DO of the ovaries and oviduct

Question 1

The most common cause of a simple cystic mass in the reproductive age years is a
________

Answer 1

physiologic cyst (luteal or follicular cyst).

Question 2

Origin of the functional cyst

Answer 2

During the reproductive years the ovaries are functionally active, producing a dominant follicle in the first half of the cycle and a corpus luteum after ovulation in the second half of the menstrual cycle

Question 3

The most common cause of a pelvic mass in the reproductive years is______

Answer 3

pregnancy

Question 4

The most common complex adnexal mass in young women is a ______ or ______ Other diagnoses include endometrioma, tuboovarian abscess, and ovarian cancer

Answer 4

dermoid cyst or benign cystic teratoma.

Question 5

• Pelvic mass in reproductive
years
• β-hCG (–)
• Sonogram: fluid-filled
ovarian simple cyst

Answer 5

Functional Ovarian Cyst

Question 6

Mx of Functional Ovarian Cyst

Answer 6

the sonogram shows a simple cyst it is probably benign but careful
follow-up is needed.

Follow-up examination should be in 6–8 weeks, at which time the functional cyst should have spontaneously resolved

Question 7

________ can be used to help prevent further functional cysts from forming.

Answer 7

Oral contraceptive medication

Question 8

Even if the cyst is simple in appearance, surgical evaluation should be
performed if _____ or _____

Answer 8

the cyst is >7 cm or if patient had been on prior steroid contraception

Question 9

The ovaries are bilaterally enlarged with multiple peripheral cysts (20-100 in each ovary).

This is due to high circulating androgens and high circulating insulin levels causing arrest of folliclular development in various stages

Answer 9

Polycystic Ovarian Syndrome

Question 10

_______refers to the presence of nests of luteinized theca cells in the ovarian stroma that may be steroidogenically active.

Answer 10

Ovarian hyperthecosis

Question 11

Difference of Ovarian hyperthecosis vs PCOS

Answer 11

These nests, or islands, of luteinized
theca cells are scattered throughout the stroma of the ovary, rather than being confined to areas around cystic follicles, as in polycystic ovary syndrome (PCOS).

Question 12

PE of Ovarian hyperthecosis

Answer 12

However, women with ovarian hyperthecosis have more severe hirsutism, with shaving
being common.

Virilization is frequent, with clitoral enlargement, temporal balding, deepening of the voice, and a male habitus

Question 13

Unlike PCOS, which occurs only during the reproductive years, hyperthecosis of the
ovaries can occur in_______

Answer 13

postmenopausal women

Question 14

Severe hirsutism and virilization in

postmenopausal women are more often due to __________

Answer 14

ovarian hyperthecosis than to virilizing

ovarian tumors.

Question 15

Mx of Ovarian hyperthecosis

Answer 15

using oral contraceptive pills both to
suppress androgen production (by reducing LH stimulation of the theca cells) and to decrease free androgens (by stimulating sex hormone binding globulin).

Question 16

_______ is a rare, non-neoplastic tumor-like mass of the ovary that emerges
during pregnancy and regresses spontaneously after delivery.

It is usually asymptomatic and
is found incidentally during a cesarean section or postpartum tubal ligation

Answer 16

Luteoma of pregnancy

Question 17

Importance of Luteoma of pregnancy

Answer 17

It can be hormonally active and produce androgens resulting in maternal and fetal hirsutism and virilization.

Question 18

These are benign neoplasms stimulated by high levels of FSH and β-hCG

Answer 18

Theca Lutein Cysts

Question 19

Natural course of Theca Lutein Cysts

Answer 19

The natural course of these tumors is postpartum spontaneous regression
and require only conservative managment

Question 20

Association of Theca Lutein Cysts

Answer 20

They are associated with twins and molar pregnancies but they are only rarely associated with a normal singleton pregnancy.

Question 21

If sonography shows a complex adnexal mass in a girl or teenager, the possibility of ______of the ovary has to be considered

Answer 21

germ cell tumors

Question 22

The following serum tumor markers should be obtained: 
lactate dehydrogenase (LDH) for \_\_\_\_\_\_ 

b-hCG for_____, and

a-fetoprotein for _______

Answer 22

dysgerminoma,

choriocarcinoma

endodermal sinus tumor.

