Benign OvarianPathologies

Question 1

1. What percentage of benign and malignant ovarian tumors are of germ cell origin?

A) 10%
B) 20%
C) 30%
D) 40%

Answer 1

The correct answer is C) 30%.

According to the text, approximately 30% of benign and malignant ovarian tumors are of germ cell origin.

Question 2

2. What is the overall risk of malignancy of an ovarian cyst in a premenopausal woman?

A) 5%
B) 13%
C) 25%
D) 50%

Answer 2

The correct answer is B) 13%.

Question 3

3. What is the risk of malignancy of an ovarian cyst in a postmenopausal woman?

A) 13%
B) 25%
C) 45%
D) 50%

Answer 3

C) 45%

Question 4

4. What type of ovarian tumors are characterized by production of estrogen, leading to abnormal uterine bleeding or postmenopausal bleeding?

A) Germ cell tumors
B) Sex cord-stromal tumors (Thecoma)
C) Epithelial tumors
D) Mucinous tumors

Answer 4

The correct answer is B) Sex cord-stromal tumors (Thecoma).

According to the text, Thecomas are a type of sex cord-stromal tumor that produce estrogen, leading to abnormal uterine bleeding or postmenopausal bleeding.

Question 5

5. What is the triad of symptoms associated with Ovarian Fibroma?

A) Ascites, pleural effusion, and ovarian torsion
B) Ascites, pleural effusion, and ovarian fibroma (Demons-Meigs syndrome)
C) Pelvic pain, abnormal bleeding, and ovarian cysts
D) Infertility, pelvic mass, and ovarian tumor

Answer 5

The correct answer is B) Ascites, pleural effusion, and ovarian fibroma (Demons-Meigs syndrome).

According to the text, Demons-Meigs syndrome is a triad of symptoms associated with Ovarian Fibroma, consisting of:

1. Ascites
2. Pleural effusion
3. Ovarian fibroma

Question 6

6. What is the characteristic ultrasound pattern seen in Theca Lutein Cysts?

A) String of beads appearance
B) Spoke-wheel pattern
C) Solid mass with calcifications
D) Simple cystic structure

Answer 6

B) Spoke-wheel pattern.

Theca Lutein Cysts have a characteristic “spoke-wheel pattern” on ultrasound.
The characteristic pattern seen in Theca Lutein Cysts is ;
- anechoic,
- multi-loculated ovarian cysts.
These cysts develop in 25–65% of complete molar pregnancies, particularly when hCG levels exceed 100,000 mIU/ml. Key features include¹:
- Cyst Characteristics:
- Anechoic: Cysts appear as echo-free, fluid-filled structures.
- Multi-loculated: Cysts have multiple compartments or locules.
- Size: Mean diameter is around 7 cm, but can range from 3 to 20 cm.

• Regression: Cysts regress slowly over 2–4 months following molar evacuation as hCG levels decline.
• Complications: Rarely, these cysts can rupture spontaneously or undergo torsion, requiring prompt laparoscopic intervention.

Question 7

7. What type of ovarian tumor is composed of well-differentiated tissue derived from any of the 3 germ cell layers, including hair and teeth?

A) Mature Teratoma (Dermoid cyst)
B) Immature Teratoma
C) Serous Cystadenoma
D) Mucinous Cystadenoma

Answer 7

The correct answer is A) Mature Teratoma (Dermoid cyst).

According to the text, Mature Teratomas (Dermoid cysts) are composed of well-differentiated tissue derived from any of the 3 germ cell layers especially the ectoderm including hair and teeth.

Question 8

8. What is the recommended management for a simple ovarian cyst <5 cm in an asymptomatic premenopausal woman?

A) Surgical intervention
B) Repeat ultrasound in 3 months
C) Expectant management
D) Hormonal therapy

Answer 8

The correct answer is C) Expectant management.

According to the text, asymptomatic premenopausal women with simple ovarian cysts <5 cm do not require follow-up, implying expectant management.

