Quiz 3 Flashcards
1
Q
what are the types of tumors?
A
- surface epithelial-stroma
- germ cell
- sex cord-stromal
- metastatic
2
Q
what is the most common of all ovarian tumour groups?
A
Serous Cystadenoma / Serous cystadenocarcioma
3
Q
describe Serous Cystadenoma / Serous cystadenocarciomas
A
- big ovarian tumors
- malignant version usually affects peri and post menopausal women
- looks similar to mucinous-usually more anechoic
- not good prognosis if malignant due to late detection
4
Q
describe Mucinous cystadenoma/cystadenocarinoma
A
largest of all tumors
- 30cm taking up all pelvis
- thick mucous within sonographically debris within
- very similar to serous variety
5
Q
what is largest of all tumors?
A
Mucinous cystadenoma/cystadenocarinoma
6
Q
slide 8 lesson 9
A
doesn’t make sense
7
Q
Transitional cell aka Brenner Tumour appearance
A
can look like a hypoechoic mass (thick fibroid)
8
Q
what are differentials for Transitional cell aka Brenner Tumour?
A
tumors in sex-chord stromal group
9
Q
what are borderline tumors for Transitional cell aka Brenner Tumour?
A
can look similar to serous and mucinous
10
Q
where do the germ cell tumors originate?
A
endoderm
mesoderm
ectoderm
11
Q
what is the most common and benign Represent 95% of all the tumours in the Germ cell category?
A
dermoid or cystic teratoma
12
Q
what are dermoid filled with?
A
hair
teeth
fat
13
Q
why may dermoids have a different sonographic appearance?
A
based on the tissue growing within the tumor
14
Q
what is the significance of knowing the dermoid?
A
easily missed if not looking due to attenuation “tip of the iceburg” might think its bowel
15
Q
what are some names of appearances of a dermoid?
A
- dermoid plug
- tip of the iceberg
- dermoid mesh
16
Q
what are some other rare germ cell tumors?
A
- yolk sac
- immature teratoma
17
Q
yolk sac tumor
A
- malignant
- young age
- fatal
18
Q
immature teratoma
A
look similar to dermoid start to have malignant features
19
Q
what are sex chord-stromal tumors formed from?
A
sex chord cells
20
Q
what does sex chord stromal tumors cause?
A
- produce estrogen (granulosa and thecoma)
- cause viralization (male traits)
21
Q
are sex-chord stromal tumours rare or common?
A
rare
22
Q
who does sex chord stromal tumours tend to affect?
A
younger women and girls
23
Q
what looks like fibroids with sex chord-stromal tumours?
A
fibroma and thecoma
24
Q
what is sex cord-stromal tumours associated with?
A
meig’s syndrome
25
what is meig's syndrome?
the presence of ascites and pleural effusion in association with a benign, usually solid ovarian tumour
(ovarian fibroma or fibroma-like tumor)
26
what is the etiology of meig's syndrome?
The cause of Meigs' syndrome does not appear to be clear although there seems to be an inflammatory reaction that causes the ascites and pleural fluid accumulation.
27
what are the signs and symptoms of meig's syndrome?
```
Fatigue
Shortness of breath
Increased abdominal girth
Weight gain/weight loss
Bloating
Amenorrhea
Menstrual irregularity
Benign ovarian tumor
Ascites
Pleural effusion
```
28
what is the sonographic appearance of meig's syndrome?
- tumor arising from the pelvis
- fullness of flanks
- ovarian mass
- hypoechoic mass with marked posterior attenuation
29
differential diagnosis of meigs syndrome?
```
Cirrhosis
Colon Cancer, Adenocarcinoma
Hypoalbuminemia
Lung Cancer
Milroy Disease
Nephrotic Syndrome
Ovarian Cancer
Tuberculosis
pedunculated fibroid or Brenner's Tumor
```
30
what are the outcomes of meig's syndrome?
- bengin and the ascites and pleural effusion resolves after resection of the primary pelvic tumour
- drain off the excess fluid for symptomatic relief
- unilateral salpingo-oophorectomy or wedge resection is the treatment of choice
31
are metastatic ovarian tumours benign or malignant?
malignant
32
where do metastatic ovarian tumours come from?