Question 23

In a prepubertal patient who is symptomatic and has ultrasound evidence of an adnexal mass, a _____ is recommended

Answer 23

surgical evaluation

Question 24

Pre-pubertal adnexal mass MX

Simple mass. If the ultrasound shows the consistency of the mass to be simple (no
septations or solid components), this mass can be evaluated through a ______

Answer 24

laparoscopic

approach

Question 25

Pre-pubertal adnexal mass MX If the mass has septations or solid components, a_______ or ______ should be performed, depending on the experience of the surgeon

Answer 25

laparoscopy or laparotomy

Question 26

Mx of GCT

Answer 26

A unilateral salpingo-oophorectomy and surgical staging (peritoneal and diaphragmatic biopsies, peritoneal cytology, pelvic and para-aortic lymphadenectomy, and omentectomy) should be done

Question 27

T or F All patients with germ cell tumors require postoperative chemotherapy

Answer 27

T

Question 28

MC regimen for GCT

Answer 28

The most active regimen used is vinblastine, bleomycin, and cisplatin.

Question 29

Prognosis of GCT

Answer 29

The current survival is >95% in patients with germ cell tumors managed with conservative management and chemotherapy

Question 30

The most common complex adnexal mass in young women is a ________

Answer 30

dermoid cyst or benign cystic teratoma

Question 31

Patients in the reproductive age group with a complex adnexal mass should be treated _______

Answer 31

surgically.

Question 32

Dermoid cyst Mx At the time of surgery an ovarian ____should be attempted to preserve ovarian function in the reproductive age. Careful evaluation of the opposite adnexa should be performed

Answer 32

cystectomy

Question 33

dermoid cysts can occur bilaterally in _____

Answer 33

10–15% of cases

Question 34

If an ovarian cystectomy cannot be done because of the size of the dermoid cyst, then an _______ is performed

Answer 34

oophorectomy

Question 35

Sudden onset of severe lower abdominal pain in the presence of an adnexal mass is presumptive evidence of _______

Answer 35

ovarian torsion

Question 36

The management of the torsion should be to untwist the ovary and observe the ovary for a few minutes in the operating room to assure ______. This can be performed with _______

Answer 36

revitalization laparoscopy or laparotomy

Question 37

Ovarian torsion If revitalization occurs, an ______can be performed with preservation of the ovary

Answer 37

ovarian cystectomy

Question 38

Ovarian torsion If the ovary is necrotic, a______is performed.

Answer 38

unilateral salpingo-oophorectomy

Question 39

Ovaries in the postmenopausal age | group should be atrophic; anytime they are enlarged, the suspicion of _______

Answer 39

ovarian cancer arises

Question 40

Only ____ of patients undergoing laparotomy for sonographically detected pelvic masses actually have ovarian cancer

Answer 40

3%

Question 41

_______ is the second most common gynecologic malignancy, with a mean age at diagnosis of 69 years

Answer 41

Ovarian carcinoma

Question 42

______percent of women die of ovarian cancer. It is the most common gynecologic cancer leading to death

Answer 42

One

Question 43

RF for ovarian CA

Answer 43

These include BRCA1 gene, positive family history, high number of lifetime ovulations, infertility, and use of perineal talc powder

Question 44

Protective factors for ovarian CA

Answer 44

These are conditions that decrease the total number of lifetime ovulations: oral contraceptive pills, chronic anovulation, breast-feeding, and short reproductive life

Question 45

The most common type of histologic ovarian carcinoma is_____ which predominantly occurs in postmenopausal women.

Answer 45

epithelial cancer,

Question 46

Types of epithelial cancer,

Answer 46

serous, mucinous, Brenner, endometrioid, and clear cell tumors

Question 47

The most common malignant epithelial cell type is_______

Answer 47

serous

Question 48

15%. of cases Another histologic type of ovarian cancer is the _______ which predominantly occurs in teenagers

Answer 48

germ cell tumor,

Question 49

Types of germ cell tumor,

Answer 49

dysgerminoma, endodermal | sinus tumors, teratomas, and choriocarcinoma.

Question 50

The most common malignant germ cell type is _______ It is uniquely x-ray sensitive.

