Test 1 Part 2 Flashcards
what is endometriosis?
result of functioning endometrial tissue being located outside of the uterus
when is endometriosis stimulated?
hormonally stimulated during the reproductive years and can affect 25%-35% of infertile women
what are symptoms of endometriosis?
- pelvic pain
- dyspareuinia
- abnormal uterine bleeding
- dysmenorrhea
- can be asymptomic
endometriosis can be _____ or ________
localized or diffuse
where is the most common place for endometriosis to occur?
ovaries
how is endometriosis treated?
medically with hormones
what is endometrioma also known as?
chocolate cyst
how does an endometrioma appear?
a mass involving the ovary
what is the classic sonographic sign of an endometrioma?
- well defined
- thin-walled mass containing low level echoes
- internal echoes with through transmission
endometrioma may be unilocular or multilocular are are frequently __________
multiple in number
what are other sonogrpahic features of endometrioma?
- masses with thick walls
- internal septations
- fluid/debris levels in the depensant portion of lesion
how are endometriomas most easily characterized?
transvaginally
what is polycystic ovarian syndrome (PCOS)?
an endocrine disorder that produces anovulation and results in infertility
PCOS has high levels of what?
androgen hormones
what are the clinical symptoms of PCOS?
- infertiity
- early pregnancy loss
- hirtusism
- acne
- amenorrhea
- asymptomatic
how is the diagnosis made for PCOS?
evaluation of the clinical presentation and hormone levels
why may PCOS patients be monitored?
PCOS may incur the risks associated with unopposed estrogen and may be monitored for endometrial carcinoma and breast cancer
what is the sonographic appearance of PCOS?
- bilateral ovaries that contain multiple smal follicles
- follicles usually in periphery
- STRING OF PEARLS
- ovaries have increase in stromal echogenicity
- normal or large in size
what is the sonographic criteria for PCOS?
- presence of 12 or more follicles measuring 2-9 mm OR
- increased ovarian volume greater than 10 mL
what is the summary of criteria for diagnosing PCOS?
- Oligoovulation or anovulation
- clinical or biochemical signs of hyperandrogenism
- polycystic ovaries
what modality is superior for detecting and determining the type of anomaly present in ovaries?
3D imaging and MRI
what is helpful for diagnosing anomalies?
Hysterosalpingogram
a defect can be removed during a ___________
hysteroscopy
the development of the uterus is closely associated with the development of what system?
excretory system
when a uterine anomaly is identified, what should also be evaluated for the presence of congenital anomalies?
kidneys
unilateral renal ageneis or renal ectopia
what is uterus didelphys?
complete failure of the mullerian ducts to fuse together
what is the sonographic appearance of a uterus didelphys?
- 2 seperate endometrial echo complexes
- a deep fundal notch is present, seperated widely with a full complement of myometrium
- 2 cervices and vagina
what may occur with uterus didelphys?
hematocolpos or hematometracolpos
what is a bicornuate uterus?
duplication of the uterus entering 1 cervix or 2 cervices with only 1 vagina
how does bicornuate uterus occur?
results from partial fusion of the mullerian ducts during embryologic development
what is Bicornis bicollis?
duplication of both cervix and uterus
what is Bicornis unicollis?
duplication of the uterus without duplication of the cervix
what is the sonographic appearance of a bicornuate uterus?
- shows a deep fundal notch
- endometrial echoes appear as 2 different complexes widely seperated
- same appearance as uterus didelphys in fundal region
how can bicornuate uterus and uterus didelphys be differentiated?
with identification of duplication of the vaginal canal, which is evident in uterus didelphys
what is the most common congenital uterine abnormality?
septate uterus
how does septate uterus occur?
result of a failure in reabsorption of the median septum
what is the treatment for a septate uterus?
can have septum removed via hysteroscopy if infetility occurs
what is the mildest congenital uterine abnormality?
arcuate uterus
what is an arcuate uterus?
minor lack of fusion of the fundal region that results in a slight depresion in that area
does an arcuate uteris considered to be an infertility issue?
no
what is the sonogrpahic appearance of an arcuate uterus?
normal with no change to external uterine contour and the uterine cavity is slightly concave
what plays a key role in the evaluation and managment of infertility treatment?
sonography
depending of the specific cause for infertility, what may be the treatment for infertility?
- ovarian stimulation to induce ovulation
- intrauterine semination
- in virtro fertilization
how is stimulation of the ovaries often monitored?
with serum estradiol level and transvaginal sonogrpahy to determine follicle size and number
what is ovarian hyperstimulation?
serious complication that can result from stimultion of the ovaries for induction of ovulation
how do theca lutein cysts occur?
ovaries massivly enlarge with multiple luteinized follicles
what causes theca lutein cysts?
excessive human chorionic gonadotropin levels
what can ascites and pleural effusions devlop and lead to?
hypovolemia
hypotension
impaired renal function
what are indications that may prompt a sonographic evaluation to assess for an ovarian mass?
- pelvic pain
- pelvic fullness
- palpable mass
- fam history of ovarian or breast cancer
when an adnexal mass is discovered during sonogram, what should be evaluated?
- location
- echotexture
- size of mass
- any associated findings such as ascites
- cystic, solid, complex?
- acoustic enhancement or atten.
- presence on internal echoes by optimized gain and freq
- loculation, thickness, iregularity
- apply colour
what needs to be considered when scanning for ovarian pathology?
