Ovarian and Uterine Diseases -> Flashcards
(180 cards)
1
Q
What is an ovarian cyst?
A
A fluid or semi-liquid filled sac which forms on or inside an ovary
2
Q
Are most ovarian cysts benign or malignant?
A
Benign
3
Q
Do most ovarian cysts require surgery?
A
No, most resolve without
4
Q
At what stage of life can ovarian cysts form?
A
Any: infancy to menopause
5
Q
Epidemiology of ovarian cysts?
A
10-20%
6
Q
Risk factors for ovarian cysts?
A
Infertility tx, Tamoxifen (benign functional cysts), 2nd trimester of pregnancy (hCG peak), hypothyroidism, smoking, tubal ligation (functional cysts)
7
Q
3 layers of ovarian tissue?
A
Epithelium, stroma, germ cells
8
Q
Each layer of ovarian tissue can produce what types of cysts?
A
Benign, malignant, cystic, solid
9
Q
ddx?
A
10
Q
Which ovarian cysts are most common and typically asymptomatic?
A
Follicular
11
Q
Size range of follicular ovarian cysts?
A
3-15 cm
12
Q
Which ovarian cysts may cause dull pelvic pain?
A
Corpus luteal cysts
13
Q
Which ovarian cysts are considered functional (physiologic) cysts?
A
Follicular and Corpus luteal
14
Q
Characteristics of follicular functional cysts?
A
Form when follicle fails to rupture, asymptomatic, simple/unilocular cyst, 3-15cm, often regress spontaneously
15
Q
Characteristics of corpus luteum functional cysts?
A
Form when there is failure of corpus luteum to regress in 14 days, smaller/3-6cm, firm/solid, more likely to have pain, delayed menses
16
Q
Oocyte cycle?
A
17
Q
What may cause a theca-lutein ovarian cyst?
A
High levels of hCG in molar pregnancy, choriocarcinoma, or fertility tx
18
Q
Characteristics of theca-lutein cysts?
A
Bilateral, massive ovarian enlargement, prone to torsion/hemorrhage/rupture, benign, usually resolve after tx of underlying issue
19
Q
What causes a luteoma of pregnancy?
A
Proliferation of luteinized stromal cells
20
Q
Characteristics of a luteoma of pregnancy?
A
Multifocal, bilateral, 5-10cm, hormonally active (androgens), maternal virilization (30%), female fetus virilization (50%)
21
Q
When do luteomas of pregnancy typically resolve?
A
After delivery
22
Q
What are endometriomas?
A
Blood filled cysts from ectopic endometrium (chocolate cysts)
23
Q
What are endometriomas associated with?
A
Endometriosis
24
Q
What kind of cysts are involved with PCOS?
A
Multiple cystic follicles 2-5mm
25
What are neoplastic cysts?
Overgrowth of cells in the ovary
26
Are neoplastic cysts malignant or benign?
Can be either, yet malignant can form from any cell type
27
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28
What are teratomas?
Cysts that contain all 3 embryonic germ layers (dermoid cysts)
28
Most common cell type which causes malignant neoplastic cysts?
Surface epithelium (mesothelium)
29
Do most ovarian cysts cause symptoms?
No, most asx
30
When will malignant cysts tend to cause sx?
Late stages
31
What kind of pain is caused by torsion or rupture of an ovarian cyst?
Severe, sudden, unilateral, sharp pain which could radiate to the upper thigh
32
What can bring on an ovarian cyst rupture/torsion?
Exercise, trauma, coitus
33
Possible symptoms of ovarian cysts?
Difficult bowel movements, frequent urination, irregular menses, dyspareunia (genital pain), abdominal bloating/fullness, early satiety, indigestion, heartburn, tenesmus
34
What triad of symptoms can be caused by endometriomas?
Dysmenorrhea, infertility, dyspareunia
35
What symptoms can be caused by PCOS?
Hirsutism, infertility, oligomenorrhea, obesity, acne
36
Who are ovaries normally palpable in? When should ovaries be non-palpable?
Palpable: thin, premenopausal pt
Non-palpable: post-menopausal pt
37
Large cysts can be palpable, yet what may interfere with palpation?
Ascites
38
Cysts may be _____ to palpation?
tender
39
Ruptured ovarian cysts can cause a patient to become ________ ________.
Hemodynamically unstable
40
Labs for ovarian cyst diagnosis?
Urine preg test, CBC (bleeding/infection), urinalysis (?), endocervical swabs (check for chlamydia/gonorrhea), cancer antigen 125 (CA125)
41
CA125 tests are most useful in conjunction w/ what modality?
