ADNEXA/OVARIES Flashcards

Question

Most common cause E of fever in Post partum

Answer 1

'endometritis

Answer 2

20mm More than Endometritis hemorrhage Retained products of pregnancy Risk increases Prom Retained clot Prolonged labor

Answer 3

Presence of functionalendometrial tissue in abnormal locations Anywhere Especially more dependent Parts of pelvic Cut de sac

Answer 4

Severe diysmenorrhea Chronic pelvic pain Adhesion Bleeding Dysparenuia during sexual intercourse

Answer 5

Internal and External

Answer 6

Within the uterus Adenomyosis

Answer 7

Outside the uterus Pouch of Douglas Surface of ovaries Fallopian tube Uterus broad ligaments Rectovaginal septum

Answer 8

External or indirect

Answer 9

Adenomyosis Invading the uterin body Invading junction al zone and myometrium Heavy menstrul bleeding and uterin e enlargement C

Answer 10

Women had uterin surgery

Answer 11

Uterin bulbous Myometrial cysts Border between endometrium and myometrium is in distinct BLUURED BORDER appearance more common in posterior of uterus MRI more than US IN distinct

Answer 12

Discrete mass Endometrioma Or chocolate cyst Asymptomatic May enlarged Surgical emergency By rupture Causing ovary twisted Common site is ovaries chocolate cyst enlarge ovaries

Answer 13

Rarely detected Unless focal mass Endometrioma present Endometriomas may uni or bilateral ovarian mass Ranging from anechoic To solid depending on amount of blood Ovaries adhere to pos uterine or in culled sac Difficult to define May be cystic mass be disseminated cancer or pelvic infection

Answer 14

Diffuse external endometriosis

Answer 15

Endometrioma and mass in the ovaries fills with blood

Answer 16

If uterus in the midline lateral or posterolateral Uterus in one side of midline ipsilateral ovary superior to uterine fundus In retroverted ovaries lateral and superior Enlarge ed uterus ovaries more superior and laterally Hysterectomy ovaries in midline superior to vaginal cuff Or in high in pelvis or in curl de sac TV if ovaries superiorly or extremely latterly can not be seen

Answer 17

As eccentrically located cyst like 1 mm internal mural protrusion Mature follicle and ovulation

Answer 18

Occasionally follicles decrease in size and develops a wall

Answer 19

Develops if fluid in non dominant follicles not reabsorbed Like simple cyst Dominant follicles disappear after ruptured at ovulation

Answer 20

Commonly seen in. Lute all phase after ovulation

Answer 21

Mature corpus luteim Develops and may be identified in US as small hypoechoic or isoechoic structure periphery within the ovary May appear irregular with echo genie crenulated wall contain low level echoes

Answer 22

RING OF FIRE In Doppler around wall of the isoechoic corpus That the same as ectopic pregnancy

Answer 23

Very small 1 2 mm Periphery no shadowing Multiple

Answer 24

22 ml in menstration mean 9;8 ml +- 5.8 In pst menopause more than 8 ml abnormal If one side is twice of another

Answer 25

Simple cysts benign If in post menopause seen more than 5 cm with septation and solid echoes surgery recommended

Answer 26

Follicular cyst Capos luteum Cystic teratoma Para ovarian cyst Hydrosalpinx Endometrioma Hemorrhagic cyst

Answer 27

Any simple cyst that hemorrhages as involuted برگشتن به حالت اولیه خودش

Answer 28

Adnexal mass Ectopic Endometrioma Endometriosis PID dermoid and other benign tumours Cystadenoma Granulosa cell Tumours or Tubo ovarian abscess

Answer 29

Serous types Cyst Adenoma Cyst adeno carcinoma

Answer 30

More complex the Tubo more more likely to be malignant Especially with ascites

Answer 31

To deferentiate ovarian lesion from pedunculated uterine fibroid Color Doppler to see the vascular pedicle between uterus and mass

Answer 32

Solid teratoma Adenocarcinoma Arrhenoblastoma Fibroma Dysgerminoma Torsion

Answer 33

Suspected cystic lesion In differentiating potential cyst from adjustment vascular iliac artery Pulse Doppler for Adnexal branch uterin artery Ovarian artery Intramural flow To determine resistive index

