Surgery Ovary

Question 1

causes of pelvic mass by frequency and age group

Answer 1

read

Question 2

when to suspect malignancy

Answer 2

pelvic or adnexal mass in extreme of age

Question 3

prepubertal vs postmenopausal masses

Answer 3

prepubertal: functional cyst, gem cell tumor
postmenopausal: epithelial ovarian tumor

Question 4

clinical presentation of pelvic mass

Answer 4

vague fullness, pressure, early satiety, flatulence

late: increasing abdominal girth, pain, mass, bleeding

Question 5

abdominal enlargement happens when ovary is ___

Answer 5

10-15 cm

Question 6

___ has the greatest influence in evaluation of pelvic mass

Answer 6

age, neoplasms more prevalent in older women

Question 7

important findings in pelvic exam

Answer 7

• check rectovaginal portion (posterior cul de sac)
• firm nodularity in posterior cul de sac = further evaluation
• benign: cystic and movable
• malignant: solid and fixed

Question 8

pertinent lab exams

Answer 8

all premenopausal: pregnancy test and cbc

ca 25 + he4

Question 9

what is ca 125

Answer 9

• tumor marker for epithelial ovarian tumors
• n: <35 u/ml
• not effective screening tool

Question 10

tumor markers

Answer 10

epithelial ovarian ca = ca 125
mucinous cystadenoca = ca 125, ca 19-9
mixed germ cell tumor, chorioca = bhcg
granulosa cell tumor = inhibin
 yolk sac tumor = afp
dysgerminoma = ldh

Question 11

diagnostic test of choice for evaluating pelvic mass

Answer 11

uts

Question 12

characteristics of ovarian mass

Answer 12

solid areas, thickened capsule, adhesions, size and composition, laterality

Question 13

excellent modality for retroperitoneal masses

Answer 13

ct scan

Question 14

central pathogenesis in ovarian ca

Answer 14

incessant ovulation

Question 15

risk factors and protective factors for ovarian ca

Answer 15

risk: age, fhx, late menopause, nulliparity, late childbearing
protective: ocp, breastfeeding, tubal ligation

Question 16

t/f ovarian ca is staged with ct scan

Answer 16

false, surgically with histopath confirmation

Question 17

washings needed for staging

Answer 17

• diaphragm
• right and left hemiabdomen
• pelvis even if there is tumor rupture or tumor on external capsule
• ascites or abdominal cavity

Question 18

t/f you need to remove primary ovarian / fallopian tube tumor with intact capsule

Answer 18

true, with thbso

infracolic omentectomy. infragastric omentectomy for gross omental involvement

Question 19

2 samples of random biopsy from

Answer 19

• undersurface of right hemidiaphragm
• bladder reflection
• cul de sac
• r and l paracolic recesses
• r and l pelvic side walls

Question 20

what is systematic lymphadenectomy

Answer 20

complete pelvic ln dissection and paraaortic ln sampling

appendectomy also possible

Question 21

stage I ovarian ca

Answer 21

Ia = 1 ovary or fallopain tube
1b = both ovaries of fallopian tube
1c1 = surgical spill
1c2 = capsule ruptured before surgery or tumor on ovarian/f tube surface
1c3 = malignant cells in ascites or peritoneal washings

Question 22

stage II ovarian ca

Answer 22

IIa = extension on uterus and/or fallopian tubes and/or ovaries
IIb = extension to other pelvic intraperitoneal tissues

Question 23

stage III ovarian ca

Answer 23

IIIa1 = microscopic positive retroperitoneal ln only
IIIa2 - microscopic extrapelvic peritoneal involvement +/- retroperitoneal
IIIb = macroscopic peritoneal metastasis beyong pelvis up to 2 cm - metastasis to retro ln
IIIc = macroscopic peritoneal metastasis beyond pelvis >2 cm

Question 24

stage IV ovarian ca

Answer 24

IVa pleural effusion with (+) cytology

IVb parenchymal metastases and metastases to extraabdominal organs

Question 25

most frequent epithelial ovarian tumors

Answer 25

serous, mucinous, endometrioid, clear cell

Question 26

management for epithelial ovarian tumros

Answer 26

adjuvant chemo, paclitaxel-carboplatin

Question 27

most common ovarian epithelial tumor

Answer 27

serous cystadenocarcinoma (resembles fallopian tube e)

risk: reproductive, >40 yo

Question 28

classic triad for fallopian tube ca

Answer 28

• clear or blood tinged vaginal discharge (hydrops tubae profluens)
• pelvic pain
• pelvic mass

Question 29

type of surgery for all ovarian/ fallopian/ peritoneal tumors

Answer 29

cytoreductive = want to get zero residual

Question 30

what is mucinous cystadenocarcinoma

Answer 30

• mucin filled
• risk: reproductive, 30-60
• resemble endocervical or intestinal e.

Question 31

what is endometrioid ca

Answer 31

• risk: peri or postmenopausal with low parity

- associated with endometriosis

Question 32

what is clear cell ca

Answer 32

• less common, more aggressive
• risk: 40-70 yo
• identical histo with endometrium, cervix, vaginal tumors
• hobnail cells w/ nucleus standing on stalk of cytoplasm

Question 33

second most frequent ovarian neoplasm

Answer 33

germ cell tumors

Question 34

what are germ cell tumors

Answer 34

• risk: young (<30 yo)

- have homologous counterparts in males

Question 35

diagnosis for germ cell tumors

Answer 35

• tumor markers

- frozen section

Question 36

management for germ cell tumors

Answer 36

• remove ovary, stage
• leave uterus and contra ovary (sensitive to chemo)
• adjuvant: multiagent chemo

Question 37

most common malignant germ cell tumor

Answer 37

dysgerminoma

• tumor marker: ldh
• analogous to seminoma in males

Question 38

second most common malignant germ cell tumor

Answer 38

immature teratoma

• tumor marker: afr
• resemble benign dermoid cyst

Question 39

what is endodermal sinus tumor

Answer 39

• yolk sac tumor

- tumor marker afp

Question 40

most common sex cord stromal tumor

Answer 40

granulosa cell tumor

• estrogen producing
• seen in extremes of age
• tumor marker: inhibin

Question 41

rare sex cord stromal tumor

Answer 41

sertoli leydig cell tumor (androblastoma)

• virilizing tumor
• indolent

Question 42

what is metastatic ovarian tumor (krukenberg tumor)

Answer 42

• usually bilateral and solid
• signet ring adenoca
• tx: remove tumor and manage primary site
• poor prognosis