Question 9

9. What is the recommended course of action for women with an ovarian cyst >7 cm?

A) Repeat ultrasound in 3 months
B) Surgical intervention
C) Hormonal therapy
D) CT scan for further evaluation

Answer 9

The correct answer is B) Surgical intervention.

surgical intervention is considered for ovarian cysts >7 cm.

Question 10

What factors are used to calculate the Risk of Malignancy Index (RMI)?

Question 11

What is the name of the syndrome associated with ovarian fibroma, characterized by ascites and pleural effusion?

Answer 11

“Demons-Meils syndrome” or “Meigs syndrome”)

Question 12

What type of ovarian tumor is known for producing estrogen, potentially leading to abnormal uterine bleeding or postmenopausal bleeding?

Answer 12

The correct answer is Thecoma.

Thecomas are a type of sex cord-stromal tumor known for producing estrogen, which can lead to abnormal uterine bleeding or postmenopausal bleeding.

Question 13

What is the typical presentation of a Brenner tumor?

Answer 13

Brenner tumors are characterized by cells similar to those found in the bladder, specifically transitional-type epithelium.

Question 14

What type of ovarian tumor is often associated with torsion?

Answer 14

Dermoid cyst (Mature Teratoma). Dermoid cysts are known to have a higher risk of ovarian torsion due to their size and weight.

Question 15

What is the typical characteristic of a simple ovarian cyst on ultrasound?

Answer 15

A simple ovarian cyst typically appears as an anechoic (not echoic) structure with a single lobule or unilocular, and smooth walls on ultrasound.

Question 16

What is the definition of benign ovarian pathologies according to the text?

A) Diseases of the ovary with malignant potential
B) Diseases of the ovary without any malignant potential
C) Diseases of the ovary caused by infection
D) Diseases of the ovary caused by tumors

Answer 16

Answer: B) Diseases of the ovary without any malignant potential

Question 17

What are the locations of the ovaries in the female pelvis?

A) In the broad ligament
B) On the posterior wall of the broad ligament in the paraovarian fossa
C) In the peritoneal cavity
D) Attached to the uterus

Answer 17

Answer: B) On the posterior wall of the broad ligament in the paraovarian fossa

Rationale: the ovaries are “Paired, pinkish white located in paraovarian fossa • On posterior wall of broad ligament.”

Question 18

What are the three main histologic compartments of the ovary?

A) Surface müllerian epithelium, germ cells, and sex cord–stromal cells
B) Surface müllerian epithelium, germ cells, and connective tissue
C) Germ cells, sex cord–stromal cells, and muscle cells
D) Surface müllerian epithelium, muscle cells, and connective tissue

Answer 18

Answer: A) Surface müllerian epithelium, germ cells, and sex cord–stromal cells

Rationale: According to the text, the ovary has three main histologic compartments: Surface müllerian epithelium, Germ cells (produce oocyte), and Sex cord–stromal cells.

Correct! Well done!

Question 19

What are the attachments of the ovary?

Answer 19

Suspensory ligament (infundibulopelvic), utero-ovarian ligament, mesovarium and fimbria ovarica

Question 20

What is the blood supply to the ovary?

Answer 20

The blood supply to the ovary comes from two arteries:

1. Ovarian artery (branch of the aorta)
2. Uterine artery (branch of the internal iliac artery)

Question 21

What is the size of a mature follicle?

Answer 21

That’s correct! According to the text, a mature follicle measures:

17-28mm

Question 22

Where do the lymphatics of the ovary drain?

Answer 22

Lymphatics: drain into
• Left: lateral and pre aortic lymph nodes
• Right: lateral and pre caval lymph nodes

Question 23

What type of pathologies do benign ovarian pathologies span?

Answer 23

Tumoral, nontumoral, and infectious pathologies.

Question 24

What is the structure that forms after ovulation?

Answer 24

Corpus luteum

Question 25

What are the functions of the ovary?