Answer 50

dysgerminoma

Question 51

5% of the cases . The third type of ovarian tumor is the _______ which is functionally active

Answer 51

stromal tumor,

Question 52

Types of stromal tumors These include ____which secrete estrogen and can cause bleeding from endometrial hyperplasia and __________, which secrete testosterone and can produce masculinization syndromes

Answer 52

granulosa-theca cell tumors, Sertoli-Leydig cell tumors

Question 53

Mx of stromal tumors

Answer 53

Patients with stromal tumors usually present with early stage disease and are treated either with removal of the involved adnexa (for patients who desire further fertility) or a TAH and BSO (if their family has been completed)

Question 54

Cx of stromal tumors

Answer 54

They metastasize infrequently, and then | they require chemotherapy (vincristine, actinomycin, and Cytoxan

Question 55

• Postmenopausal pelvic mass • Masculinization • ↑ testosterone level

Answer 55

Sertoli-Leydig Tumor

Question 56

* Postmenopausal woman * Pelvic mass * ↑ hCG level

Answer 56

Choriocarcinoma

Question 57

Postmenopausal woman • Pelvic mass • ↑ CEA or CA-125 level

Answer 57

Serous Carcinoma

Question 58

CA-125 (cancer antigen 125) and CEA (carcinoembryonic antigen) ______. * LDH, hCG, and a-fetoprotein should be drawn for the possibility of_____ * Estrogen and testosterone should be drawn for the possibility of ______

Answer 58

should also be drawn for the possibility of ovarian epithelial cancer germ cell tumors. stromal tumors.

Question 59

Ovarian CA stages

Answer 59

Stage I: Spread limited to the ovaries Stage II: Extension to the pelvis Stage III: Peritoneal metastases or positive nodes Stage IV: Distant metastases

Question 60

This is the most common stage at | diagnosis for Ovarian Ca

Answer 60

Stage III: Peritoneal metastases or positive nodes

Question 61

Ovarian CA If abdominal or pelvic CT scan shows no evidence of ascites or spread to the abdominal cavity, and if the surgeon is an experienced laparoscopist, then the evaluation could be performed ______

Answer 61

laparoscopically

Question 62

If the patient is not a good surgical candidate or the patient desires to maintain her uterus and contralateral ovary, a _______

Answer 62

USO is sufficient treatment

Question 63

If the USO by frozen section is benign and the patient is a good surgical candidate, then a _______ may be performed even though it is benign disease because the uterus and ovaries are not unusual sites of pathology in a woman.

Answer 63

TAH and BSO

Question 64

Ovarian CA Malignant Histology. In this case, a debulking procedure (cytoreduction) should be performed. This procedure consists of a _____

Answer 64

TAH and BSO, omentectomy, and bowel resection, if necessary. Postoperative chemotherapy (carboplatin and Taxol) should be administered.

Question 65

Ff up of malignant histology for ovarian CA

Answer 65

If the pathology report was carcinoma, then she would be followed up every 3 months for the first 2 years and then every 6 months for the next 2 years with follow-up of the CA-125 tumor marker

Question 66

Another entity of ovarian cancer is the borderline tumors also known as _______. These are characterized by no invasion of the basement membrane and can also be treated conservatively

Answer 66

tumors of low malignant potential

Question 67

``` • Postmenopausal bilateral pelvic masses • Weight gain, anorexia • Abdominal “shifting dullness ```

Answer 67

Ovarian Carcinoma with | Peritoneal Metastasi

Question 68

_______ is the triad of ascites, pleural effusion, and benign ovarian fibroma

Answer 68

Meigs syndrome

Question 69

The most common method of ovarian carcinoma spread is by

Answer 69

peritoneal dissemination (exfoliation) and is commonly seen metastatic to the omentum and to the GI tract.

Question 70

The cause of death of patients with advanced ovarian carcinoma is

Answer 70

bowel obstruction.

Question 71

After an abdominal pelvic CT scan confirms the presence of ascites and the adnexal mass, an ______ and surgical staging should be performed. A salpingo-oophorectomy of the enlarged ovary should be done and sent for _____

Answer 71

exploratory laparotomy frozen section evaluation.

Question 72

If ovarian carcinoma is confirmed, then a debulking (cytoreductive) surgical procedure should be performed. This procedure usually includes a

Answer 72

TAH, BSO, omentectomy, and, frequently, bowel resection

Question 73

Ovarian CA with ascites post op

Answer 73

Postoperatively patients should be treated with 6 courses of a standard chemotherapy regimen, which includes Taxol and carboplatin