US
42
Should CA125 be drawn in acute care settings?
No, elevated in cyst rupture, infections, hemorrhage, endometriosis
43
What lab can help evaluate ovarian cancer progression?
CA125
44
Transvaginal US appearance of normal ovary?
2.5cm - 5cm long, 1.5 - 3cm wide, 0.6 - 1.5cm thick
45
What is the primary tool for ovarian cysts eval?
Transvaginal US -> can show morphology and resolution
46
Simple ovarian cyst appearance on tansvag US?
thin walled, uniform, 2.5-15cm diameter
47
Ovarian torsion appearance on tansvag US?
ovarian edema from blocked lymphatic drainage *colored US will show bloodflow
47
Complex ovarian cyst appearance on tansvag US?
multilocular, thick walled, projects into lumen
48
When is abdominal US used?
Large masses and complications, other organs, ascites
49
Treatment for ovarian cysts?
Simple: most require no tx, resolve in ~60d
50
Tx for neonatal/fetal cysts?
Most small and involute w/in first few mos of life, monitor w/ serial US
51
Tx for ovarian cysts in pregnancy?
Most resolve by 14-16wks
if persist and US not suggestive of malignancy --> watch
if sx, pain, rapid growing --> surgery considered after 1st trimester if needed
52
Management of pre-menopausal asx simple cysts?
<8cm on US, normal CA125, rpt US in 8-12 wks
53
Management of postmenopausal ovarian cysts?
If asx, <5cm:
-rpt US in 4-6wks w/ CA125 studies
-half will resolve in 2mos
-if rising CA125 or size, consider surgery
54
Why is follow up important with ovarian cysts?
Malignancy risk rises from 13% in premenopausal to 45% in postmenopausal
55
Tx for persistent simple ovarian cysts >5-10cm?
Laparotomy or laparoscopy
-confirm dx, assess if malignant, obtain fluid, remove cyst w or w/o ovary, assess other ovary/organs
56
3 complications of ovarian cysts?
Rupture, hemorrhage, torsion
57
What serves as major blood supply and support of the ovaries?
Ovarian ligament and vessels (comes from pelvic side wall)
58
Median age for ovarian torsion?
28
59
20% of ovarian torsions happen when?
Pregnancy
60
How does ovarian torsion occur?
Ovary flips over, cuts off blood supply, ovarian tumors (benign or malignant) involved in 50-60% cases (usually dermoid)
61
2/3 of ovarian torsions are on which side?
Right
62
Presentation of those w/ ovarian torsion?
Hx of cyst/pain w/ sex, exercise, trauma
Sx of acute unilateral sharp pain, vomiting, pelvic mass, leukocytosis, fever
63
PE for ovarian torsion?
Nonspecific/variable: tender unilateral pelvic mass, absence of tenderness does not r/o
64
Tests for ovarian torsion?
US w/ color doppler, presence of blood flow on doppler does not r/o
65
Tx for ovarian torsion?
Oophrectomy or untwisting if done immediately
66
Complications of ovarian torsion?
Infection, peritonitis, sepsis, adhesions, chronic pain
67
Women with PCOs have abnormalities with the metabolism of what?
Androgens and estrogen
68
Cause of PCOS?
Unknown but possible abnormal function of hypothalamic-pituitary-ovary (HPO) axis
69
Pathology of PCOS?
Peripheral insulin resistance/hyperinsulinemia, ovaries bilaterally enlarged and spherical w/ multiple 1cm follicles arranged along periphery
"string of pearls"
70
Hx of those w/ PCOS?
Menstrual disorders, hirsutism, infertility, obesity/metabolic syndrome, T2DM, sleep apnea
71
PE for PCOS?
Hirsutism/virilizing signs, obesity, acanthosis nigricans, HTN, enlarged ovaries
72
Rotterdam criteria for diagnosing PCOS?
2 of the following:
-polycystic ovaries on US, signs of excess androgen (acne, hirsutism, temporal balding, male pattern hair loss), menstrual irreg
*AND r/o Cushing syndrome, adrenal hyperplasia, androgen-secreting tumors
73
DDx for PCOS?
Amenorrhea, Cushing synd, Acromegaly, Hyperprolactinemia, hyper/hypo thyroid, ovarian tumors
74
Labs for PCOS?
TFTs, serum prolactin, free androgen index, serum hCG, oral glucose tolerance test, infertility w/u
75
Imaging for PCOS?
Transvag US
76
Tx for PCOS?