Answer 25

Ovaries could be said to represent the brain of the female genital system The ovaries play a crucial role, and their functions include: 1. Production of hormones (estrogen, progesterone, little androgen etc.) 2. Ovulation (release of oocytes) These functions enable female reproductive system development, regulation, and fertility.

Question 26

What are the types of ovarian masses?

Answer 26

According to the text, ovarian masses are categorized into: 1. *Surface Epithelial Tumors* (e.g., Serous cystadenoma, Mucinous cystadenoma) 2. *Germ Cell Tumors* (e.g., Mature cystic teratoma (dermoid cyst)) 3. *Sex Cord–Stromal Tumors* (e.g., Fibroma)

Question 27

Characterize ovarian masses

Answer 27

ovarian masses can be categorized into: A) ## Functional ovarian cysts 1. *Follicular Cysts*: Result from ovulation failure, typically asymptomatic, can cause pelvic pain, dyspareunia, and abnormal uterine bleeding. 2. *Corpus Luteum Cysts*: Failure of involution of corpus luteum, may be associated with torsion, rupture, and bleeding, can simulate ectopic pregnancy. 3. *Theca Lutein Cysts*: Elevated hCG levels, associated with hydatidiform mole, choriocarcinoma, or normal pregnancy, usually bilateral and filled with clear fluid. 4. *Endometriomas* (Chocolate Cysts): Develop in women with endometriosis, contain thick, brown blood debris. 5. *Hyperthecosis*: Characterized by nests of stromal cells, often associated with virilization and clinical findings similar to PCOS. 6. Polycystic Ovarian Syndrome (PCOS) (Stein-Leventhal Syndrome): • Characterized by persistent anovulation, hyperandrogenism and enlarged polycystic ovaries 7. *Luteoma of Pregnancy*: Tumorlike nodules of lutein cells forming during pregnancy, often multifocal and bilateral. B) ## Benign Ovarian Neoplasms/Organic Cysts Histologically, organic ovarian cysts can be: • Benign epithelial tumors (serous, mucinous, endometrioid, clear cell or Mesonephroid, transitional cell or Brenner) • Sex cord tumors (thecoma, fibroma, hilus cell tumor) • Germinal cell tumors (mature teratoma)

Question 28

What are the risk factors for functional ovarian cysts?

Answer 28

Previous cysts, smoking, Tamoxifen, POPs The text also mentions that COCs (Combined Oral Contraceptives) reduce the risk of functional cysts.

Question 29

What is the result of failure of involution of corpus luteum at the end of the luteal phase?

Answer 29

Corpus Luteum Cysts.

Question 30

Which functional cyst is most at risk of rupturing

Answer 30

Corpus Luteum Cysts.

Question 31

What is the characteristic ultrasound finding in Theca Lutein Cysts?

Answer 31

Spoke-wheel pattern "The cysts are multilocular • Characteristic spoke-wheel pattern on ultrasound." Well done!

Question 32

What are Theca Lutein Cysts usually filled with?

Answer 32

Clear, straw-colored fluid

Question 33

What is the common size range of endometriomas?

Answer 33

6-8 cm

Question 34

What is another name for endometriomas due to their characteristic content?

Answer 34

endometriomas are also referred to as "chocolate cysts" because they contain thick, brown blood debris inside.

Question 35

What is hyperthecosis or thecomatosis characterized by?

Answer 35

Hyperthecosis is characterized by: - No gross enlargement of the ovary - Lesions demonstrable only by histologic examination of the excised gonad - Nests of stromal cells demonstrating increased cytoplasm, simulating the changes seen in the normal theca after stimulation by pituitary gonadotropin. Great job!

Question 36

What is the typical presentation of luteoma of pregnancy?

