Ovary

Question 1

follicular cyst

Answer 1

graafian follicle does not rupture at ovulation, continues to grow

resolves spontaneously

Question 2

Corpus luteum cyst

Answer 2

corpus luteum does not degenerate

filled w/ fluid

resolve spontaneously

frequently hemorrhagic

Question 3

Theca-Lutein cyst

Answer 3

high hCG levels

multiple gestations, molar pregnancies
gestational trophoblastic dz
assistive reproduction techniques

B/L, multiple

Question 4

Dermoid cyst

Answer 4

benign cystic teratoma

tissue of multiple germ layers

Question 5

Hemorrhagic cyst

Answer 5

cyst w/ blood - any type

Question 6

Endometroid cyst

Answer 6

endometriosis inside ovary

cyclic bleeding in ovary –> chocolate cyst

Question 7

Ovarian torsion

Answer 7

twisting of supportive ligaments –> impaired vascular supply –> ischemia and necrosis

Risk increases with ovarian mass >5cm diameter

Acute onset of severe pelvic pain -sharp, stabbing
possible radiation to back or groin
+/- N/V

Dx: clinical, pelvic US

Tx: surgery

Question 8

Clomiphene

Answer 8

first line SERM for infertility d/t anovulation

Hypothalamus:
Binds estrogen receptors –> blocked negative feedback of endogenous estrogens
–>increased LH, FSH –> follicle maturation and ovulation

SE:
hot flashes
ovarian enlargement
multiple gestations
Visual disturbances - blurred vision, scotomida, retinal toxicity

Question 9

Evidence of ovulatory cycles

Answer 9

cyclic menses
Mittelschmerz - midcycle pelvic pain assoc w/ ovulation
LH surge: tested for by OTC ovulation prediction kits
Biphasic basal body temperature - 1/2 degree rise after ovulation

Question 10

Infertility

Answer 10

inability to conceive after 1 year

1/3 of females

• PCOS - anovulation
• endometriosis
• uterine fibroids
• PID
• Turners
• Intrauterine adhesions
• Asherman Syndrome

Use hysterosalpingography to check abnormal anatomy

Question 11

Symptoms of ovarian cancer

Answer 11

ascites
abdominal distention
abdominal pain
Nausea
early satiety
vaginal bleeding
urinary sx

Question 12

Risks of ovarian cancer

Answer 12

Family Hx - BRCA1 or 2

Lynch Syndrome - HNPCC
-risk colon, ovarian, endometrial cancers

Uninterrupted ovulatory cycles

• nulliparity
• infertility
• early menache
• late menopause

Question 13

CA125

Answer 13

elevated w/ anything causing peritoneal irritation

Can be used for ovarian cancer marker to monitor

Question 14

4 main categories of ovarian tumors with origin

Answer 14

Surface epithelium –> epithelial tumors

Stroma –> sex-cord - stromal tumors

Primordial germ cell –> germ cell tumors

Metastatic

• Uterus, tubes, ovary
• Krukenberg tumors - gastric adenocarcinoma - met to ovaries b/l; signet ring cells - filled with mucin, nuclei pushed to peiphery

Question 15

Epithelial tumors

Answer 15

“Serious Epithelial Malignancies are Clearly Bad”

Serous tumors
Endometroid tumors
Mucinous tumors
Clear cell tumors
Brenner tumor

40s-60s
often b/l
Poor prognosis

Question 16

Germ cell tumors

Answer 16

Teratomas
Dysgerminoma
Yolk sac aka endodermal sinus tumors
Choriocarcinomas

teens-20s
u/l (15% teratomas b/l)

excellent prognosis, responsive to chemo

Question 17

Sex Cord-Stromal tumors

Answer 17

Granulosa cell tumors
sertoli-Leydig tumors
Fibromas
Thecomas

All ages
u/l

good prognosis, found early

Question 18

Serous tumors

Answer 18

originate in fallopian tubes
ciliated columnar epithelium
Psammoma bodies

Benign: serous cytoadenoma
Malignant: serous cystadenocarcinoma

Question 19

Mucinous tumors

Answer 19

multiloculated
filled w/ mucin - to 50 lbs
can look like gastric or intestinal tissue

Benign: mucinous cystadenoma
Malignant: mucinous cystadenocarcinoma

Question 20

Pseudomyoma peritonei

Answer 20

abundant mucinous ascites

primary cancer of appendix

Question 21

Endometroid tumors

Answer 21

malignant
look like endometrium w/ tubular glands
assoc w/ endometriosis

30% coexist w/ endometrial cancer

Question 22

Clear cell tumors

Answer 22

variant of endometroid cancer

clear cytoplasm

Question 23

Brenner tumor

Answer 23

benign

urinary tract-like epithelium

Question 24

Teratomas

Answer 24

tissue from all 3 germ layers

Benign: mature teratoma
Malignant: immature teratoma

neuroectoderm

Struma ovarii - functional thyroid tissue –> hyperthryoidism, ovarian mass

Question 25

Dysgerminoma

Answer 25

seminoma in males
malignant
produce hCG and LDH
fried egg appearance

Question 26

Yolk sac tumor

Answer 26

“Endodermal sinus tumors”

malignant
produce AFP
Schiller Duval bodies

Question 27

Choriocarcinomas

Answer 27

malignant
produce hCG
mets to lung

Question 28

Granulosa Cell tumors

Answer 28

potentially malignant
produce estrogen

Kids –> precocious puberty
Post meno –> abnl vaginal bleeding, post menopausal bleeding, endometrial hyperplasia/cancer

yellow - cholesteral laden

Call Exner body - rosette surrounding eosinophilic spaces

Question 29

Sertoli-Leydig tumors

Answer 29

Potentially Malignant
resemble seminiferous tubules
produce androgens –> virilization
-hirsuitism, deepning voice, clitoromegaly

yellow

Question 30

Fibromas

Answer 30

Benign

arise from fibroblasts - firm tumors
no hormones

Meigs syndrome: ovarian tumor + ascites + hydrothorax

Question 31

Thecomas

Answer 31

Benign

arise from spindle cells
can be mixed w/ estrogen producing cells