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Reproductive and sexual medicine > Benign ovarian pathology > Flashcards

Benign ovarian pathology Flashcards

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1
Q

What are some forms of ovarian pathology

A

Ovarian cysts
Rupture ovarian cyst
Endometrioma
Ovarian torsion

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2
Q

What are some forms of ovarian cyst?

A
  • Follicular (E.g. polycystic ovaries)
  • Luteal
  • Endometriotic
  • Epithelial
  • Mesothelial (Neoplastic)
  • Serous and mucinous cystadenoma
  • Dermoid cysts (Teratoma)
  • Sex cord-stomal tumours
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3
Q

What is a cyst?

A

A cyst is afluid-filled sac.

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4
Q

What is meant by a functional ovarian cyst?

A

Ovarian cysts that are related to the fluctuating hormones of the menstrual cycle

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5
Q

Who is most at risk of malignancy in ovarian cysts

A

Post-menopausal women

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6
Q

How do ovarian cysts present?

A
  • Asymptomatic
  • pelvic pain
  • Bloating
  • Fullness in the abdomen
  • Palpable pelvic mass
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7
Q

What are follicular ovarian cysts

A

Cysts that form when the developing follicle fails to release the egg

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8
Q

Describe the characteristics of follicular cysts

A
  • Often disappear after a few cycles
  • Thin walled
  • No internal structures
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9
Q

What is a corpus luteum cyst?

A

A cyst forming when the corpus luteum fails to break down and instead fills with fluid

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10
Q

How do corpus luteum cysts usually present?

A

Pelvic discomfort
Pelvic pain
Delayed menstruation
In early pregnancy

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11
Q

What is a serous cystadenoma

A

benign tumour of epithelial cells

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12
Q

What is a mucinous cyst adenoma

A

Benign tumour of epithelial cells that can grow very large

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13
Q

What are dermoid cysts?

A

Teratomas in the ovary that arise from germ cells and so can contain many tissue types such as skin, teeth, hair, fat and bone

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14
Q

What are sex cord-stromal tumours

A

Rare benign or malignant tumours arising from either the stroma (Connective tissue) or sex cords (Embryonic structures associated with follicles)

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15
Q

What are examples of a sex cord-stromal tumour

A

Sertoli-Leydig cell tumours
Granulosa cell tumours

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16
Q

What are some features that suggest malignant transformation of an ovarian cyst

A
  • Abdominal bloating
  • Reduce appetite
  • Early satiety
  • Weight loss
  • Urinary symptoms
  • Pain
  • Ascites
  • Lymphadenopathy
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17
Q

Who does not need further testing in ovarian cysts

A

Pre-menopausal women with a simple cyst <5cm on USS

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18
Q

Management of dermoid cysts

A

Referral to gynaecology for further investigation and surgery

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19
Q

Management of simple ovarian cyst < 5cm

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A

Conservative (Will usually resolve in a few cycles)

20
Q

Management of simple ovarian cyst 5-7cm

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A

Routine gynae referral and yearly US monitoring

21
Q

Management of simple ovarian cysts >7cm

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A

MRI or surgical evaluation (Difficult to characterise with US

22
Q

Investigation of cysts in post-menopausal women

23
Q

Complications of ovarian cysts

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A

Torsion
Haemorrhage into the cyst
Rupture into peritoneum

24
Q

What is Meig’s syndrome

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A

Meig’s syndrome involves atriadof:

  • Ovarian fibroma(a type of benign ovarian tumour)
  • Pleural effusion
  • Ascites
25
How is Meig's syndrome managed?
Surgical removal of the tumour (Will resolve ascites and effusion)
26
What are the most common ovarian cysts that rupture
Functional cysts (Most common) Dermoid and endometrioma
27
What are some causes of ovarian cyst rupture?
Spontaneous Post-trauma (E.g. Sex, Contact sports)
28
What are some symptoms of ovarian cyst rupture?
Acute pelvic pain Afebrile
29
What are some signs of ovarian cyst rupture
Rebound tenderness Haemorrhage occasionally causes shock
30
What investigations are required in ovarian cyst rupture?
US - Shows rupture and haemorrhage
31
How is ovarian cyst rupture managed?
Treated conservatively if pre-menopausal unless evidence of shock Surgical evaluation if post-menopausal
32
What is an endometrioma?
A cystic lesion in the ovary arising from the disease process of endometriosis
33
Describe the macroscopic characteristics of endometrioma
Filled with dark-brown endometrial fluid and so are known as chocolate cysts Also fibrous adhesions and peritoneal spots or nodules
34
What are some symptoms of endometrioma
- Pelvic pain - Heavy menses - Painful menses - Back pain - Painful sexual intercourse (dyspareunia) - Painful defecation (dyschezia) - Painful urination (dysuria) - Urinary frequency - Nausea/vomiting - Bloating
35
How do endometriomas usually form?
seeding of ectopic endometrial tissue occurs, most often on the ovary, bleeds, causing a hematoma. This typically occurs with the natural menstrual cycle of a woman because the ectopic endometrial tissue is still hormonally active. Therefore, this tissue will naturally shed with the withdrawal of progesterone after the breakdown of the corpus luteum.
36
How is endometrioma diagnosed?
Can be visualised on imaging but pathology is only discovered through surgery
37
How is endometrioma usually managed
Endometriomas suggest a more severe endometriosis so are treated surgically
38
What are some complications of endometriomas?
Pain Cyst formation Adhesions Infertility Ectopic pregnancy Malignancy (Endometrioid carcinoma)
39
What is ovarian torsion?
A condition where the ovary twists in relation to the surrounding tissue, fallopian tube and blood supply (Adnexae)
40
What are the usually causes of ovarian torsion?
Ovarian mass >5cm (E.g. cyst, tumour)
41
Who is most at risk of ovarian torsion?
Pregnant women Girls pre-menarche (Longer infundibulopelvic ligaments)
42
Describe the pathophysiology of ovarian torsion
twisting leads to ischaemia followed by necrosis if it lasts long enough
43
How does ovarian torsion present?
Sudden onset severe unilateral pain Progressively worse Nausea and vomiting Localised tenderness Possible palpable mass
44
What investigations are required in ovarian torsion
Pelvic US - Whirlpool sign (Free fluid and oedema) laparoscopic surgery
45
How is ovarian torsion managed?
De-torsion and fixing OR Oophorectomy
46
What are some complications of ovarian torsion?
Infection Abscess Sepsis Rupture -> Peritonitis
47

Reproductive and sexual medicine (78 decks)

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