Answer 36

- Can be hormonally active, with production of androgens resulting in maternal and fetal hirsutism and virilization. However, the text also mentions that luteoma of pregnancy is typically discovered during cesarean delivery and usually regresses after pregnancy. The text also states that luteomas can be: - Tumorlike nodules of lutein cells that may form in the ovaries during pregnancy - Often multifocal and bilateral - Usually discovered during cesarean delivery

Question 37

Presentation of hyperthecosis or thecomatosis

Answer 37

In the premenopausal woman, hyperthecosis is 1) virilization 2) clinical findings similar to those seen in polycystic ovarian disease. 3) postmenopausal bleeding 4) endometrial hyperplasia.

Question 38

What is the common size range of luteoma of pregnancy nodules?

Answer 38

Luteoma of pregnancy nodules can range up to 20 cm in diameter, but most often from: 5–10 cm

Question 39

What is Polycystic Ovarian Syndrome (PCOS) characterized by?

Answer 39

That's mostly correct! According to the text: Polycystic Ovarian Syndrome (PCOS) is characterized by: - Anovulation - Hyperandrogenism - Bilateral polycystic ovaries 12 or more peripherally oriented cystic structures (2 to 9 mm) with a "string of pearls" or "string of beads" appearance on ultrasound Great job!

Question 40

Diagnosis of PCOS

Answer 40

The Rotterdam criteria for PCOS diagnosis include: - exclusion of other possible causes of hyperandrogen .( including two of the following) - Oligo-anovulation or anovulation - Clinical and/or biochemical signs of hyperandrogenism - Polycystic ovaries on ultrasound

Question 41

What are the clinical features of PCOS?

Answer 41

The clinical features of PCOS include: - Hirsutism - Weight gain or obesity - Anovulation or oligomenorrhea (infrequent periods) - Hyperandrogenism (acne, male pattern baldness) Androgen excess can also cause: - Acne - Male pattern baldness Great job!

Question 42

What are the long-term health risks associated with PCOS?

Answer 42

That's one of them! According to the text: PCOS is associated with several long-term health risks, including: - Infertility - Metabolic syndrome - Insulin resistance - Type 2 diabetes - Cardiovascular disease

Question 43

What is the typical treatment approach for PCOS?

Answer 43

The treatment approach for PCOS often includes: - Lifestyle modifications: weight loss through diet and physical exercise - Medications: Combined Oral Contraceptives (COCs) to regulate menstrual cycles and reduce androgen levels - Other treatments may be added depending on the individual's specific needs and symptoms.

Question 44

Let's start with a question: What percentage of all benign ovarian neoplasms are Mature Teratomas (dermoid cysts)? A) 10-20% B) 20-30% C) 40-50% D) 60-70%

Answer 44

40-50 %

Question 45

That's correct! According to the text: Mature Teratomas (dermoid cysts) account for 40-50% of all benign ovarian neoplasms. Well done! Next question: What is the typical fluid produced by serous cystadenoma? A) Mucinous fluid B) Watery fluid C) Thick, brown blood debris D) Purulent fluid

Answer 45

B watery fluid

Question 46

What type of tissue can be found in mature teratomas?

Answer 46

mature teratomas contain well-differentiated tissue derived from any of the 3 germ cell layers, especially ectodermal derivatives." "..hair and teeth, skin, bone etc

Question 47

What is the typical presentation of Hilus Cell Tumors?

Question 48

Benign ovarian neoplasms/organic cysts classification

Answer 48

Histologically, organic ovarian cysts can be: • Benign epithelial tumors (serous, mucinous, endometrioid, clear cell or Mesonephroid, transitional cell or Brenner) • Sex cord tumors (thecoma, fibroma, hilus cell tumor) • Germinal cell tumors (mature teratoma)

Question 49

What is the typical presentation of Hilus Cell Tumors?

Answer 49

hirsutism, virilization, and menstrual irregularities

Question 50

4. What type of fluid is produced by mucinous cystadenoma?

Answer 50

mucinous fluid.

Question 51

What are the sonographic indices suspicious for malignancy in ovarian neoplasms?