- colon or gastric
- breast
- lymphoma
33
metastatic ovarian tumours are not a good _____________
prognosis
| -already have primary now spread
34
krukenburg tumour
metastatic ovarian tumor that originates from the stomach/colon cancer
35
are metastatic tumors unilateral or bilateral?
bilateral
36
sonographic appearance of bengin
- well defined anechoic lesions
| - thin septations
37
sonographic appearance of malignant
- irregular walls
- thick irregular septations
- mural nodules
- solid echogenic element
38
what should doppler findings be combined with?
- morphological
- clinical findings
- patient age
- phase of menstrual cycle
39
colour and pulsed wave doppler benign
- more peripheral flow
| - higher resistive flow
40
colour and pulsed wave doppler malignant
- tend to have more centralized flow
- lower PI
- Lower RI
- higher diastolic flow
41
what is one of the leading causes of maternal deaths in the US?
ectopic pregnancy
42
what is an ectopic pregnancy?
pregnancy not implanted within the endometrium
43
what is the classic triad for clinical presentation for ectopic pregnancy?
- pain
- abnormal vaginal bleeding
- palpable adnexal mass
44
what are some further clinical presentations of ectopic pregnancy?
Pain
Abnormal vaginal bleeding
Palpable adnexal mass
Amenorrhea
Adnexal tenderness
Cervical excitation pain
45
what are some pathologies with similar presentation of ectopic pregnancy?
- PID
- dysfunctional uterine bleeding
- spontaneous abortion
- ovarian cysts
46
was are risk factors of ectopic pregnancy?
- tuba abnormality
- previous tubal pregnancy
- Hx of tubal reconstructive surgery
- PID
- IUD
- increased maternal age
- increased parity
- previous cesarean section
47
what are increased risks with infertility?
- ovulation induction
- IVF
- Embryo transfer
48
if you have an increased risk with infertility what else may you be at risk for?
ectopic and heterotopic pregnancy
49
what is the most common reason for morbidity?
bleeding
50
what are the hCG levels in ectopic pregnancy?
lower than in normal pregnancy
51
what in very important in clinical tests for ectopic pregnancy?
serial hCG
52
what must you see if hCG is present?
gestational sac
53
how fast does GS grow?
1 cm per week
54
how much should hCG grow?
double every 2-3 days
55
why is transvaginal ultrasound used?
- increased accuracy of diagnosis
| - increased visual of intrauterine and adnexal findings
56
what are the sites of ectopic pregnancy?
- ampulla or ithmus
- intramural portion
- cervix
- ovary
- abdominal
57
what is the most common site of ectopic pregnancy?
ampulla or isthmus
58
what is the most vascular increase risk of massive bleeding?
- intramural portion of tube
- cervix
- ovary
59
what is another name for intramural location of ectopic pregnancy?
interstitial ectopic (cornual)
60
why is intramural location ectopic pregnancy hard to detect?
myometrium covers tube in this region
61
when may their be a late rupture for intramural ectopic pregnancy?
3-4 months
62
is there bleeding for intramural ectopic pregnancy?
+++bleeding
63
what do you have a higher risk for in intramural location of ectopic pregnancy?
higher morbidity rate
64
what may be seen on ultrasound with intramural ectopic pregnancy?
interstitial line sign
65
what does the interstitial line sign look like on ultrasound?
thin, echogenic line extending from the endo canal to the interstitial sac or ectopic site
66
what is absent with intramural ectopic pregnancy?
no double-decidual sign
67
what is the treatment of intramural ectopic pregnancy?
- surgical laparotomy & cornual resection
| - methotrexate therapy
68
cervical scar implantation ectopic
- painless vaginal bleeding
- Hx of cesarean sections
- can look similar to spontaneous abortion
69
what is cervical scar implantation?
sac implanted in lower uterine segment and local myometrial thinning
70
what happens with cervical scar implantation?
+++vascularity at implantation site
| no D&C due to thin myometrium
71
what nay happen with cervical scar implantation?
catastrophic hemorrhage
| -one sav detached "no vascularity"
72
what is the treatment of cervical scar implantation?
complete hysterectomy
73
what is an increased risk to get cervical ectopic pregnancy?
Hx of D&C
74
how does vascularity determine cervical ectopic pregnancy?
implantation-vascular
| incomplete abortion-nonvascular
75
what is the treatment for cervical ectopic pregnancy?
medical injection KCl (potassium chloride)
76
what is abdominal pregnancy treated like?
diagnosed in 1st trimester and treated like a tubal ectopic
77
what are the sonographic appearances of ectopic?