Answer 34

Normal men’s in first 10 days of cycle To avoids confusion with normal changes in intraovarian blood flow because high diastolic flow occurs in luteal phase

Answer 35

RI > 0.4 PI > 1

Answer 36

Intramural vessels Low resistance flow Absence of normal diastolic notch in DOPPLER

Answer 37

Inflammatory masses Metabolically active masses ectopic pregnancy corpus luteum cysts RI is not the sensitive indicator of malignancy

Answer 38

Sign of benign disease

Answer 39

Follicular Corpus luteum Hemorrhagic Theca lutein cysts

Answer 40

When dominant follicles does not succeed in ovulating and remains active Unilateral Thin wallled translucent watery fluid 1- 8 cm Disappear or rupture Simple cyst

Answer 41

From hemorrhage whitin mature corpus luteum that persisted Filed with blood 1-10 cm May accompany the intrauterine pregnancy May mimic ectopic Rupture cyst type lesion internal echo Increase color

Answer 42

Internal hemorrhage can occur in follicular cyst Or corpus luteual cyst Acute onset of the pelvic pain Appearance: Hemorrhagic cyst with Retracted blood clot showing reticular inner or cobweb or fishnet appearance Indicating hemolysis of the blood

Answer 43

In Endometriomas Chocolate chips and ground glass

Answer 44

Large bilateral multiloculated cyst With high level of bhcg In 30% of trophoblastic molar enlarged uterus filled with grapelike clusters Nausea vometing In US, multilocular cyst in both ovaries

Answer 45

Mild Severe Severe pelvic pain Ascites Abdominal distension Pleural effusion Ovaries more than 10 cm Numerous large thin walled cyst Ovaries no more in pelvic cavity and become abdomen organ

Answer 46

Include stein levanthal syndrome an endocrine disorder with chronic an ovulation Bilaterally enlarge polycystic ovary Clinical amenorrhea Obesity Hirsutism Infertility In US Multiple tiny cyst around periphery of ovary may be normal or enlarged ovary Imbalance in FSH LH. Abnormal estrogen and progesterone characteristics finding in poly Ovaries are rounded increase number of follicles

Answer 47

Imbalance in FSH LH. Abnormal estrogen and endrogen Elevated LH / FSH ratio

Answer 48

Unopposed esterogenic hyperplasia and endometrial carcinoma occurs in significant proportion PCOS common cause of infertility and early pregnancy loss

Answer 49

Enlarge ovary with string of pearls enlarged follicles prominent follicles around peripheral ovary

Answer 50

When adhesion trap peritoneal fluid around ovaries Resulting in large Adnexal mass Pelvic pain pelvic mass

Answer 51

Simple Wolfian duct remnant Can bleed undergo torsion In broad ligament Asymptomatic Simple cyst adjuscent to ovary May completely fill the Adnexal region

Answer 52

Endometrioma chocolate cyst

Answer 53

3% of gynaecology operative emergencies Partial or complete rotation of ovarian pedi ul on its axis Enlarge edematose ovary more than 4 cm Hypoechic mass Free fluid in pelvic Absent of blood flow to TOR sed ovary Result in Edelman Loss of arterial perfusion Infarction of the ovary Involves ovary and fallopian tube

Answer 54

In children and younger female with mobile Adnexa pre-existing ovarian cysts or mass Or pregnancy More often in the right side can mimic appendicitis

Answer 55

Enlarged echogenic ovaries

Answer 56

Absent of symptoms in early stage Not detected until advanced Having spread beyond capsule but still within pelvic stage ll In to abdomen stage lll Normal to slightly enlarge firm irregular ovaries to pelvic mass Differentials Endometriosis Hemorrhagic ovarian cyst Ovarian torsion PID Benign ovarian neoplasm Increase age increase malignant Less than 5 cm benign More than 10 cm malignant

Answer 57

Family history of ovarian and breast cancer Other Nulliparity Infertility Uninterrupted ovulation Late menopause

Answer 58

80 to 90% malignancy 65% to 75% ovarian neoplasm Surface epithelial stromal tumours Arise from surface epithelium cover ovary and underlying stroma