Lifestyle changes: diet/exercise
Meds for anovulation/menstrual irreg/hirsutism/acne: oral contraceptives
Endocrinology consult: thyroid/pituitary causes
Surgery: restore ovulation --> electrocautery, laser drilling
77
Special considerations for those w/ PCOS?
High risk for COVID-19 (T2DM, NAFLD->MASLD steatotic liver dz, CVD), depression, fertility eval
78
Are most ovarian neoplasms benign or cancerous?
Benign
79
What guides the dx/tx of ovarian neoplasms?
Age and type of mass
80
What % of ovarian neoplasms are epithelial cystadenomas?
60-80% (serous, mucinous, endometrioid, clear cell, transitional cell/benner tumors)
81
Who are serous cystadenomas common in?
Peri/postmenopausal *benign
82
What are the largest tumors in the human body?
Mucinous cystadenomas
83
What % of ovarian neoplasms are germ cell tumors?
20% (mature teratomas aka dermoid cysts)
84
What % of ovarian neoplasms are stromal tumors?
*% (thecoma, fibroma, hilus cell)
85
Mucinous or cystadenocarcinoma (epithelial cystadenomas) characteristics?
malignant or benign, look cimilar to serous cysts, can be very large
86
Germ cell tumor (mature teratoma/dermoid) characteristics?
40-50% of all benign ovarian neoplasms, usually asx unless torsion/rupture, 15% bilateral (may grow up to several kg)
87
Thecomas (stromal neoplasm) are usually found in which pts?
Postmenopausal (tumor produces estrogen)
88
Fibromas (stromal neoplasm) are usually found in which pts?
Perimenopausal women (incidental finding or >20cm)
89
What is Meig's syndrome?
Ascites, Pulmonary embolism, benign ovarian fibroma
90
What do Hilus cell tumors (Sertoli-Leydig/Hilar-Leydig) (stromal neoplasm) secrete?
Androgens (hirsutism, virilization, menstrual irreg)
91
Characteristics of stromal fibromas?
Solid mass (benign or malignant)
92
Treatment of ovarian neoplasms?
Surgical excision w/ exploration of abdomen, possible unilateral oophrectomy, based on pathology of neoplasm, options weighed if fertility is a concern
93
Why are malignant ovarian neoplasms called "the silent killer"?
Any ovarian neoplasm can be malignant, all 3 layers have malignant counterparts, presentation is vague
94
#1 cause of GYN cancer deaths?
Ovarian CA
95
Survival rate for ovarian CA?
Low d/t not being diagnosed until later stages
96
Most common type of ovarian CA?
Epithelial *MC > Germ cell > Stromal
97
Majority of epithelial neoplasms causing ovarian CA?
Serous: bilateral and dx late
98
Diagnosis rate of mucinous (epithelial) neoplasms causing ovarian CA?
usually early dx & unilateral
99
Endometrioid and clear cell neoplasms (epithelial) causing ovairan CA are associated w/ what?
Endometriosis
100
A majority of stromal tumors causing ovarian CA are what type?
Granulosa-Theca cell tumors (hormone secretors!)
101
Risk factors for ovarian CA?
FAMILY HX** (BRCA1, BRCA2), inc age, nulliparity, early menarche (<12), late menopause (>50), caucasian>hispanic>AA>asian, infetility
102
Protective factors against ovarian CA?
Use of OCPs (50% reduction w/ 15yrs use), breast feeding, multiple pregnancies
103
BRCA1 has what lifetime risk of ovarian CA?
35-45%
104
Family hx alone has what time of lifetime risk of ovarian CA?
2-10%
105
BRCA2 has what lifetime risk of developing ovarian CA?
15-24%
106
Familial ovarian CA runs in what descents?
Ashkenazi jewish, french canadians, icelandic
107
Prevention for those w/ fam hx of ovarian CA?
Annual US, prophylactic ovary removal
107
Sx of ovarian CA?
Inc. abdominal girth, abdominal pain, early satiety, urinary frequency/urgency, weight gain, change in bowel habits
108
PE for ovarian CA?
Ascites, pelvic mass (usually fixed, hard, irreg), pleural effusion
109
How to diagnose ovarian CA?
Transvag US (complex cystic/solid mass), elevated CA125, elevated Inhibin B (granulosa cell tumors, epithelial mucinous tumors), surgical tissue dx
110
Testing for ovarian CA per Society of Gynecologic Oncology?
CT of abdomen, pelvis, chest
111
Testing for ovarian CA per National Comprehensive Cancer Network Guidelines?
US and/or abd/pelvic CT or MRI, CXR
112
If there are upper GI sx with ovarian CA, what tests should be done?
