Chapter 30 Pathology----GYN Flashcards
(32 cards)
- These are caused by continued hormonal stimulation of a FOLLICLE that does not rupture at ovulation. Usually disappears within a few weeks.
- usually 3-5 cm in diameter, can get to be 10 cm—when hemorrhage occurs, there may be internal echoes
What age group does this occur most in? (reproductive or postmenarche?)
Why should you do a repeat study after 3-4 weeks??
Follicular cysts
reproductive age group
Because ovulation often takes place on alternate sides. By doing a repeat study, we can document that the mass has disappeared
Progesterone-producing cysts that occur after ovulation or in the first 10-15 weeks of pregnancy.
- Variable in size
- can contain echoes (due to hemorrhage)
- hyperechoic rim w/ increased vascularity (“ring of fire”) after ovulation
What age group does this occur in (reproductive or postmenarche or both?)
Corpus Luteum Cysts
Reproductive age group
MOST COMMON BENIGN TUMOR OF OVARY.
- large, thin-walled cysts that may have septa
- common within the 20-50 year age group
- may grow large enough to occupy abdomen
- 30% are BILATERAL
- highly resistive
What age group does this occur?
(reproductive or postmenarche, or both??)
Cystadenoma
Both reproductive and postmenarche
Postmenopausal women:
- small cysts that are up to 3-4 cm in diameter
- follow up of 6-month to 1 year intervals
- disappears spontaneously
Postmenopausal cysts
- contain echogenic structure or calcifications but some are also cystic
- teeth and hair may cause shadowing
Dermoid
- a type of carcinoma
- are practically never entirely cystic, may also be echo-free
Cystadenocarcinoma
lie between the UTERUS and OVARY.
-to represent embryonic remnants, they are echo-free
Paraovarian cyst
a consequence of previous surgery or infection in which the PERITONEAL surfaces become adhesed and fluid slowly collects.
-these may be of ANY shape and may contain septa and debri
Peritoneal inclusion cyst
a sequelae of pelvic inflammatory disease or endometriosis involving the FALLOPIAN tube.
The pus in pyosalpinx resorbs and is transformed into fluid.
Sonographically–tube folds over on itself forming a funnel-shaped or kinked structure
CLUE: (fluid build up in the fallopian tubes)
Hydrosalpinx
- a disease state that occurs in the reproductive years
- caused by implantation of endometrial tissue in ABNORMAL locations outside of the endometrium. This ectopic endometrial tissue responds to cyclic ovarian hormones and bleeds as if it was located w/i uterus.
- Endometrial cysts (endometerioma) may develop in areas of bleeding.
- The small cysts are BLEBS
- The larger are called CHOCOLATE CYSTS (hence the blood and color)
Endometriosis
Most endometriomas occur in the _______
- ovary
- fallopian tube
- endometrium
Ovary
- irregularly shaped, thick-walled, fluid-filled structures in the ADNEXA that may develop multiple echoes and even an internal fluid-filled level
- Very tender, often bilateral, not usually an isolated finding
Tubo-ovarian abscesses
less common than the serous type of mass
often spherical cystic mass that may have many septa; with solid material (papillary) arising from septa.
Often seen in which age group? (reproductive or postmenopausal or both?)
MUCINOUS cystadenoma and cystadenocarcinoma
both reproductive and postmenopausal age groups
When mucinous cystadenomas are benign the margins are ___________?
well-defined or irregular
well-defined
When mucinous cystadenomas are malignant the margins are ___________ and contains large amounts of ______ tissue?
irregular or well-defined
irregular margins
solid tissue
similar to the mucinous form of cystadenoma but the septa is THINNER and papillary material ( the solid mass within the septa) is less commmon
May be malignant if there are poorly defined walls, large amounts of solid tissue and ascites
SEROUS cystadenoma and cystadenocarcinoma
-occur in females 10-30 with a variety of sonographic appearances.
1) Mainly CYSTIC, containing echogenic area w/ shadowing because of a hairball, teeth or fat
2) Complex internal structure–echogenic areas because of fat, hair, or bone w/ shadowing
3) “ICEBERG” appearance–dense echogenic material within mass shadows the bulk of lesion (use endovaginal to help)
4) echogenic mass—this may blend with bowel, but the lesions presence will be revealed by indentation of bladder
5) fluid-filled level—may lie posteriorly or anteriorly–sometimes there is a hariball floating at the top(appearing mobile echogenic casting a shadow)
6) multiple thick septa within round cyst
—another word for dermoid
Cystic teratomas
one of the LEADING causing of death in women—Ultrasound cannot fully diagnose the malignancy of the cancer. Malignancy is suggested with:
- poor definition of borders (tumor spread)
- multiple unconfined cystic areas containing irregulary shaped solid material
- Malignant ascites–loculated fluid between loops of bowel w/ peritoneal metastases
- solid ovarian mass
- bilateral nature.
- low-resistance
Ovarian cancer
- frequently located in ovary.
- cystic mass w/ internal echoes
- ecdhogenic border
- echogenicity is similar to dermoid
Endometrioma
- looks similar to endometrioma
- contains low level echoes w/o the same evenness of texture
- the “ring of fire” will disappear after the hemorrhage has been there for a while.
- follow up after 6 weeks
Why is there a follow up after 6 weeks?
Corpus Luteum hemorrhage
-Helps distinguish between corpus luteum w/ hemorrhage or endometrioma. The corpus luteum will spontaneously disappear after some weeks.
- Solid ovarian mass
- tends to be large and similar to fibroids
- calcification can occur
- Meigs syndrome may be seen.
What age group does it affect?
(Menopausal and postmenopausal or both)
Fibroma
Menopausal and postmenopausal
- associated with fibroma
- can cause ascites and pleural effusion
Meigs Syndrome
Why is it important to look at the kidneys when examining a patient with a large pelvic mass?
To rule out hyndronephrosis caused by pressure on ureters
- To rule out a pelvic kidney (examine normal sites)
Where is the most common site for metastatic lesions from pelvic masses?
Peritoneum, para-aortic nodes, and liver.
