
Pain
Pressure
Fullness

162
Q

Granulosa sonographically…

A

Variable
Mass w/o torsion
Similar to endometrioma or cystadenoma
If torsion occurs, multilocular cyst contains blood or fluid
Solid masses may have echogenicity similar to uterine fibroids

163
Q

Describe metastatic disease…

A

Ovaries affects more than any other pelvic organ

Mimics stage II to III ovarian CA

Arises from breast, upper GI tract, & other pelvic organs by direct extension or lymphatic spread

Krukenberg tumors - “drop” metastases to ovaries

164
Q

Metastatic disease sonographically…

A

Bilateral

Ascites

Completely solid or solid w/ “moth-eaten” cystic patterns occur when necrotic

165
Q

Describe metastatic lymphoma generally & sonographically…

A

Diffuse & disseminated; bilateral

Sono - mass appears solid, hypoechoic; similar to lymphoma elsewhere in the body

166
Q

Describe Fallopian tube CA…

A

Least common gyne malignancy
Adenocarcinoma most common histological
Postmenopausal w/ pain, bleeding, mass
Distal end of tubes more common than entire tube

167
Q

Fallopian tube CA sonographically…

A

Sausage shaped
Complex mass
Papillary projections
Similar to ovarian CA clinically & sono

168
Q

Name other pelvic masses…

A 
Pelvic kidneys
Omental cysts
Feces in colon
Distended bladder
Hydroureters
Colonic CA or masses
Abscesses
Retroperitoneal masses
Ectopic pregnancy
169
Q

Identify pelvic masses by…

A

Location
Size
Consistency
Source of adnexal masses

170
Q

How to distinguish ovarian masses from other masses?

A

Identify uterine connection & search for ovaries

171
Q

What can show malignancy in other pelvic masses?

A

Ascites

172
Q

What do pathologists do?

A

Make histologist diagnosis

Spring 2014 - OB TEST 6 - OVARIES ✔️ (1 decks)

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