Disorders of the Ovary Flashcards by Katie Keller

What are the four types of ovarian cysts?

Follicular cysts
Corpus luteum cysts
Theca leutein cysts
Endometriomas

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Which type of ovarian cyst is described below?

Simple cysts resulting from failure of ovulation

Fluid of incompletely developed follicle is not reabsorbed, producing an enlarged cyst

Typically asymptomatic - However bleeding and torsion can occur

Follicular cysts

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Most follicular cysts typically disappear spontaneously within what time frame?

60 days

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What type of medication has been recommended for follicular cysts but may not produce quicker resolution than expectant management, however may keep new cysts from forming

OCPs

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Which type of ovarian cyst is described below?

Thin-walled unilocular cysts

Sizes from 3-11cm

When corpus luteum exceeds 3cm, it becomes known as a cyst

Corpus Luteum Cyst

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Which type of ovarian cyst is described below?

Associated with pregnancy (increased gonadotropins)

More common with multiple gestations and trophoblastic disease

Typically bilateral

Multicystic

Theca Lutein Cyst

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Which type of ovarian cyst is described below?

Benign

Palpable mass on ovary

Occur as a consequence of ovarian endometriosis

Grow up to 6-8cm

“chocolate cysts”

Endometriomas

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Most Corpus Luteum cysts typically disappear spontaneously within what time frame?

Typically resolves over 1-2 months in menstruating patients

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Which ovarian cyst is typically seen in first trimester of pregnancy?

Corpus Luteum Cyst

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A patient with a Corpus Luteum Cyst typically presents with this triad of signs/symptoms

Unilateral lower quadrant pain

Missed period

Adnexal enlargement on PE

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In a case of suspected corpus luteum cyst, what other condition needs to be ruled out ASAP in the workup?

ectopic pregnancy

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What type of medication is used for prevention of corpus luteum cysts?

OCPs

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Recurrent hemorrhagic corpus luteum cysts should raise suspicion of what?

bleeding disorder

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What is a complication of a corpus luteum cyst to keep in mind?

If rupture occurs, may require surgery to stop the bleeding

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What is the least common functional cyst?

Theca Lutein Cyst

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What ovarian cyst is associated with pregnancy
(increased gonadotropins), especially with multiple
gestations?

Theca Lutein Cyst

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“chocolate cysts”

Endometriomas

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Polycystic Ovarian Syndrome is also known as what?

Stein-Leventhal syndrome

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Common endocrine disorder with unknown etiology

Affects 5-10% of reproductive age women

Characterized by persistent anovulation

Polycystic Ovarian Syndrome

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Unrecognized and untreated Polycystic Ovarian Syndrome is an important risk factor for what disease process?

CVD

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Persistent anovulation in polycystic ovarian syndrome leads to what complications/conditions?

Enlarged polycystic ovaries

Secondary amenorrhea or oligomenorrhea

Infertility issues

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What are the essentials of diagnosis for polycystic ovarian syndrome?

Clinical or biochemical evidence of hyperandrogenism

Oligoovulation or anovulation

Polycystic ovaries on ultrasound

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What is the “typical patient” for polycystic ovarian syndrome?

Typically an obese female with hirsutism with or without acanthans nigricans who is complaining of either missed periods or infertility

Has many signs of metabolic syndrome

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List some signs and symptoms of polycystic ovarian syndrome?

Infertility
Chronic menstrual irregularities
Hyperandrogenism
Insulin Resistance
Obesity
Hirsutism
Virilization
Amenorrhea
Abnormal uterine bleeding
Normal menstruation
Acanthosis nigricans

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What ultrasound sign is a classic finding of polycystic ovarian syndrome?

“string of pearls” sign

What are some disorders to keep in mind for a differential diagnosis of polycystic ovarian syndrome, since these conditions also present with high androgen levels with anovulation and polycystic ovaries?

Cushing Syndrome CAD – congenital adrenal hyperplasia Androgen secreting adrenal tumors

What is a major treatment of PCOS?

