Class 7 Flashcards by Christian Tinio

Where do most cystic pelvic masses originate from?

The ovaries

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Ultrasound appearance of Cystic Pelvic Mass

Smooth well defined borders
Lack of internal echoes
Posterior enhancement

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What does the size of a pelvic cyst determine? What are the results of each of the sizes of cyst measuring <3cm, 3-5cm, >5cm, and >10cm?

< 3 cm - usually resolve (follicular)
3 - 5 cm - followed by US; most resolve, but some enlarge
> 5 cm - followed by US; 60% resolve in 3 months
> 10 cm - rarely resolve (have more malignant potential; are surgically removed)

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Where are Ovarian follicles located?

In both ovaries

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Ultrasound Appearance of Ovarian follicles

Small anechoic structures

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True or False: DOMINANT FOLLICLE REACHES 2.0-2.5 CM BEFORE OVULATION OCCURS

True

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Are Follicular Cyst bilateral or unilateral?

unilateral

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How large can a Follicular Cyst get?

1.0 - 10.0cm in size

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True or False: Few Follicular Cysts resolve or change size

False: Most resolve or change in size

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How large can a Corpus Luteum Cyst get?

5 - 8cm

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True or False: Corpora lutea forms after dominant follicle ruptures. (Reaches 3 cm in size)

True

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True or False: Corpus Luteum Cysts in pregnancy RESOLVES if fertilization occurs

False: Corpus Luteum Cysts remains if fertilization occurs and only resolves between 10 to 16 weeks after estimated last menstrual period (LMP)

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What causes a Theca Lutein Cyst?

Caused by high levels of human chorionic gonadotropin

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50% of Theca Lutein Cysts are associated with?

Gestational Trophoblastic Disease (Molar Pregnancy)

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Drug therapy for infertility (ovarian hyperstimulation syndrome) is known to cause?

Theca Lutein Cysts

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Theca Lutein Cysts are:
Bilateral or Unilateral?
Unilocular or Multilocular?
Small or Large?

Bilateral
Multilocular
Large (3-20cm)

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How long after evacuation of molar pregnancy do Theca Lutein Cysts persist?

2-4 Months

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Paraovarian Cysts are found in what ligament?

Broad ligament

True or False: it is difficult to determine if Paraovarian Cysts are ovarian or paraovarian

True

What is the largest that a paraovarian cyst can reach in cm?

15cm

Are paraovarian cyst permanent?

Yes, they do not regress or change with time

What are differential Diagnoses of Paraovarian Cyst?

Serous cystadenoma or Endometrioma

What is Ovarian Torsion?

Complete or incomplete rotation of ovary on its vascular pedicle

Ovarian Torsion causes what?

Causes arterial, venous, or lymphatic occlusion

Ultrasound Appearance of Ovarian Torsion

On ultrasound, may appear as a large ovary with hypoechoic and hyperechoic areas

Ovarian Torsion occurs most commonly in what age group?

Most common in childhood or women < 30 years of age

Signs and symptoms of Ovarian Torsion?

- Acute onset of pelvic pain - Nausea - Vomiting

In Polycystic Ovaries, endocrine disorders result in?

High free serum testosterone | High LH or FSH

Ultrasound Appearance of Polycystic Ovaries

- Normal ovaries | - Bilaterally enlarged ovaries with multiple small follicles around periphery

What are the categories of benign Ovarian Neoplasms?

Epithelial tumors Germ cell tumors Stromal tumors

What percentage of Ovarian Neoplasms are benign?

80%

What are the 3 types of Epithelial neoplasms?

- Serous cystadenoma - Mucinous cystadenoma - Brenner tumor

Epithelial Neoplasms: Serous Cystadenoma

- More common than mucinous cystadenoma (not as large) - Contain serous fluid - Bilateral 25% of time - Usually unilocular - May have septations (thin) and papillary projections - Malignant counterpart: serous cystadenocarcinoma

Epithelial Neoplasms: Mucinous Cystadenoma

-Larger than serous cystadenoma (up to 15-30 cm) -Filled with thick mucin -Bilateral in < 5% of cases -Cystic with multiple thicker septations Debris filled -With rupture---Pseudomyxoma Peritonei

Epithelial Neoplasms: Brenners Tumor

- Not common (1 - 2% of all ovarian neoplasms) - Solid firm tumor - On US, may see solid echogenic or hypoechoic mass with anechoic spaces - Small to 8 cm in size - Most common in post menopausal patient - US unable to differentiate between other solid ovarian tumors

Benign Cystic Teratoma

AKA: dermoid cyst, teratoma - Common germ cell tumors - Most common in premenopausal women - Most common ovarian tumor for women less than 20 years of age - Have little malignant potential

Ultrasound appearance of Benign Cystic Teratoma

- Complex with internal echoes and posterior acoustic shadowing - Tip of the iceberg sign - Unilocular or multilocular cyst with internal echoes or mural echogenic projections - Echogenic mass with acoustic shadowing - Fat/fluid or hair/fluid level - Echo poor mass with echogenic or echo poor central portion

What are the kinds of Stromal Tumors?

Fibroma Thecoma Sertoli-leydig

Stromal Tumors: Fibroma

5 % of ovarian tumors More common in 50’ s or 60 ‘s 90% unilateral 5-16 cm in size Solid and hypoechoic - often shadow posteriorly The most common tumor associated with Meigs’ syndrome

Stromal Tumors: Fibroma: Meig's Syndrome

TRIAD OF MEIGS’ SYNDROME - Benign ovarian tumor (fibroma) - Ascites - Pleural effusion * SYMPTOMS SUBSIDE AFTER TUMOR REMOVAL

Stromal Tumors: Thecoma (Theca Cell Tumor)

1 - 2 % OF OVARIAN TUMORS SOLID ESTROGEN PRODUCING MOST COMMON IN POST MENOPAUSAL PATIENTS WITH ABNORMAL UTERINE BLEEDING MAY BE LARGE (UP TO 30 CM) UNILATERAL HYPOECHOIC AND MAY CAST LARGE SHADOW POSTERIORLY

Stromal Tumors: Sertoli-Leidig Cell tumor

- Rare - Less than .5% of ovarian tumors - Most occur in patient < 30 years - Secrete androgens

Signs and symptoms of Sertoli-Leidig Cell Tumors

Pain Abdominal swelling Masculinization effects due to increased testosterone

Ultrasound Appearance of Sertoli-Leidic Cell Tumors

Solid echogenic mass