Pathology of the ovaries Flashcards

0
Q

for a normal ovary, will you see blood flow IN it?

A

Yes…not just on the periphery on a normal ovary

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1
Q

Where do the ovaries lie in an anteflexed uterus position?

A

lateral or posteriolateral

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2
Q

review cyclic changes of the ovary

A

do it now!

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3
Q

3 phases of menstrual cycle

A

menstrual days 1-6

proliferative days 7-14

secretory days 15-28

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4
Q

What is the cumulus oophorus?

A

visualization of the cumulus oophorus within the mature follicle

gts this

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5
Q

when will you find fluid in the cul-de-sac during the menstrual month?

A

commonly seen after the ovulation and peaks in early luteal phase

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6
Q

what is the normal ovarian volume for a menstruating female?

A

large as 22 cc

mean: 9.8+/- 5.8 cc

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7
Q

What is a simple cystic mass on the ovary?

A

larger than 2.5 cm

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8
Q

What is a complex cystic structure in the ovary?

A

when you see an abnormal unruptured follicle

size 1-10cm

complex echogenicity

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9
Q

What is the most common pathology of the ovary?

A

simple cyst

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10
Q

When is surgery considered on a simple cyst?

A

when it’s >6m and persists for more than 8 weeks

check slide 18

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11
Q

What do postmenopausal ovaries look like?

A

small anechoic cysts may be seen

can disappear or change in size over time

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12
Q

What happens if you see a cyst that is > than 5cm on a postmenopausal woman?

A

surgery generally recommended

for those containing internal septations and/or soild nodules

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13
Q

When would you do serial sonographic studies on a postmenopausal patient?

A

when a cyst starts to change or is too large to begin with

will want to document any changes

larger is a problem not smaller

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14
Q

ovarian masses usually grow ______?

A

quickly

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15
Q

WHat is the most common mass you will see on an ovary?

A

follicular cyst

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16
Q

What is a complex mass?

A

not completely anechoic

has debris

solid portions in it

can be predominantly cystic but has other stuff in it

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17
Q

When does a simple cyst become complex?

A

when it hemorrhages as it involutes

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18
Q

What are classic differential considerations of complex adnexal masses?

A

ectopic pregnancy (with positive pregnancy test, but nothing in uterus)

endometriosis

pelvic inflammartory disease

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19
Q

What can a dermoid appear as?

A

complex mass on the ovary

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20
Q

most masses on the ovary are _____?

A

benign

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21
Q

What are the complex masses?

A

cystadenoma

dermoid cyst

tubo-ovarian abscess

ectopic pregnancy

granulosa cell tumor

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22
Q

if you do not have a completely anechoic structure you need to identify it ______?

A

accurately - it matters as does a complete patient history

these things will sway the doctor one direction or another

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23
Q

What age frames would you most likely find solid tumors?

A

during peak fertile years: only 1 in 15 malignant

after age 40: ratio becomes 1 in 3

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24
Q

Mixed solid to cystic ovarian masses typical of all __________ovarian tumors.

A

epithelial

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25
Q

how can you tell a solid mass from gas?

A

can you reproduce it at different times in the scan in two planes

does it move?

a solid mass won’t move

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26
Q

What are the keys to malignancies?

A

ascites

complex-ness of mass

age of patient

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27
Q

The more sonographically ________the tumor, the more likely to be ________.

A

complex

malignant

especially with ascites

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28
Q

What are the symptoms of ovarian cancer?

A

typically asymptomatic until its too late

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29
Q

When would you consider a large ovary abnormal?

A

when it is twice the volume of the opposite ovary

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30
Q

When you see a pedunculated fibroid what do you need to do?

A

investigate…you have to be able to determine where and what it is!

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31
Q

why would you use doppler on the ovary?

A

to differentiate potential cysts from adjacent vascular structures

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32
Q

What can be obtained on all ovarian masses?

A

localized flow with pulsed doppler

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33
Q

What is performed to determine resistive index or pulsatility index?

A

Pulsed doppler

interrogation of adnexal branch of uterine artery, ovarian artery, intratumoral flow

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34
Q

What are some doppler signs that might be worrisome for malignancy?

A

intratumoral vessels

low-resistance flow

absence of normal diastolic notch in doppler waveform

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35
Q

What are the cut-off values for PI and RI?

A

PI: 1.0

RI: 0.4

36
Q

if a mass shows complete absence or minimal diastolic flow is it malignant or benign?

A

typically benign

37
Q

What are functional cysts?

A

result from normal function of the ovary

38
Q

What is the most common cause of ovarian enlargement in young women?

A

functional cysts

39
Q

What do functional cysts include?

A

follicular

corpus luteum

hemorrhagic

theca-lutein cysts

40
Q

When does a follicular cysts occur?

A

when the dominant follicle does not succeed in ovulating na dremains active through immature

41
Q

Are follicular cysts unilateral?

A

yes, usually

42
Q

What are thin-walled, translucent, have watery fluid and may project above or within surface of ovary?

A

folllicular cysts

43
Q

How large can a follicular cyst grow?

A

1-8cm

44
Q

How do you treat a follicular cyst?

A

usually disappears spontaneously by resorption or rupture

45
Q

What are the clinical signs or a follicular cyst?

A

asymptomatic to dull

adnexal pressure and pain

abnormal ovarian function

torsion of ovary resulting in severe pain

46
Q

What is a corpus luteum cyst?

A

result from hemorrhage within persistently mature corpus luteum

47
Q

What is a corpus luteum cyst filled with?

A

blood and cystic fluid

48
Q

How large to corpus luteum cysts grow?

A

may grow 1-10cm in size

often complex

49
Q

What may accompany a corpus luteum cyst/

A

intrauterine pregnancy (IUP)

50
Q

What are hemorrhagic cysts?