Answer 59

Serous and mucinus tumours Serous epithelial tumours are common

Answer 60

Benign ovarian Mucinous cystadenocarcinoma 5%to 10% malignant ovarian neoplasm

Answer 61

Second most common benign tumour of the ovary after dermoid 20% to 25% of all benign ovarian tumours Serous cyst adeno carcinoma 60 to 80% ovarian carcinoma

Answer 62

Benign or low malignancy potential

Answer 63

Lesion cystic Malignant form adenocarcinoma Fibroma more than 50% of tumour fibrous

Answer 64

Type of epithelial tumour lined by Mucinous elements 20% to 25% benign ovarian neoplasm Mucinous cystadenocarcinoma malignant

Answer 65

Septal nodularity Large sized and septation

Answer 66

Benign large sized septation are characteristics in women 13 to 45 80% to 85% is benign Very large 15-30 cm

Answer 67

• In 75% of patients with mucinous tumors, ultrasound examination shows simple or septate thin-walled multilocular cysts • Contain internal echoes with compartments differing in echogenicity caused by mucoid material in dependent portions

Answer 68

• Unusually large (15 to 30 cm) • Most common cystic tumor • Usually, unilateral • Cyst filled with sticky, gelatin-like material • Multilocular cystic spaces • Benign type more common than malignant • Clinical: pressure, pain, increased abdominal girth • Sonographic findings: simple or septate thin-walled multilocular cysts

Answer 69

• Most frequently occurs in women 40 to 70 years old • Accounts for 5% to 10% of all primary malignant ovarian neoplasms • 15% to 20% bilateral when malignant

Answer 70

• 10% occur in menopausal women • Can also become very large and more likely than benign form to rupture • If tumor ruptures, associated with pseudomyxoma peritoneum • Causes loculated ascites with mass effect

Answer 71

Sonographic findings • Malignant cysts tend to have thick, irregular walls and septations with papillary projections and echogenic material. •Generally, have sonographic appearance similar to serous cystadenocarcinomas

Answer 72

• Bilateral • May occur in menopausal women (10%) • Large, likely to rupture-ascites • Clinical: pelvic pressure; pain when ruptured • Sonographic findings: ascites appears as hypochoic fluid with bright punctate echoes; thick, irregular walls and septations

Answer 73

• Second most common benign tumor of ovary (after dermoid cyst) • Represents 20% to 25% of all benign ovarian neoplasms • Is usually unilateral; 20% are bilateral

Answer 74

G, H, and I are images in a single patient with a serous cystadenocarcinoma. Extensive nodularity shows vascularity confirming the morphologic suspicion of a malignant mass. There is high diastolic flow resulting in a low resistive index.

Answer 75

Sonographic findings • Usually, unilocular or multilocular with thin septations • Smaller than mucinous cysts (up to 20 cm); borders irregular with loss of capsular definition • Multilocular cysts contain small amount of solid tissue in chambers of varying size with occasional internal septum or mural nodules

Answer 76

• External papillary mass adhesions and infection lead to bilateral involvement. • Loss of capsular definition and tumor fixation; calcifications Peritoneal implants; ascites; metastases to omentum, lymph nodes, liver, and lungs • Clinical: pelvic fullness, bloating • Sonographic findings: cystic structure with septations and/or papillary projections; internal and external papillomas usually present

Answer 77

• Account for 15% to 20% of ovarian neoplasms, with approximately 95% being benign cystic teratomas • Besides teratomas, germ cell tumors include dysgerminoma, embryonal cell carcinoma, choriocarcinoma, and transdermal sinus tumor.

Answer 78

• Often occur as mixed tumors with elements of two or three varieties of germ cell layers • Associated with elevated alpha-fetoprotein (AFP) and hCG levels

Answer 79

Teratoma: Dermoid Tumors • Size ranges from small to 40 cm • Unilateral, round to oval mass • Contains fatty, sebaceous material, hair, cartilage, bone, teeth • Clinical: asymptomatic to abdominal pain, enlargement and pressure; pedunculated; subject to torsion • Sonographic findings: cystic/complex/solid mass; echogenic components; acoustic

Answer 80

2) Cystic mass with very echogenic nodule along mural wall representing "dermoid plug"