Exercise and weight control

In PCOS, this medication is used to reduce insulin-resistance, thus targeting the pathophysiologic basis for PCOS

Metformin

This condition is a gynecological emergency and results in hypoxia and necrosis of ovary leading to an acute abdomen

Ovarian Torsion

twisting of ovary or ovary + tube

Ovarian Torsion

This gynecological emergency can be seen during treatment of infertility with ovulation-inducing medications

Ovarian Torsion

Acute onset of severe abdominal/pelvic pain often accompanied by nausea and vomiting is the common presentation of what gynecological emergency?

Ovarian Torsion

What is the clinical definition of infertility in women <35?

Women < 35 years: failure to conceive after 12 months of frequent, unprotected sex

What is the clinical definition of infertility in women >35?

Women >35 years: failure to conceive after 6 months

List some common causes of infertility

PCOS Thyroid disorders Hyperprolactinemia History of PID endometriosis

What is the most common teratoma?

dermoid cyst

A benign germ cell neoplasm

Teratoma

What is the median age for a teratoma?

30 year olds

What is the malignancy risk for a teratoma?

<1% malignancy risk

What percentage of teratomas are bilateral?

10-20%

What is the pathophysiology of teratomas?

Derived from primary germ cells Contain well-differentiated tissue from all embryonic germ layers

What is a risk of teratoma to be worried about and why?

High fat content Causing buoyant tendency in the pelvis 🡪 HIGH risk of torsion!!

A surgical removal of a teratoma is the treatment due to the risk of these two complications

ovarian torsion Spillage of contents can lead to chemical peritonitis

Benign germ cell tumor Usually found in young women Typically asymptomatic finding on bimanual exam

Dermoids

What percentage of dermoids are bilateral?

15%

Second most common gynecologic malignancy

Ovarian Cancer

Most common cause of death of women who develop a gynecologic malignancy – 50% morbidity

Ovarian Cancer

What is the lifetime risk of ovarian cancer?

This is a disease of post-menopausal women, with the highest incidence between 65-74 y/o

Ovarian Cancer

What therapy does not increase risk of ovarian cancer

HRT

What percentage of ovarian cancers develop sporadically?

90%

A familial pattern is seen in patients with family history containing which genes/conditions?

BRCA 1 BRCA 2 HNPCC

Why is ovarian cancer usually diagnosed at Stage III or IV?

Typically develops with few signs or symptoms until the disease is widely disseminated throughout the abdomen Early diagnosis is difficult due to lack of effective screening tools

What is the most common type of ovarian cancer?

Epithelial Cell tumors

What are the different types of ovarian cancers and how are they categorized?

categorized by the cell type Epithelial Cell tumors Germ Cell tumors Stromal Cell tumors

List some risk factors for ovarian cancer

Genetics (highest) – 8-13% have a genetic predisposition Early menarche Late menopause Nulligravidity/nulliparity Infertility (NOT infertility treatment) Endometriosis Older age First degree relatives Environmental

What are the lifetime risks of developing ovarian cancer with the BRCA mutations?

BRCA1: 50% lifetime risk BRCA2: 27% lifetime risk

What are the lifetime risk of developing ovarian cancer with Lynch Syndrome (HNPCC)?

12% lifetime risk

What are some environmental risk factors for ovarian cancer?

Talc Smoking Diet high in fat Lack of exercise obesity

What are some protective factors against ovarian cancer?

Multiparity OCPs - 5 year usage = 50% reduction Breastfeeding Chronic anovulation Total hysterectomy Bilateral tubal ligation

What is an imperfect test but could potentially help in the screening of ovarian cancer?

Ca-125 cancer antigen (>35 is abnormal)

Why is Ca-125 cancer antigen an imperfect test for ovarian cancer?

May also be elevated in multiple other cancers or disorders – limits its usefulness in premenopausal women Normal CA-125 does not rule out ovarian cancer False positives and negatives

When elevated in a post-menopausal woman with a pelvic mass, high suspicion but NOT diagnostic for cancer

CA-125

CA-125 has a better use for what in ovarian cancer?

Baseline measurement is useful for evaluating success of treatment – good marker for treatment progress

Disorders of the Ovary Flashcards

(64 cards)