- donut sign
- live fetal pole
- decidual reaction
- free fluid
78
is heterotropic gestation rare or common?
very rare
79
what is heterotropic gestation?
intrauterine pregnancy and an ectopic pregnancy occurring simultaneously
80
what excludes an heterotopic gestation from ectopic?
Intrauterine pregnancy
81
when may you suspect heterotopic gestation?
patient IVF
Ov. Induction
ET
82
when is heterotopic gestation definitely diagnosed?
if live embryo in adnexa and IUP
83
what are some abnormalities of the cervix?
```
Nabothian cysts
cervical polyps
leiomyomas
cervical carcinoma
cervical cerclage
```
84
what is the size of Nabothian cysts?
4cm
85
Nabothian cysts
- single or multiple
- benign
- simple or have internal echoes
- multiple cysts can result enlargement of cervix
86
cervical polyps
- cause vaginal bleeding
| - can be seen U/S usually diagnosed clinically
87
leiomyomas 8% cx
- pedunculated
| - may prolapse into vagina
88
cervical carcinoma
- usually diagnosed clinically
- U/S may show solid retro vesical mass (look like a fibroid)
- MRI is best
89
adenoma malignum
- rare
- associated Peutz-jeghers syndrome inherited
- U/S appears as multiple cystic areas seen within a sold cx mass
90
what is the most common congenital abnormality of the female genital tract?
imperforate hymen
91
what is gartner's duct cysts
remnants of caudal end of mesonephric cysts
92
where can gartner's duct cysts occur?
anterolateral or anterior wall of vagina
93
what are the symptoms of gartners duct cyst?
asymptomatic
94
what are the size of gartner's duct cysts?
usually small
95
what is gartner's duct cysts associated with?
renal and ureteral abnormalities
96
what may ultrasound not be used for in a diagnosis but may be used for staging?
vaginal pathologies
| -neurofibroma
97
what can cervical remnant be mistaken for?
mass
98
what can cervical remnant measure?
4.4 mm AP and 4.3 mm length
99
what may happen after hysterectomy?
vaginal cuff and cervical cuff after hysterectomy mistaken for mass
100
what is the vaginal cuff upper limit?
TV-2.2mm (AP)
| TA-2.4mm (AP)
101
hydro
fluid
102
pyo
puss
103
hemat
blood
104
colpos
vagina
105
what could fluid in the PCDS be from?
blood or fluid from follicular rupture or retrograde menses
106
what is PCDS fluid collections seen with?
- general ascites
- blood (ruptured ectopic or hemorrhagic cyst)
- pus (infection)
- PID
107
anechoic PCDS fluid
serous fluid
108
fluid containing echoes in PDCS
blood
pus
mucin
(clotted blood can look echogenic)
109
why may fluid not suppost to be in cul-de-sac be there?
- pelvic abscesses
| - hematomas
110
are congenital anomalies of fallopian tubes rare or common?
rare
111
what are some abnormalities of fallopian tubes?
- pregnancy (ectopic)
- infection (PID)
- torsion
- neoplasm
- scarring & obstruction due to other causes
112
why would we look at fallopian tubes
important to determine adnexal cyst verus fluid filled tube "hydrosalpinx" (asymptomatic)
113
tubal torsion is usually with what?
ovary torsion
114
isolated torsion of fallopian tubes
- paratubal cysts
- chronic hydrosalpinx
- tubal torsion & hydrosalpinx
115
what will the patient present with for tubal torsion?
severe pelvic pain
116
what may be the initial development of high grade serous cystadenocarcinomas?
fallopian tube carcinoma
117
how is fallopian tube carcinoma managed?
same as ovarian cancer
118
if a patient has fallopian tube carcinoma what can a 'minority of patents' present with?
hydrops tubae profluens (profuse watery discharge)
119
where is the most common place to see fallopian tumor?
distal end of tube more common or entire
120
what does fallopian tumor look like?
- sausage shaped
| - solid or cystic mass with papillary projections
121
Dx of fallopian tube tumor can be considered if________
solid "mobile" vascular mass with normal ovaries
122
what are vascular abnormalities in the adnexa?
- ovarian vein thrombosis or thrombophlebitis
| - pelvic congestion syndrome
123
is ovarian vein thrombosis or thrombophlebitits common or rare?
rare
124
when may ovarian vein thrombosis occur?
