Things i think i should know 5A-5B Flashcards
What are some symptoms of PCOS?
chronic anovulation
• serum LH level is elevated
• FSH level depressed
• results in abnormal oestrogen and androgen production
• excessive androgen production causes symptoms;
o greasy skin
o Acne
o hirsutism (= growth of terminal hair on the body of a woman in the same patterns and sequence as that which develops in the normal post-pubertal male)
o androgenetic alopecia
What is PCOS associated with?
• Associated with
o obesity
o abnormal carbohydrate metabolism
o disturbance of lipid profile
What are women with PCOS t increased risk of?
o endometrial carcinoma
o ovarian carcinoma
o diabetes
o cardiovascular disease
What is the sonographic appearance of PCOS?
- bilaterally enlarged ovaries (>10mL)
- containing multiple small, 2- to 9-mm follicles (at least 20)
- Above criteria are not considered valid if the patient is taking oral contraceptives or has a dominant follicle greater than 10 mm
- increased stromal echogenicity
- Ovaries are a rounded shape
- follicles usually located peripherally (“string of pearls”)
What are the three categories of functional cysts?
o follicular
o corpus luteum
o theca lutein cysts
When does a follicular cyst develop?
when a mature follicle fails to ovulate or to involute and becomes large than 2.5cm
When can you use the term corpus lutein cyst?
When it is greater than 4cm
What is a theca lutein cyst?
• associated with high beta–human chorionic gonadotropin (B-hCG) levels
• the largest of the functional ovarian cysts
• increasing the risk of ovarian torsion
• typically occur in patients with gestational trophoblastic disease
- can also be seen as a complication of drug therapy for infertility causing ovarian hyperstimulation syndrome.
What does a theca lutein cyst look like on sonography?
o Bilateral
o Multilocular
o very large.
o Similar to other functional cysts, they may undergo hemorrhage or rupture.
What is the most common presentation of a haemorrhagic cyst?
• Common presentation is with acute onset pelvic pain
What helps to confirm the diagnosis of a ruptured haemorrhagic cyst?
The presence of echogenic, free intraperitoneal fluid in the cul-de-sac helps confirm the diagnosis of a leaking or ruptured hemorrhagic cyst.
What is ovarian remnant syndrome?
- cystic mass may be encountered in a patient who has undergone bilateral oophorectomy
- due to a small amount of residual ovarian tissue has been unintentionally left behind.
List the pregnancy associated ovarian lesions?
o hyperstimulated ovaries o ovarian hyperstimulation syndrome o theca lutein cysts o hyperreactio luteinalis o the rare luteoma of pregnancy
What are hyper stimulated ovaries?
- a normal response to elevated circulating levels of hCG
- most common in women undergoing ovulation induction
- the ovaries are enlarged with multiple cysts
- some of which may be hemorrhagic
What is ovarian hyperstimulation syndrome?
• used when the hyperstimulation is accompanied by fluid shifts
What are the different forms of OHS?
- The mild form
- Moderate OHS
- severe OHS
What is mild OHS?
o associated with lower abdominal discomfort
o no significant weight gain
o ovaries are enlarged, but less than 5 cm in average diameter
What is moderate OHS?
o presents with weight gain of 5 to 10 pounds
o ovarian enlargement 5 to 12 cm
o patient may have nausea and vomiting
What is severe OHS?
o weight gain of more than 10 pounds
o typically severe abdominal pain and distention.
o The ovaries are greatly enlarged (>12 cm in diameter)
o contain numerous large, thin-walled cysts, which may replace most of the ovary.
o The associated ascites and pleural effusions may lead to
depletion of intravascular fluids and electrolytes
resulting in hemoconcentration with hypotension, oliguria, and electrolyte imbalanceevere
What is hyperreactio luteinalis and when does it occur?
• caused by an abnormal response to circulating hCG in the absence of ovulation induction therapy
• incidence of hyperreactio luteinalis increases in women with polycystic ovarian disease
• In contrast to OHS, body fluid shifts are rare.
• Sonographically, there are;
o bilaterally enlarged ovaries with multiple cysts similar to OHS
o the ovaries tend not to be as large
o occurs later in pregnancy.
When should you suspect a luteoma of pregnancy?
• Most patients are asymptomatic, although maternal virilization may occur in up to 30%
• 50% risk of virilization of the female fetus
• Sonographically;
o luteomas usually present as nonspecific
o heterogeneous
o predominantly hypoechoic masses
o may be highly vascular.