Upper/Lower endoscopy, barium enema, upper GI series
113
What evaluation is done for dx/staging of ovarian CA?
Surgical
114
Treatment for ovarian CA?
Surgery, chemo, marker evaluation (CA125)
115
What is the most common benign neoplasm of the uterus?
Leiomyoma (fibroids)
116
Who is Leiomyoma (fibroids) most common in?
Women 40+, AA
117
Pathology of Leiomyoma (fibroids)?
Arise from smooth muscle, usually benign, tissue examination needed for dx
118
Types of fibroids?
Intramural, pedunculated subserosal, pedunculated submucosal, subserosal, submucosal
119
Presentation of uterine fibroids (Leiomyoma)?
Heavy menses: usually d/t submucosal fbroids (cannot be felt on exam), pelvic fullness, inc abd girth, frequent urination, dypareunia, lower back pain or no sx
120
Diagnostics for fibroids (Leiomyoma)?
US (abd or transvag), MRI, CT, Hystersalpingogram (HSG): Fluoroscopy, Sonohystogram (injects water into uterus and uses ultrasound)
121
Hystersalpingogram (HSG): Fluoroscopy process?
Contrast (iodine) injected into uterus through catheter, uterine cavity and fallopian tubes opacified on image
122
Treatment option 1 for fibroids?
Watchful waiting
123
Treatment option 2 for fibroids?
Multivitamin, iron supplements, NSAIDS, hormonal tx (w/ caution): estrogen-progestin OCP, Levonorgestrel releasing uterine system, progestin implants/inj/pills, gonadotropin releasing agents
124
Treatment option 3 for fibroids?
Hysteroscopy, removal of submucosal fibroids using electrocautery wire (hysteroscopic myomectomy)
*large submucosal fibroids not eligible)
125
Treatment option 4 for fibroids?
Endometrial ablation: radiofrequency, freezing, heated fluid, microwave, cautery
126
Treatment option 5 for fibroids?
Embolization: using arterial catheterization synthetic emboli are introduced to artery feeding fibroid
127
Treatment option 6 for fibroids?
Hysterectomy *most utilized, 70% of all fibroid procedures in US
128
Treatment option 7 for fibroids?
Myomectomy: hysteroscopic, laparoscopic, abdominal
*monitor for reoccurrence @ 3mos, 6mos, yearly
129
Treatment option 8 for fibroids?
Focused ultrasound surgery: high intensity US energy to induce coagulative necrosis of fibroids
130
Most common diagnosed GYN malignancy?
Endometrial CA (ovarian is #2)
131
Most common population who develop endometrial CA?
Women 70+, white>AA
132
RF for endometrial CA?
Age, obesity, DM, HTN, nulliparity, late menopause, early menses, caucasian, PCOS, chronic anovulation, hx of breast CA, hereditary nonpolyposis colorectal CA, Tamoxifen, Estrogen alone
133
What reduces the chance of developing endometrial CA?
Cigarette smoking
134
Pathophys of endometrial CA?
Precursor lesion, endometrial hyperplasia (thickening of endometrium, thicker lining = heavier period, can slowly progress to CA if untreated)
135
Presentation of endometrial CA?
Heavy bleeding, postmenopausal bleeding
136
Sx of endometrial CA?
Abnormal menses in 80%, postmenopausal bleeding
advanced: abd pain, bloating, weight loss, change in bowel/bladder habits
137
Classic presentation of someone with endometrial CA?
Obese, nulliparous, infertile, HTN, DM, white women
138
PE of endometrial CA?
Uterus can be normal size
139
Labs for endometrial CA?
CBC, UA, endocerv/vag cytology, glucose, LFT, BUN/CR
*40% missed on pap
*CA125 not utilized
140
All post menopausal women w/ endometrial cells on routine pap require what?
Eval for uterine CA w/ endometrial sampling
141
Tests for endometrial CA?
US: thickening of endometrium (if <4mm no D&C unless bleeding continues), D&C: definitive for dx, endometrial biopsy for dx
142
Differential dx for endometrial CA?
Polyps, fibroids, cervical CA
143
Tx for endometrial CA?
Surgery (hysterectomy, bilat salpingo-oophrectomy, pelvic lymphadenectomy), radiation (indicated if invasion of myometrium), hormonal tx w/ progesterone
144
Prognosis for endometrial cancer?
Good, many found in stage 1 bc of recognizable sx (10% of postmenopausal bleeding = cancer)
145
Surveillence/follow up after tx for endometrial CA?
