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Module 203, Theme 3- Gynaecological pathology, common gynaecological disorders and sexual health > T3 L6 Ovarian Cysts > Flashcards

T3 L6 Ovarian Cysts Flashcards

1
Q

What is the name of the structures in the ovaries that forms the ovum?

A

One of the PRIMORDIAL FOLLICLES become dominant and forms the ovum

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2
Q

How many women have a cyst but are unaware of it?

A

1 in 10

NOTE: Most cysts are asymptomatic

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3
Q

Why is pain felt during ovulation?

A

The pain is felt because the capsule of the ovary is breached

NOTE: Some women are able to tell which ovaries they are ovulating from due to the pain coming from one side, they feel when they ovulate.

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4
Q

TRUE OR FALSE

Ovulation is not random, but it alternates between the left and the right ovaries each month.

A

FALSE
Ovulation is TOTALLY random.

It doesn’t alternate between the left and right ovaries each month, it primarily depends on which ovary is dominant.

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5
Q

Describe the epidemiology of ovarian cysts

A

4th most common cause of gynaecological admission

4% of all women in U.K. will be admitted with this by age 65 years

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6
Q

Are ovarian cysts neoplastic or non-neoplastic?

A

They are BOTH

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7
Q

What % of ovarian cysts are benign?

A

90%

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8
Q

What % of surgically managed tumour are malignant in:

  • premenopausal women
  • postmenopausal women
A

Premenopausal women : 13%

Postmenopausal women : 45%

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9
Q

What are the complications of ovarian cysts?

A
  • Torsion
  • Rupture
  • Haemorrhage
  • Infection
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10
Q

What is torsion?

A

Spinning of the organ around its blood supply, which eventually cuts off the blood supply

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11
Q

In which sex is it harder to diagnose torsion? Why?

A

Women

Because the ovaries are buried deep within the abdomen (unlike the testes which is outside the body)

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12
Q

When can the cyst become infected?

A

The cyst can become infected if it sits against the wall of the bowel, especially when the bowel is inflamed (e.g. in diverticulitis)

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13
Q

How does torsion occur in the ovaries?

A

The ovarian arteries come from further up near the renal arteries, and they travel down the abdomen to the ovaries.

Therefore the ovaries can spin around the their blood supply, due to their position lower down in the pelvic cavity

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14
Q

What does “gravida” and “para” connote?

A 
Gravida = number of pregnancy
Para = number of babies
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15
Q

What do peritoneal signs (e.g. lower abdominal pain) indicate?

A

An ovarian cyst rupture

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16
Q

What are the types of ovarian cyst ruptures?

A

Traumatic

Spontaneous

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17
Q

What happens when the ovarian cyst ruptures?

A

Its contents are disseminated throughout the abdomen

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18
Q

What do the symptoms of the ovarian cyst depends on?

A

Amount
AND
Character

Of the contents (in the ovarian cysts)

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19
Q

How can you treat the ovarian cysts rupture if it is mild?

A

-Treat conservatively with morphine

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20
Q

What can you do if you are unsure about the diagnosis (e.g. if you’re not sure whether it is an ovarian cyst rupture)?

A

Laparoscopy can be carried out

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21
Q

What are the sequelae of an ovarian cyst rupture?

A

Peritonitis : inflammation of the periotneum

Pseudomyxoma peritonei : rare cancer that usually starts in the appendix

22
Q

What are the signs of haemorrhage (in the ovarian cyst)?

A

Localised tenderness

Bleeding causes a local mass which can stretch the ovaries causing pain

23
Q

What is the adnexum of the uterus?

A 
Fallopian tube (a.k.a uterine tube)
Ovaries
24
Q

If a female comes to the hospital with a pale face and in a lot of pain and has a distended abdomen what must you rule out first?

A

An ectopic pregnancy

25
Q

Describe the classic presentation of torsion

A

Acute abdominal pain with nausea and vomiting.

Tachycardia and temperature 37.8C (febrile)

Lower abdo guarding and rigidity

26
Q

What usually occurs before surgery to treat an ovarian torsion?

A

Ovarian infarction

27
Q

What is the usual surgical treatment for an ovarian torsion?

A

Salpingo-oophorectomy

28
Q

Why are ovaries prone to cysts formation?

A

Because of their dynamic nature

The ovaries undergoes changes each month

29
Q

What is the germinal epithelium of the ovaries?

A

A layer of simple squamous-to-cuboidal epithelial cells covering the ovary.

30
Q

Where do most cysts and tumours occur?

A

The germinal epithelium

31
Q

Is the germinal epithelium part of the germ cell?

A

NO

The germ cells are separate from the germ cell epithelium and they make eggs

32
Q

Which cells in the ovaries make hormones?

A

Stromal cells

33
Q

What is dysparunia?

A

Pain during sexual intercourse

34
Q

Where do dermoid cysts arise from?

A

Germ cells

35
Q

COMPLETE THE SENTENCE

Majority of dermoid cysts are __________ but some can be ______________

A

BENIGN

MALIGNANT

36
Q

Name the tumour markers

A

beta hCG
lactate dehydrogenase
alpha-beta proteins

37
Q

What could be a potential presentation of Sertoli-Leydig tumour?

A

Amenorrhoea
Hair recession and hirsuitism
Clitoromegaly
Slightly tender mass

38
Q

What can happen if the woman has undergone a lot of androgenisation due to the Sertoli-Leydig tumour?

A

Their periods may go back to normal but their vocal cord may never go back to normal

39
Q

What investigations could be carried out to diagnose a Sertoli-Leydig tumour?

A

Blood test results

Laparotomy

40
Q

What’s the origin of Sertoli-Leydig tumour?

A

Stromal cell origin

NOTE: It is rarely bilateral

41
Q

What is the prognosis for a Sertoli-Leydig tumour?

A

Very good

42
Q

Define a borderline epithelial ovarian tumour

A

The tumour can spread around the abdomen but it cannot invade and form a metastasis somewhere else

43
Q

What is the RMI and how is it calculated?

A

RMI = Risk of Malignancy Index

RMI = MS (menopause status) x USSS (ultrasound severity) x CA125 (levels of CA125)

44
Q

Where do epithelial ovarian tumour metastasise to?

A
  1. Contralateral spread
  2. Small bowel
  3. Large bowel
  4. Omentum
  5. Diaphragm
  6. Liver
  7. Pleural cavity
45
Q

What is the survival rate of these different stages of epithelial ovarian cancers?

Stage I
Stage II
Stage III
Stage IV

A

Stage I = 70-100%

Stage II = 55-63%

Stage III = 10-27%

Stage IV = 3-15%

46
Q

Why is ovarian cancer called the “silent disease”?

A

60-80% present at advanced stage

47
Q

Between what ages does the incidence of ovarian epithelial cancers have the greatest increase?

A

35-60 years

48
Q

What could be the symptoms of large ovarian cysts?

A 
Vague abdominal discomfort
Nausea
Poor appetite
Loss of weight
Increasing malaise and tiredness
49
Q

Why do women with large ovarian cysts lose weight?

A

For some women, it is intentional weight loss because they feel (due to their cysts) that they are getting larger/gaining weight

50
Q

What happens to the total body weight when the large ovarian cyst is removed?

A

The total body weight decreases

NOTE: Their actual body weight (minus the cyst), may drop dangerously low due to the intentional weight loss (as a result of the large cyst)

Module 203, Theme 3- Gynaecological pathology, common gynaecological disorders and sexual health (8 decks)

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