• An ovarian mass in a pregnant patient with signs of virilization should suggest this diagnosis, because luteoma is the most common cause of maternal virilization during pregnancy.
IN what circumstances do you see peritoneal inclusion cysts?
- seen in patients with peritoneal adhesions
- occurring mostly in premenopausal women with a history of previous abdominal surgery
- may also be seen in patients with a history of trauma, PID, or endometriosis
How do peritoneal inclusion cysts occur?
• fluid produced by the ovary (which is the main producer of peritoneal fluid in women) accumulates within the adhesions and entraps the ovaries
• This results in an adnexal mass
Most patients present with pain and/or a pelvic mass
How do peritoneal inclusion cysts appear on sonography/
- multiloculated cystic adnexal masses
- often with a bizarre shape frequently described as a spider web pattern
- The diagnostic finding is the presence of an intact ovary positioned eccentrically amid septations and fluid
Why is diagnosis of peritoneal inclusion cysts important?
- Accurate diagnosis of peritoneal inclusion cysts is important because the risk of recurrence after surgical resection is 30% to 50%
- Conservative therapy, such as ovarian suppression with oral contraceptives or fluid aspiration, is recommended.
What age group does ovarian torsion predominantly effect?
Women of reproductive age or younger
Why are there so many differentials to torsion and what are they?
- Multiple due to the only consistent symptom being intense progressibe abdominal pain localised to the lower quadrants.
- PID
- ovarian cysts
- ectopic pregnancy
- as well as nongynecologic causes
- A right-sided predominance also exists that may mimic appendicitis.
How does torsion appear on sonography?
- enlarged edematous ovary
- or ovarian complex of ovary and adnexal mass
- Lack of arterial and venous Doppler flow should enable confident diagnosis
- presence of Doppler signal cannot eliminate the diagnosis
What are the four types of ovarian neoplasms?
- Epithelial-stromal tumours 65-75%
- Germ cell tumours: 15-20%
- Sex cord-stromal tumours: 5-10%
- Metastatic tumours: 5-10%
What are the different types of epithelial stromal tumours?
Serous cystadenoma Serous cystadenocarcinoma Mucinous cystadenoma Mucinous cystadenocarcinoma Endometrioid tumour Clear cell tumour Transitional cell tumour
What are the different types of germ cell tumour?
Teratoma
Dysgerminoma
Yolk sac tumour
What are the different types of sex cord-stromal tumours?
Granulosa cell tumour
Sertoli-Leydig cell tumour
Thecoma and fibroma
What do ovarian neoplastic lesions look like on sonography and how do they present?
• usually presents as an adnexal mass. • Can also present as ascites, abdominal pain and vaginal bleeding. • Well-defined anechoic cysts are more likely to be benign • Malignant lesions o irregular walls o thick irregular septations o mural nodules, o solid elements with flow o more likely to be malignant
How can colour be used in differentiating neoplasms?
- Not reliable for differentiation
- Malignant lesions may have a low PI and RI
- Malignant lesions tend to have central flow
- Doppler ultrasound is likely valuable in assessing the mass that is morphologically indeterminate or suggestive of malignancy.
- Doppler findings should be combined with morphologic assessment, clinical findings, patient age, and phase of menstrual cycle for optimal evaluation of an adnexal mass
What is the usual order of ovarian cancer spread?
- local invasion in the pelvis
- peritoneal seeding across the abdominal cavity
- lymphatic embolisation to:
o para-aortic nodes
o uterus
o other ovary - blood-borne metastasis to liver, lungs, brain, bone
What are the most common epithelial-stromal tumours?
Serous Cystadenoma and Cystadenocarcinoma
How do Serous Cystadenoma and Cystadenocarcinoma appear on ultrasound?
Serous cystadenoma • large • thin-walled cysts • typically unilocular • may contain thin septations • Papillary projections are occasionally seen Bilateral 20%
Serous cystadenocarcinomas
o may be quite large
o usually present as multilocular cystic masses
o containing multiple papillary projections arising from the cyst walls and septa
o septa and walls may be thick
o Echogenic solid material may be seen within the loculations.
o Papillary projections may form on the surface of the cyst and surrounding organs, resulting in fixation of the mass.
o Ascites is frequently seen.
bilateral 50%