48-96 hours post partum
125
what are S/S of ovarian vein thrombosis?
- fever
- lower abd pain
- palpable mass
126
which ovarian vein is mostly affected?
right ovarian vein 90% of the time
127
what is good for diagnosing ovarian vein thrombosis?
CT & MRI
128
what may ovarian vein thrombosis be seen on ultrasound?
- inflammatory mass anterior to psoas and lateral to uterus
| - ovarian vein
129
what is treatment for ovarian vein thrombosis?
anticoagulant
| antibiotic therapy
130
what is pelvic congestion syndrome?
pelvic varices and reduced venous return
131
what are S/S of pelvic congestion syndrome?
- dull chronic pain worse when standing
| - relieved with lying down and elevation of legs
132
what is the diagnosis of pelvic congestion syndrome?
venography reference standard
133
what may ovarian vein look like with pelvic congestion syndrome?
- diameter over 5-10mm with reflux
- uterine varicosities
- congestion of ovarian plexus (tortous)
134
what most commonly causes PID?
STI
- gonorrhea
- Chlamydia
135
what are causes of PID?
- STI
- Direct Extension
- hematogenous spread from TB rare (blood)
136
what are signs and symptoms of PID?
- pain
- fever
- chills
- vaginal discharge
- increased WBC
137
how does PID enter the body?
outside to inside
| -vagina-cervix-uterus (endometritis)-tubes (acute sapingitis)-into pelvis
138
what increases the risk of PID?
IUCD
139
what are long term problems of PID?
- infertility
- chronic pelvic pain
- increased risk of ectopic pregnancies
140
what are sonographic findings of PID?
- endometritis
- purluent material in cul-de-sac
- periovarian inflammation
141
periovarian inflammation
enlarged ovaries with multiple cysts and indistinct margins
142
pyosalpinx
- pus filled
| - dilated, tortuous tubes with low level echoes
143
hydrosalpinx
- fluid filled
- dilated tortuous tubes
- anechoic
144
what are different US appearances of tubal wall structure of PID?
- cogwheel sign
- beads on a string design
- incomplete septa (waist sign)
145
cogwheel sign
- visible in cross section of tube
- anechoic with thickened walls
- acute disease
146
beads on a string design
- hyperechoic mural nodules within fluid filled tubes
| - chronic disease
147
incomplete septa (waist sign)
- hyperechoic septa (acute and chronic)
| - good for differentiating hydrosalpinx from other adnexal masses
148
as infection worsens-tubo ovarian complex
- increased echogenicity of inflamed fat
- fusion of the inflamed tube with the ovary (adhesions)
- ovary is visible does not separate from the tube with TV
149
what is the worse outcome of PID?
tubo-ovarian abscess
150
what does tubo-ovarian abscess look like?
-complex, multiloculated mass
-septations
-irregular margins
-scattered internal echoes
-usually posterior enhancement
-fluid-debris level or gas can sometimes be seen
CLINICAL CORRELATION IS NEEDED TO DETERMINE B VS M
151
ultrasound for PID
- useful for making initial diagnosis of PID
| - help with determining pt managment
152
trans abdominal for PID
extent of disease
153
transvaginal for PID
better detail
154
treatment of PID for mild to moderate cases?
outpatient antibiotics
| -follow up is then needed
155
treatment for ovarian abscess
hospitalization IV antibiotics
| -follow up then needed
156
what happens if antibiotics fail?
-US guided TV aspiration and drainage in combo with antibiotics
157
what are some post operative pelvic masses?
- Abscesses
- Hematomas
- Lymphoceles
- Seromas
- Uriomas
158
what does an abscess pelvic mass look like?
- ovoid
- anechoic
- thick, irregular walls
- posterior enhancement
- variable internal echogenicity
- shadowing from gas
159
what do hematoma pelvic masses look like?
- variable appearances with time (start anechoic and end anechoic)
- can be hard to distinguish hematoma and abscess
160
lymphoceles
- disruption of lymphatic channels
| - cystic
161
uriomas
- cystic
| - collection of urine
162
seromas
- cystic
| - collection of serum
163
pseudomasses
fecal material in rectum or rectosigmoid colon
164
bowel neoplasms usual appearance
target sign
| -central echogenic focus with thickened hypo echoic wall
165
pelvic abscesses RLQ
- appendicitis
| - chron's
166
pelvic abscesses LLQ
diverticular disease