Answer 81

Sonography may demonstrate one of several patterns: 1) Completely cystic mass 2) Cystic mass with very echogenic nodule along mural wall representing "dermoid plug" 3) Fat-fluid level 4) High-amplitude echoes with shadowing (e.g., teeth or bone) 5) Complex mass with internal septations

Answer 82

• Immature teratomas uncommon; occur in girls and young women 10 to 20 years of age • Rapidly growing, solid malignant tumors with many tiny cysts • AFP elevated in 50% of patients • Unilateral and small in size; may grow to larger dimension

Answer 83

Immature teratoma because of shadowing you cannot say how deep it is the posterior margins is not appreciated

Answer 84

Hyper echo IVC lines corresponding hair in dermoid tumours TERATOMAS small hyperechoic floating lines and dots

Answer 85

Hyperexhoic nodule situated near the wall of the cyst with posterior shadowing

Answer 86

Image (5). A well-defined large complex adnexal mass lesion, with multiple large floating / mobile echogenic spherical structures (named mobile spherules) in benign cystic TERATOMAS

Answer 87

Image (6). A well-defined large cystic adnexal mass lesion, with fat-fluid level (non-dependent lower density hyperechoic fat floating over dependent higher density hypochoic fluid).

Answer 88

Dysgerminoma and serous cystadenoma are two

Answer 89

Dysgerminoma • Rare malignant germ cell tumor bilateral in 15% of cases • Mass constitutes 1% to 2% of primary ovarian

Answer 90

• Entirely solid ovarian mass in woman <30 years of age usually dysgerminoma

Answer 91

• Endodermal sinus tumors rare rapidly growing tumors also called yolk sac tumors • Usually occurs in women <20 years of age; is almost always unilateral • Increased serum AFP may be seen.

Answer 92

Endodermal Sinus Tumor

Answer 93

• Endodermal sinus tumor has poor prognosis. • Second most common malignant ovarian germ cell neoplasm after dysgerminoma •Sonographic appearance similar to dysgerminoma

Answer 94

Endodermal Sinus Tumor

Answer 95

Endodermal Sinus Tumor

Answer 96

• Sex cord-stromal tumors typically solid adnexal masses that arise from sex cords of embryonic gonadal and/or ovarian stroma • Includes granulosa cell tumor, thecoma, fibroma, and Sertoli-Leydig cell tumors (androblastoma) • Accounts for 5% to 10% of all ovarian neoplasms and 2% of all ovarian malignancies

Answer 97

• Both fibroma and thecoma tumors arise from ovarian stroma; are pathologically similar • Tumors with abundance of thecal cells called thecomas, and those with abundance of fibrous tissue called fibromas • Thecomas usually benign and unilateral, comprising 1% of all ovarian neoplasms; 70% occur in postmenopausal women • Frequently show signs of estrogen production

Answer 98

Fibroma and Thecoma

Answer 99

• Comprise 4% of ovarian neoplasms • Rarely associated with estrogen production • Clinical signs include lack of symptoms if tumor small • If large, increasing pressure and pain apparent • Ascites has been reported in up to 50% of patients with fibromas >5 cm in diameter

Answer 100

with fibromas >5 cm in diameter

Answer 101

Meigs syndrome is defined as the triad of benign ovarian tumor with ascites and pleural effusion that resolves after resection of the tumor.

Answer 102

• Associated ascites along with pleural effusion • Referred to as Meigs syndrome; occurs in 1% to 3% of patients with fibroma • Not specific; it can occur with other ovarian neoplasms as well • Found in postmenopausal women

Answer 103

Ovarian fibromas constitute the majority of the benign tumors seen in Meigs syndrome.

Answer 104

• Clinical symptoms of estrogen production may include precocious puberty or vaginal bleeding and full breasts. • Pain, pressure, fullness may also be present. • May twist on itself to cause torsion or rupture, leading to Meigs syndrome • Malignant transformation rare, but when it occurs, lesion spreads via lymphatics and bloodstream

Answer 105

• Feminizing neoplasm composed of cells resembling graafian follicle • Most common hormone-active estrogenic tumor of ovary • More common after menopause (50%) • Also seen in reproductive ages (45%) and in adolescence (5%)

Answer 106

Granulosa Cell Tumor

Answer 107

Granulosa Cell Tumor

Answer 108

precocious puberty or vaginal bleeding and full breasts. • Pain, pressure, fullness may also be present. • Maystwist on itself to cause torsion or rupture, leading to Meigs syndrome • Malignant transformation rare, but when it occurs, lesion spreads via lymphatics and bloodstream

Answer 109

Sonographic findings • Variable appearance • Mass without torsion • Similar to endometrioma or cystadenoma, with low-level homogeneous echoes • If torsion occurs, multilocular cyst containing blood or fluid seen • Solid masses may have echogenicity similar to uterine fibroids.

