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OB/Gyn > Pathology of the ovaries > Flashcards

Pathology of the ovaries Flashcards

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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
Mixed solid to cystic ovarian masses typical of all __________ovarian tumors.
epithelial
25
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
26
What are the keys to malignancies?
ascites complex-ness of mass age of patient
27
The more sonographically ________the tumor, the more likely to be ________.
complex malignant *especially with ascites*
28
What are the symptoms of ovarian cancer?
typically asymptomatic until its too late
29
When would you consider a large ovary abnormal?
when it is twice the volume of the opposite ovary
30
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!
31
why would you use doppler on the ovary?
to differentiate potential cysts from adjacent vascular structures
32
What can be obtained on all ovarian masses?
localized flow with pulsed doppler
33
What is performed to determine resistive index or pulsatility index?
Pulsed doppler interrogation of adnexal branch of uterine artery, ovarian artery, intratumoral flow
34
What are some doppler signs that might be worrisome for malignancy?
intratumoral vessels low-resistance flow absence of normal diastolic notch in doppler waveform
35
What are the cut-off values for PI and RI?
PI: 1.0 RI: 0.4
36
if a mass shows complete absence or minimal diastolic flow is it malignant or benign?
typically benign
37
What are functional cysts?
result from normal function of the ovary
38
What is the most common cause of ovarian enlargement in young women?
functional cysts
39
What do functional cysts include?
follicular corpus luteum hemorrhagic theca-lutein cysts
40
When does a follicular cysts occur?
when the dominant follicle does not succeed in ovulating na dremains active through immature
41
Are follicular cysts unilateral?
yes, usually
42
What are thin-walled, translucent, have watery fluid and may project above or within surface of ovary?
folllicular cysts
43
How large can a follicular cyst grow?
1-8cm
44
How do you treat a follicular cyst?
usually disappears spontaneously by resorption or rupture
45
What are the clinical signs or a follicular cyst?
asymptomatic to dull adnexal pressure and pain abnormal ovarian function torsion of ovary resulting in severe pain
46
What is a corpus luteum cyst?
result from hemorrhage within persistently mature corpus luteum
47
What is a corpus luteum cyst filled with?
blood and cystic fluid
48
How large to corpus luteum cysts grow?
may grow 1-10cm in size often complex
49
What may accompany a corpus luteum cyst/
intrauterine pregnancy (IUP)
50
What are hemorrhagic cysts?
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
What are the clinical signs for a hemorrhagic cyst?
acute onset of pelvic pain
52
What are theca-lutein cysts?
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
What are the ovarian syndromes?
ovarian hyperstimulation polycystic ovarian syndrome ovarian remnant
54
What is ovarian hyperstimulation syndrome?
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
how does a patient present with severe OHS?
severe pelvic pain abd distention notably enlarged ovaries measuring >10cm in diameter associated ascites, pleural effusions, numerous large thin walled cysts thoughout the
56
What is polycystic ovarian syndrome?
**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
WHAT ARE THE BENIGN OVARIAN CYSTS?
peritoneal inclusion cysts paraovarian cysts fluid collections in adhesions benign cysts in fetuses
58
What are para-ovarian cysts?
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
what is endometriosis?
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
what does endometriosis look like in its diffuse form?
leads to disorganization of pelvic anatomy with appearance similar to PID or chronic ectopic pregnancy two forms: diffuse and localized ***(endometrioma)***
61
What is endometriosis diagnosis based on?
patient history of symptoms ***a normal pelvic ultrasound does not exclude the presence of endometriosis***
62
what is ovarian torsion?
is caused by partial or complete rotation of ovarian pedicle on its axis produces enlarged edematous ovary...usually >4cm in diameter
63
What does ovarian torsion classically look like?
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
When would you look for ovarian torsion?
when patient presents with acute, severe abd pain medical emergency venous drainage goes first, artery flow second
65
in the ovaries, which side typically has torsion first?
right side
66
what percentage of ovarian cysts <5cm are malignant?
3%
67
neoplasm is __________?
excessive growth....not necessarily cancer
68
What is Meigs syndrome frequently associated with?
fibroma ovarian Ca
69
What volume of the ovary is abnormal for a post menopausal woman?
8.0 cc
70
The ovary synthesizes __________ and converts them to ________.
androgens estrogens
71
Name the 5 complex masses
cystadenoma dermoid cyst tubo-ovarian abscess ectopic pregnancy granulosa cell tumor
72
What are the 7 common cystic or complex ovarian masses?
follicular cyst corpus luteum cyst of pregnancy cystic teratoma paraovarian cyst hydrosalpinx endometrioma (low level echoes) hemorrhagic cyst
73
an ovary with volume twice that of the opposite side generally considered ________
abnormal
74
What are the 6 common solid masses?
solid teratoma adenocarcinoma arrhenoblastoma fibroma dysgerminoma torsion
75
What can be obtained on all ovarian masses?
localized flow with pulsed doppler
76
Why would you doppler the ovary?
to differentiate potential cysts form adjacent vascular structures
77
What are some doppler signs that raise concern for malignancy?
intratumoral vessels low-resistance flow absence of normal diastolic notch in doppler waveform
78
What is NOT a senstitive indicator of malignancy?
RI
79
What are some masses that cause abnormal waveforms on doppler?
inflammatory masses metabolically active masses (including ectopic pregnancy) corpus luteum cysts
80
What does increased diastolic flow suggest?
neovascularity and the likelihood of malignancy
81
masses showing complete absence or minimal diastolic flow (very elevated RI and PI values) usually means what?
the mass is benign
82
What is a sign of benign disease in early diastole?
diastolic notch
83
What are functional cysts a result of?
normal function of ovary
84
What is the most common cause of ovarian enlargement in young women?
functional cysts
85
What are the four cysts that are included in functional cysts?
follicular corpus luteum hemorrhagic theca-lutein cysts
86
What are the three ovarian syndromes?
ovarian hyperstimulation polycystic ovarian syndrome ovarian remnant
87
What are the two non-functioning cysts?
para-ovarian cysts endometrioma

OB/Gyn (14 decks)

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