- patients age
- menstraul status
- symptoms
- fam history
who is more likely to present with benign ovarian pathology?
women in their reporductive years
who is at a higher risk for malignant ovarian pathology?
postmenopausal women and women of reproductive years and fam history of ovarian or breast cancer
when can a functional or physiologic cyst occur?
of an ovarian follicle or corpus luteum fails to regress, it can continue to fill with fluid
what does the term functional cyst mean?
means that the cyst is ovarian in origin and responds to cyclic hormonal changes
what are one of the most common causes of ovarian enlargment in young women?
follicular cysts
when do follicular cysts occur?
when a dominant follicle fails either to ovulate or to regress
what are hemorrhagic cysts?
functional cysts bleeding inside
what are theca lutein cysts?
functional cysts related to human chorionic gonadotropin exposure
what are nonfunctional cysts?
refer to cysts that do not respond to cyclic hormonal stimulation
what are examples of nonfunctional cysts?
endometriomas
paraovarian cyst
peritoneal inclusion cysts
where do paraovarian cysts originate?
from the wolffian structures located in the broad ligament
what term describes the appearance of hemorrhagic cyst?
fishnet
what causes the ovary to enlarge with ovarian torsion?
lack of venous drainage
what can cause the ovary to infarct and necrose in ovarian torsion?
compromised arterial perfusion
when does ovarian torsion usually occur?
childhood or reproductive years
what presents clinically with ovarian torsion?
- severe pain
- nausea
- vomiting
- may be palpable mass
what is the most widely used serum tuor marker for epithelial ovarian cancer?
antigen 125 (CA 125)
what is done when a womens serum concentration of CA 125 is elevated?
transvaginal sonography may be preformed to assess for an ovarian mass
Only _________ of women with stage 1 epithelial ovarian cancer have elevated serum levels
50%-60%
what is used for screening when a women has a high risk of ovarian cancer?
combination of CA 125 with transvaginal sonography
who has a higher risk of a malignant ovarian neoplasm? premenopausal or postmenopausal?
postmenopausal
what are ovarian neoplasms classified by?
type of ovarian tissue
- germ cell
- epithelial
- sex cord-stromal tumors
what type of tumors are the 2 most common types of ovarian neoplams?
germ cell tumors
what are the 2 most common types of ovarian neoplasms?
- benign cystic teratoma
- surface epithelial-serous cystadenoma
who are germ cell tumors most commonly found in?
young women
who are epithelial tumors more common in?
women in thier fourth and fifth decades
Metastatic ovarian disease is a __________source of ovarian neoplasms
fourth
what is the sonogrpahic apperance of metastatic disease?
- pattern recognotion
- morphologic recognition
- doppler features
- clinical signs and symotoms
- consideration of age
- menpausal status
what is another name for bengin cystic teratomas?
cystic teratomas
dermoids
dermoid cyst
what are benign cystic teratomas composed of?
3 germ cell layers:
- ectoderm
- mesoderm
- endoderm
what do germ cells form?
- teeth
- bone
- skin
- fingernails
- hair
- fat
- sebum
what does a cystic teratoma usually contain?
sebum with varying amounts of fat, hair, teeth, and bone fragments
what are sonographic signs of cystic teramtoma?
- tip of the iceberg
- fat/fluid level
- dermoid plug
- dermoid mesh
are ovarian dysgerminomas malignant or benign?
malignant
what may patients with malignant dysgerminoma present with?
abdominal enlargment because of palpable mass or pain or menstrual abnormalities
what is the most common ovarian tumor among women 50 years or older and account for most malignant ovarian neoplams?
epithelial ovarian neoplams
what are the most common types of epithelial neoplams?
- serous and mucinous cystadenoma or cystadenocarcinoma
- borderline ovrian tumors
- endometroid tumors
- OTHER=clear cell tumor and brenner or transitional cell tumor
what are the most common type of epithelial neoplams?
serous cystadenoma and cystandenocarcinoma
who does serous cystadenoma (benign form) occur in?
most frequently in women 40-50 years old
who does serous cystadenocarcinoma (malignant form) occur in?
perimenopausal and postmenopausal women
what does a serous cystandenoma look like?
- simple cyst
- thin septations
- papillary projections or both
what is pseudomyxoma peritonei?
rupture of mucinous cystadenoma and cystadenocarcinoma tumor capsule may cause spillage of the gelantinous contents into the abdomen
what may an endometriod tumor be associated with?
endometrial adenocarcinoma and endoetriosis
About________ of endometrioid tumors are malignant
80%
what is the second most common malignant epithelial tumor?
endometroid tumor
what are brenner tumors also known as?
transitional cell tumors
are brenner tumors usually benign or malignant?
benign
what is the size of brenner tumors usually?
usually less than 2cm in diameter and rarely exceed 10cm
what are brenner tumors usually associated with?
ipsilateral cystic neoplasm such as a cystadenoma or cystic teratoma
what do sex cord-stromal tumors arise from?
sex cords of the embryonic gonad and from the ovarian stroma
what are the most common sex cord-stromal tumors?
- granulosa cell tumor
- sertoli-leydig cell tumor (adroblatoma)
- fibroma
- thecoma
what tumor often secrete estrogen-thickened endometrium?
granulosa cell tumor
what can excess estrogen in children cause?
precocious puberty or premature breast development
what may sertoli-leydig tumors produce?
testosterone and occasionly estrogen
what do fibromas consist of?
fibrous tissue, are not hormonally active, and tend to be asymptomatic
what do thecomas consist of?
variable combination of thecal and fibrous tissue
what causes meigs syndrome?
benign solid ovarian mass of which fibroma is the most common
what is associated with meig’s syndrome?
presence of ascites and a pleural effusion
what are the most common tumors to metastasize to the ovary?
tumors of the breast and of the GI tract
what can metastasize to the ovaries?
endometrial carcinoma
what is a krukenburg tumor?
tumors containing mucin-secreting signet ring cells, which arise from the GI tract
what is the size of a cyst versus a follicle?
over 2-3cm
