Pathology of the ovaries Flashcards
for a normal ovary, will you see blood flow IN it?
Yes…not just on the periphery on a normal ovary
Where do the ovaries lie in an anteflexed uterus position?
lateral or posteriolateral
review cyclic changes of the ovary
do it now!
3 phases of menstrual cycle
menstrual days 1-6
proliferative days 7-14
secretory days 15-28
What is the cumulus oophorus?
visualization of the cumulus oophorus within the mature follicle
gts this
when will you find fluid in the cul-de-sac during the menstrual month?
commonly seen after the ovulation and peaks in early luteal phase
what is the normal ovarian volume for a menstruating female?
large as 22 cc
mean: 9.8+/- 5.8 cc
What is a simple cystic mass on the ovary?
larger than 2.5 cm
What is a complex cystic structure in the ovary?
when you see an abnormal unruptured follicle
size 1-10cm
complex echogenicity
What is the most common pathology of the ovary?
simple cyst
When is surgery considered on a simple cyst?
when it’s >6m and persists for more than 8 weeks
check slide 18
What do postmenopausal ovaries look like?
small anechoic cysts may be seen
can disappear or change in size over time
What happens if you see a cyst that is > than 5cm on a postmenopausal woman?
surgery generally recommended
for those containing internal septations and/or soild nodules
When would you do serial sonographic studies on a postmenopausal patient?
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
ovarian masses usually grow ______?
quickly
WHat is the most common mass you will see on an ovary?
follicular cyst
What is a complex mass?
not completely anechoic
has debris
solid portions in it
can be predominantly cystic but has other stuff in it
When does a simple cyst become complex?
when it hemorrhages as it involutes
What are classic differential considerations of complex adnexal masses?
ectopic pregnancy (with positive pregnancy test, but nothing in uterus)
endometriosis
pelvic inflammartory disease
What can a dermoid appear as?
complex mass on the ovary
most masses on the ovary are _____?
benign
What are the complex masses?
cystadenoma
dermoid cyst
tubo-ovarian abscess
ectopic pregnancy
granulosa cell tumor
if you do not have a completely anechoic structure you need to identify it ______?
accurately - it matters as does a complete patient history
these things will sway the doctor one direction or another
What age frames would you most likely find solid tumors?
during peak fertile years: only 1 in 15 malignant
after age 40: ratio becomes 1 in 3
Mixed solid to cystic ovarian masses typical of all __________ovarian tumors.
epithelial
how can you tell a solid mass from gas?
can you reproduce it at different times in the scan in two planes
does it move?
a solid mass won’t move
What are the keys to malignancies?
ascites
complex-ness of mass
age of patient
The more sonographically ________the tumor, the more likely to be ________.
complex
malignant
especially with ascites
What are the symptoms of ovarian cancer?
typically asymptomatic until its too late
When would you consider a large ovary abnormal?
when it is twice the volume of the opposite ovary
When you see a pedunculated fibroid what do you need to do?
investigate…you have to be able to determine where and what it is!
why would you use doppler on the ovary?
to differentiate potential cysts from adjacent vascular structures
What can be obtained on all ovarian masses?
localized flow with pulsed doppler
What is performed to determine resistive index or pulsatility index?
Pulsed doppler
interrogation of adnexal branch of uterine artery, ovarian artery, intratumoral flow
What are some doppler signs that might be worrisome for malignancy?
intratumoral vessels
low-resistance flow
absence of normal diastolic notch in doppler waveform