A

a cyst that has bled into itself

could have debris or fluid level in it

may occur in follicular cysts or MORE COMMONLY in corpus luteal cysts

51
Q

What are the clinical signs for a hemorrhagic cyst?

A

acute onset of pelvic pain

52
Q

What are theca-lutein cysts?

A

large, bilateral, multiloculated cysts

high levels of hCG

seen in 30% of patients with trophoblastic disease

clinical: nausea and vomiting
sonographic: multilocular cysts in both ovaries

53
Q

What are the ovarian syndromes?

A

ovarian hyperstimulation

polycystic ovarian syndrome

ovarian remnant

54
Q

What is ovarian hyperstimulation syndrome?

A

OHS is frequent iatrogenic complication of ovulation induction

in mild form: patient presents with pelvic discomfort but no significant weight gain

ovaries enlarged, measure < 5cm in diameter

55
Q

how does a patient present with severe OHS?

A

severe pelvic pain

abd distention

notably enlarged ovaries measuring >10cm in diameter

associated ascites, pleural effusions, numerous large thin walled cysts thoughout the

56
Q

What is polycystic ovarian syndrome?

A

Stein-Leventhal Syndrome*

bilaterally enlarged polycystic ovaries

occurs in late teens through 20’s

may have endocrine imbalance

clinical: amenorrhea, obesity, infertility, hirsutism
sonographic: multiple tiny cysts around periphery of ovary, ovary may be normal size or enlarged

CLASSIC SIGN: STRING OF PEARLS **

57
Q

WHAT ARE THE BENIGN OVARIAN CYSTS?

A

peritoneal inclusion cysts

paraovarian cysts

fluid collections in adhesions

benign cysts in fetuses

58
Q

What are para-ovarian cysts?

A

usually simple

can bleed or torse

woliffian duct remnants

10% of all adnexal masses

located in broad ligament

clinical: asymptmatic
sonographic: simple cyst adjacent to ovary

59
Q

what is endometriosis?

A

functioning endometrial tissue outside the uterus (can be any where)

may be found anywhere in the pelvis: ovary, Fallopian tube, broad ligament, cul-de-sacs

dependant on hormonal stimulation causes discomfort where ever this tissue is

affects women in the 3rd and 4th decades

60
Q

what does endometriosis look like in its diffuse form?

A

leads to disorganization of pelvic anatomy with appearance similar to PID or chronic ectopic pregnancy

two forms: diffuse and localized (endometrioma)

61
Q

What is endometriosis diagnosis based on?

A

patient history of symptoms

a normal pelvic ultrasound does not exclude the presence of endometriosis

62
Q

what is ovarian torsion?

A

is caused by partial or complete rotation of ovarian pedicle on its axis

produces enlarged edematous ovary…usually >4cm in diameter

63
Q

What does ovarian torsion classically look like?

A

multiple tiny follicles around hypoechoic mass to completely solid adnexal mass

free fluid often present

doppler examination usually reveals absent blood flow to torsed ovary.

64
Q

When would you look for ovarian torsion?

A

when patient presents with acute, severe abd pain

medical emergency

venous drainage goes first, artery flow second

65
Q

in the ovaries, which side typically has torsion first?

A

right side

66
Q

what percentage of ovarian cysts <5cm are malignant?

A

3%

67
Q

neoplasm is __________?

A

excessive growth….not necessarily cancer

68
Q

What is Meigs syndrome frequently associated with?

A

fibroma

ovarian Ca

69
Q

What volume of the ovary is abnormal for a post menopausal woman?

A

8.0 cc

70
Q

The ovary synthesizes __________ and converts them to ________.

A

androgens

estrogens

71
Q

Name the 5 complex masses

A

cystadenoma

dermoid cyst

tubo-ovarian abscess

ectopic pregnancy

granulosa cell tumor

72
Q

What are the 7 common cystic or complex ovarian masses?

A

follicular cyst

corpus luteum cyst of pregnancy

cystic teratoma

paraovarian cyst

hydrosalpinx

endometrioma (low level echoes)

hemorrhagic cyst

73
Q

an ovary with volume twice that of the opposite side generally considered ________

A

abnormal

74
Q

What are the 6 common solid masses?

A

solid teratoma

adenocarcinoma

arrhenoblastoma

fibroma

dysgerminoma

torsion

75
Q

What can be obtained on all ovarian masses?

A

localized flow with pulsed doppler

76
Q

Why would you doppler the ovary?

A

to differentiate potential cysts form adjacent vascular structures

77
Q

What are some doppler signs that raise concern for malignancy?

A

intratumoral vessels

low-resistance flow

absence of normal diastolic notch in doppler waveform

78
Q

What is NOT a senstitive indicator of malignancy?

A

RI

79
Q

What are some masses that cause abnormal waveforms on doppler?

A

inflammatory masses

metabolically active masses (including ectopic pregnancy)

corpus luteum cysts

80
Q

What does increased diastolic flow suggest?

A

neovascularity and the likelihood of malignancy

81
Q

masses showing complete absence or minimal diastolic flow (very elevated RI and PI values) usually means what?

A

the mass is benign

82
Q

What is a sign of benign disease in early diastole?

A

diastolic notch

83
Q

What are functional cysts a result of?

A

normal function of ovary

84
Q

What is the most common cause of ovarian enlargement in young women?

A

functional cysts

85
Q

What are the four cysts that are included in functional cysts?

A

follicular

corpus luteum

hemorrhagic

theca-lutein cysts

86
Q

What are the three ovarian syndromes?

A

ovarian hyperstimulation

polycystic ovarian syndrome

ovarian remnant

87
Q

What are the two non-functioning cysts?

A

para-ovarian cysts

endometrioma