Answer 110

Metastatic Disease • Ovaries more involved with metastatic disease than any other pelvic organ • Metastases often mimic appearance of advanced stage II to III primary ovarian cancer. • Approximatelv 5% to 10% of ovarian nanni. metastatic in a

Answer 111

• Krukenberg tumors "drop" metastases to ovaries from GI tract, primarily from stomach, but also from biliary tract, gallbladder, pancreas.

Answer 112

Sonographic findings • Metastatic disease to ovaries frequently bilateral and often associated with ascites • Metastases usually completely solid or solid with "moth-eaten" cystic pattern that occurs when nectotic

Answer 113

Metastases usually completely solid or solid with "moth-eaten" cystic pattern that occurs when nectotic بید گاز زده

Answer 114

‏nvolving ovary usually diffuse and disseminated and frequently bilateral ‏• Sonographically, mass appears as solid hypochoic tumor similar to lymphoma elsewhere body.

Answer 115

• Least common (<1%) of all gynecologic malignancies • Adenocarcinoma most common histological finding • Occurs most frequently in postmenopausal women with pain, vaginal bleeding, pelvic mass • Usually involves distal end; may involve entire length of tube

Answer 116

Carcinoma of the Fallopian Tube

Answer 117

• Occurs most frequently in postmenopausal women with pain, vaginal bleeding, pelvic mass

Answer 118

Sonographic findings • Appears as sausage-shaped, complex mass, with cystic and solid components often with papillary projections • Clinical and sonographic findings similar to those of ovarian carcinoma

Answer 119

Carcinoma of the Fallopian Tube in US

Answer 120

pedunculated fibroid, dermoid, fibroma, the-coma, granulosa cell tumor, Brenner tumor ( a solid abnormal growth on the ovary most benign most often in women after menopause), and metastasis. Tubo-ovarian abscess, ovarian torsion, hemorrhagic cysts, and ectopic pregnancy also may appear solid. • Pulsed Doppler interrogation of the adnexal branch of the uterine artery, the ovarian artery, or intratumoral flow is performed to determine the resistive index or pulsatility index.

Answer 121

are the largest of the functional cysts and appear as very large, bilateral, multiloculated cystic masses. They are associated with high levels of human chorionic gonadotropin and are seen most frequently in association with gestational trophoblastic disease.

Answer 122

Omental cysts

Answer 123

teratomas, dysgerminoma, embryonal cell carcinoma ( type of testicular cancer) ( , choriocarcinoma, and transdermal sinus tumor.

Answer 124

• Follicular cyst • Corpus luteum cyst of pregnancy • Cystic teratoma • Paraovarian cyst • Hydrosalpinx • Endometrioma (low-level echoes) • Hemorrhagic cyst • Cystadenoma • Dermoid cyst • Tubo-ovarian abscess • Ectopic pregnancy • Granulosa cell tumor

Answer 125

Ovarian Remnant Syndrome. Infrequently, a cystic mass may be seen in a patient who has a history of bilateral oopho-rectomy. This usually results in a technically difficult surgery (because of adhesions), in which a small amount of residual ovarian tissue has been unintentionally left behind. The residual ovarian tissue can become functional and produce cysts with a thin rim of ovarian tissue in the wall.

Answer 126

. Fluid collections in adhesions can create cystic structures of odd shapes throughout the abdomen. Omental cysts tend to be higher in the abdo-men, and urachal cysts are midline in the anterior abdominal wall peritoneum above the bladder. Any tumor may have cystic elements, and the sonographer should demonstrate if the tumor is a simple cyst or a complex mass.