Answer 51

"Sonographic indices suspicious for malignancy are 1) septations, 2) solid components, 3) Doppler flow (blood vessels) within a neoplasm." These features are suggestive of potential malignancy.

Question 52

What type of tumor is associated with unopposed estrogen production and abnormal uterine bleeding or postmenopausal bleeding?

Answer 52

"Thecoma... Produce estrogen → abnormal uterine bleeding or postmenopausal bleeding." Thecoma is indeed associated with unopposed estrogen production, which can lead to abnormal uterine bleeding or postmenopausal bleeding.

Question 53

What type of ovarian tumor is a solid firm white mass with bands?

Answer 53

"Fibroma... Solid firm white mass with bands" Fibroma is indeed characterized by its solid firm white mass with bands.

Question 54

1. What is the most widely used tumor marker for ovarian masses?

Answer 54

CA 125.

Question 55

What are the typical symptoms of ovarian masses?

Question 56

What is the most common type of paraovarian cyst mentioned ? (

Answer 56

hydatid cyst of Morgagni (Mullerian vestiges)

Question 57

What are some conditions listed as differential diagnoses for pelvic tumors?

Answer 57

following as differential diagnoses: - Paraovarian masses - Other pelvic tumors (such as leiomyomas, adenomyosis, digestive tumors, ectopic kidney, hydrosalpinx/tubal cancers, ectopic pregnancy, tubo-ovarian abscess) - Ovarian cancer - Pain-related conditions (such as PID, ectopic pregnancy, degenerating myoma, endometriosis, appendicitis, inflammatory bowel disease, diverticulitis, renal/ureteral calculi)

Question 58

What type of analysis is mentioned as a way to make a definitive diagnosis of a tumor?

Answer 58

*Histopathological analysis* of the tumor

Question 59

What is a major risk factor for ovarian torsion mentioned in the text?

Answer 59

Mass size > 5cm

Question 60

What is a potential consequence of hemorrhagic cyst rupture mentioned in the text?

Answer 60

Hemorrhagic shock

Question 61

What ultrasound finding is mentioned as indicative of ovarian torsion?

Answer 61

Absent flow on doppler ultrasound

Question 62

What is the timeframe mentioned for ovarian salvage in cases of torsion?

Answer 62

36 hours

Question 63

What symptom is mentioned as suggesting necrosis in ovarian torsion?

Answer 63

Low grade fever Relieve in pain severity

Question 64

What are some symptoms mentioned as associated with ovarian cyst rupture?

Answer 64

- Sudden onset lower abdominal pain - Nausea and vomiting However, for ovarian cyst rupture, the text mentions: - Severe or sharp pain - Bleeding inside the abdominal cavity

Question 65

What is one potential complication of ovarian cysts mentioned in the text besides torsion and rupture?

Answer 65

c) Intra-cystic hemorrhage ( comon on corpus Leteum cyst . d) Infection e) Compression of near-by organs c) Malignancy?

Question 67

What is one potential consequence of intermittent torsion mentioned in the text?

Answer 67

Negative or inconclusive imaging

Question 69

What is the potential consequence of a larger cyst or a cyst with active intra-cystic bleeding?

Answer 69

Rupture

Question 70

What type of cysts are mentioned as having a higher chance of rupture?

Answer 70

the following types of cysts have a higher chance of rupture: - Larger cysts - Cysts with active intra-cystic bleeding