Every 3-4 mos for 1st 2 years (85% recurrence happens in first 2 yrs), then q6mos for next 3 yrs, then annually
146
Each post-CA visit for endometrial CA involves what?
Pelvic exam, pap, lymph node survey, CXR annually
147
Uterine sarcoma accounts for how many uterine malignancies?
3-4%
Carcinosarcomas > Leiomyosarcomas > endometrial stromal sarcomas
148
Average age of dx of uterine sarcoma?
50
149
Are uterine sarcomas aggressive?
YES, poor prognosis
150
Who are uterine sarcomas more common in?
AA
151
Presentation of uterine sarcoma?
Abornmal bleeding*, pelvic pain*, constipation, urinary frequency, uterus enlarged, if advanced inguinal/supraclavicular node metastases
152
How to dx uterine sarcoma?
Endometrial bx, D&C, if indeterminate --> laparotomy (check all viscera/nodes)
153
Workup for uterine sarcoma?
Labs: CBC, US, LFT
Imaging: CXR, Abd/pelvic CT/US, sigmoidoscopy, cystoscopy
154
Tx for uterine sarcoma?
Surgery, chemo, radiation
155
Complications of uterine sarcoma?
Anemia, sepsis, uterine rupture, hemorrhage, metastasis, ascites
156
Pathophys of uterine adenomyosis?
extension of endometrial glands into uterine musculature
157
S/SX of uterine adenomyosis?
Severe dysmenorrhea, heavy bleeding, chronic pelvic pain, may be asx
158
PE for uterine adenomyosis?
Enlarged boggy uterus
159
Dx for uterine adenomyosis?
Clinical, r/o other major causes of bleeding/pain
Endometrial bx, D&C or hysteroscopy will r/o endometrial CA
160
Labs for uterine adenomyosis?
Pregnancy, anemia, TFT, pituitary dysfunction, bleeding d/o, STIs
161
Imaging for uterine adenomyosis?
Transvag US: diffusely enlarged, globular, asymmetric uterus, myometrial mass w/ ill defined borders
162
Tx for uterine adenomyosis?
Anti-inflammatory drugs & hormonal therapy, hysterectomy
163
What is endometriosis?
When endometrial tissue grows outside of the endometrial cavity in pre-menopausal women (usually 20-30's)
*primary cause of infertility
164
RF for endometriosis?
Fam hx, early menses, long duration of menstrual flow, heavy bleeding, shorter cycles
165
Protective factors for endometriosis?
Regular exercise, higher parity, longer duration of lactation
166
Pathophys of endometriosis?
Ectopic endometrial tissues --> ectopic foci respond to cyclic hormonal fluctuations same way as normal intrauterine endometrium --> leads to pain/adhesions
167
Common sites of implantation for endometriosis?
Ovary MC, fallopian tubes, uterine cul de sac, uterosacral ligaments, uterus, colon, lung (recurrent right pneumothorax at time of menses = catamenial pneumo), brain (catamenial seizures), scar tissue
168
S/Sx of endometriosis?
Extent does not correlate w sx, may be asx
Sx: dysmenorrhea, dyspareunia, infertility, chronic pelvic pain, cyclic pains at implantation sites
169
PE for endometriosis?
May have no evidence, *tender nodules on posterior uterus of cul-de-sac, pain w/ uterine motion, uterus may be fixed/retroverted from adhesions, tender adnexal mass (endometrioma), implants in healed wounds
170
Dx of endometriosis?
Direct visualization of lesions/implants REQUIRED (laparoscopy)
*imaging does not help unless to r/o other d/o
171
Workup for endometriosis?
Detailed H&P, urine culture, UA, CBC, cervical gram stain/culture, US, MRI, CT, FNA
172
Complications of endometriosis?
Adhesions, infertility, chronic pain, endometriomas, obstruction/impairment of organs, catamenial pneumo (72 hours prior/post menses), catamenial seizures
173
Tx for endometriosis depends on what?
Based on severity, location, desire for childbearing: medical or surgcial
174
First line medical tx for endometriosis?
6-9 month trial of NSAIDs & hormonal tx (interrupt cycles of endometrial tissue)
175
Second line medical tx for endometriosis?
High dose progestin (Medrocyprogesterone acetate) Danazole (pseudomenopause),
GnRH agonsists (suppresses FSH/LH, dec estrogen and implantation) -> limited to 6mos
176
Surgical tx for severe endometriosis?
Conservative (preserve fertility): attempt to destroy endometriotic tissue, remove adhesions, remove endometriomas
Definitive: total abdominal hysterectomy, bilateral salpingo-oophrectomy (BSO-TAH) and excision of adhesions/implants)