Answer 127

Small simple cysts (1 to 7 mm) normally occur in fetuses and newborn girls because of stimulation by maternal hormones. In pre-menarchal girls, small follicles (less than 9 mm) are common. Larger cysts also are seen in otherwise healthy premenarchal gis. These may be followed closely if they are regressing, as jong as the child's growth and development appear normal. Occasionally, ovarian cysts produce symptoms of precocious puberty in young girls. These may arise spontaneously or in association with other hormonal derangements.

Answer 128

Less common varieties of epithelial tumors are endometrioid, clear cell, Brenner (transitional cell), and undifferentiated carci-noma. Endometrioid tumors are nearly all malignant and are the second most common epithelial malignancy. Approximately 25% to 30% are bilateral and occur most frequently postmeno-pausal; peak age ranges from 50 to 60 years. Clear cell tumors are considered to be of müllerian duct origin and a variant of the endometrioid carcinoma. Clear cell tumors are nearly always malignant and are bilateral about 20% of the time. Peak age ranges from 50 to 70 years. Transitional cell tumor, also known as Brenner tumor, is uncommon. The Brenner tumor is found in 1.5% to 2.5% of patients; peak age ranges from 40 to 70 years. It is nearly always benign and 6% to 7% are bilateral; 30% are associated with cystic neoplasms in the ipsilateral ovary. • Sonographic Findings. These types of epithelial tumors cannot be distinguished sonographically; however, they are more frequently found unilaterally. They are usually small and present as a nonspecific, complex, predominantly cystic mass. Occasionally the tumor may contain hemorrhage or necrosis. The Brenner tumors are hypochoic, solid masses that may contain calcifications in the outer wall. They are composed of dense fibrous stroma and appear similar to ovarian fibromas and thecomas.

Answer 129

Serous and mucinous Serous cystadenoma Serous cystadenocarcinoma Mucinous cystadenocarcinoma Mucinous cystadenocarcinoma Other epithelial tumors

Answer 130

Teratoma Immature and mature teratoma Dysgerminoma Endodermis sinus tumor

Answer 131

Fibroma Thecoma Granulosa Sertoli leydig cell tumors Arrhenoblastoma

Answer 132

Sertoli-Leydig cell tumors (also called androblastomas) are rare. They generally occur in women under 30 years and constitute less than 0.5% of ovarian neoplasms. Almost all are unilateral, and malignancy occurs in 10% to 20% of these tumors. Clinically, symptoms of virilization occur in about 30% of patients. Occasionally, these tumors may be associated with estrogen production. Sonographic Findings. Sonographically, the tumor usually appears as a solid hypochoic mass.

Answer 133

Arrhenoblastoma Arrhenoblastoma is a masculinizing ovarian tumor that occurs in females 15 to 65 years of age, with a peak incidence at 25 to 45 years. Clinical features are the same as for other pelvic masses, with the addition of amenorrhea and infertility. This mass may undergo malignant transformation in 22% of patients. • Sonographic Findings. The tumor is a solid mass with cystic components; it is lobulated and well encapsulated. In

Answer 134

449. All of the following are solid tumors except: A. Thecoma B. Fibroma C. Brenner's tumor D. Cystadenoma E. Teratoma

Answer 135

Most adnexal masses are: A. Cystic, ovarian in origin, and malignant B. Cystic and ovarian in origin C. Ovarian in origin and malignant D. Cystic and malignant E. None of the above

Answer 136

Benign and estrogenic. Granulosa cell tumors may be discovered in patients of all ages, including children. Smatiy are seen in posimenopausal parients. They are usually benign but do on malignant potential. These estrogenic hmors secrete estrogen, causing pander female characteristics thai present as precocious puberty in children and seas veginal bleding and breast dysplasia in ihe posimenopausal patient. 18. E. Leiomyoma.

Answer 137

459. B. Arrhenoblastoma. Arrhenoblaslomas are androgenic tumors that secrete lestosterone, causing secondary male characteristics. Female patients present with a masculine stature and male hair growth patterns on the face, abdomen, and upper thighs. After removal, female characteristics should return.

Answer 138

• Includes granulosa cell tumor, thecoma, fibroma, and Sertoli-Leydig cell tumors (androblastoma)

ADNEXA/OVARIES Flashcards

(163 cards)