Question 71

Indications for management of ovarian tumors management

Answer 71

Premenopausal women 1 ) oAsymptomatic women: ▪ Simple ovarian cyst <5 cm: watchful waiting. will usually resolve within three menstrual cycles ▪ For simple cysts of 5–7 cm, a repeat ultrasound should be obtained ▪ For cysts of >7 cm surgical intervention should be considered (cystectomy to prevent torsion/rupture) oSymptomatic women ▪ Analgesics ▪ Consider surgery if >5cm oSuspicion of cancer: ▪ Surgery and histopathology • Postmenopausal women oSimple unilateral, unilocular ovarian cysts of <5 cm and normal Ca125: ▪ expectant management and follow up ultrasound (50% resolve in 3 months) oRisk of cancer (tumour markers and ultrasound): ▪ surgery. oDo an oophorectomy rather than a cystectomy (cyst intact and prevention of spillage) oConsider Bilateral oophorectomy (contralateral ovary may also be affected). • Complications (surgery) oTorsion: ▪Detorsion and Oophoropexy (if recoloration after detorsion) ▪Adnexectomy (if necrosis) ▪Resection of any associated cyst or tumor oRupture of hemorrhagic cyst ▪ Cystectomy • Laparotomy or laparoscopy oHigh risk of rupture in laparoscopy if cyst greater than 7cm oAvoid rupture and spillage oUse retrieval bags • Avoid aspirations: higher risk of recurrence

Question 72

What is the recommended approach for a premenopausal woman with a simple ovarian cyst less than 5 cm in size?

Answer 72

- <5 cm: expectant management (watchful waiting) is recommended, as it will usually resolve within three menstrual cycles. Well done!

Question 73

What is the recommended surgical approach for postmenopausal women with ovarian cysts suspected to be cancerous?

Answer 73

for postmenopausal women with ovarian cysts suspected to be cancerous: - Oophorectomy (rather than cystectomy) is recommended to remove the affected ovary intact and prevent spillage. - Bilateral oophorectomy may also be considered, as the contralateral ovary may also be affected.

Question 74

What is the recommended management for a ruptured hemorrhagic cyst?

Answer 74

- Cystectomy is the recommended management.

Question 75

What is the recommended size threshold for considering surgical intervention in premenopausal women with ovarian cysts?

Answer 75

- Cysts >7 cm: surgical intervention should be considered (cystectomy to prevent torsion/rupture). - Cysts 5-7 cm: a repeat ultrasound should be obtained. Surgery is more strongly recommended for cysts larger than 7 cm.

Question 76

What is the procedure done if there's recoloration after detorsion in ovarian torsion?

Answer 76

- If there's recoloration after detorsion, the procedure done is *Detorsion and Oophoropexy*. Cystectomy might be done if there's an associated cyst, but Oophoropexy is specifically mentioned for fixation of the ovary.

Question 77

What is recommended to avoid during surgery to prevent spillage of cyst contents?

Answer 77

oUse retrieval bags

Question 78

What is the reason aspiration of ovarian cysts is avoided?

Answer 78

High risk of reoccurring

Question 79

What is the management approach for a simple ovarian cyst less than 5 cm in a postmenopausal woman with normal CA125 levels?

Answer 79

for a postmenopausal woman with a simple unilateral, unilocular ovarian cyst: - <5 cm and normal CA125: expectant management and follow-up ultrasound are recommended. 50% of such cysts resolve in 3 months. Oophorectomy might be considered if there's suspicion of cancer. What surgical approach is preferred for ovarian cysts larger than 7cm to minimize risk of rupture?

Question 80

What surgical approach is preferred for ovarian cysts larger than 7cm to minimize risk of rupture?

Answer 80

Laparotomy

Question 81

What procedure is done if necrosis is detected after ovarian torsion?

Answer 81

- If necrosis is detected: Adnexectomy is recommended.

Question 82

What is the purpose of doing a repeat ultrasound for simple ovarian cysts of 5-7 cm in premenopausal women?

Answer 82

for simple ovarian cysts of 5-7 cm in premenopausal women: - A repeat ultrasound should be obtained. The implication is to monitor the cyst's size and potentially determine if it resolves or changes, but the specific reason isn't detailed beyond obtaining a repeat ultrasound.

Question 83

What type of ovarian cysts in premenopausal women are likely to resolve within three menstrual cycles without intervention?

Answer 83

- Simple cysts are likely to resolve within 3-6 menstrual cycles without intervention, but the specific size isn't limited to <5 cm.