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Ovarian Cysts- Benign and Malignant Flashcards

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1
Q

The peritoneum is a continuous membrane which lines the abdominal cavity and covers the abdominal organs (abdominal viscera). This folds over the uterus forming what ligament?

A
  • broad ligament
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2
Q

The peritoneum is a continuous membrane which lines the abdominal cavity and covers the abdominal organs (abdominal viscera). This folds over the uterus forming the broad ligament. This can be further divided into 3 mesenteries, which are folds of a membrane that attaches organs to the abdominal wall and holds it in place as well as allowing blood vessels, nerves and lymphatics to pass through. Label the 3 mesentaries of the broad ligament and what each covers using the labels below:

  • mesovarium = ovaries
  • mesosalpinx = uterine tubes
  • mesometrium = uterus
A 
1 = - mesosalpinx = uterine tubes 
2 = - mesometrium = uterus
3 = mesovarium = ovaries
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3
Q

Which ligament suspends the ovaries medially?

A
  • utero-ovarian ligament
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4
Q

Which ligament connects the ovaries to the pelvic sidewall?

A
  • infundibulopelvic ligament also called the suspensory ligament of the ovary)
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5
Q

Why is the suspensory ligament particularly important?

A
  • blood vessels and nerves pass through it to ovary
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6
Q

Which artery is the primary blood source to the ovaries and what does this branch off?

A
  • ovarian artery

- branches directly from the aorta

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7
Q

What veins drain the blood from the ovaries?

A
  • right ovarian vein

- left ovarian vein

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8
Q

The right and left ovarian veins drain the ovaires. Where does each vein drain into?

A
  • left = drains into inferior vena cava

- right = drains into right renal vein

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9
Q

Label the ovary and all the aspects including follicles and oocytes using the labels below:

follicular fluid
mature graafin follicle
ovarian stroma
zona pellucida
mature ovum
primordial follicle
primary follicle
theca cells
vein
artery
antrum
corpus albicans
developing corpus luteum
corpus luteum
space filled with blood
A 
1 = primordial follicle
2 = primary follicle
3 = theca cells
4 = antrum
5 = follicular fluid
6 = mature ovum
7 = mature graafin follicle
8 = ovarian stroma
9 = zona pellucida
10 = artery
11 = vein
12 = developing corpus luteum
13 = space filled with blood
14 = corpus luteum
15 = corpus albicans
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10
Q

What can we see in the image below?

A
  • ovaries with follicle development
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11
Q

What is an ovarian cyst?

A
  • a fluid fill sac in the ovaries
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12
Q

Ovarian cysts are fluid fill sacs in the ovaries. There are 2 classes of them, which are?

A

1 - functional ovarian cyst

2 - neoplastic cysts

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13
Q

What is a functional ovarian cyst?

A
  • a cyst that forms if normal follicular development is interrupted
  • could be a dominant follicle that does not rupture in ovulation and continues to grow (could be no LH)
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14
Q

What % of women develop at least one pelvic mass in their lifetime?

A
  • 20%
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15
Q

How many different types of ovarian cysts are there?

A
  • > 30 types
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16
Q

When deciding on the management of an ovarian cyst what 3 things must we consider?

A 
1 = characteristics of the lesion
2 = age of the patient
3 = risk factors for malignancy
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17
Q

Although ovarian cysts are generally benign, they can lead to complications. What are the 4 most common complications?

A

1 - pelvic pain
2 - cyst rupture
3 - blood loss
4 - ovarian torsion

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18
Q

Women can develop functional and non-functional cysts. Are they both dangerous?

A
  • functional = generally benign

- non-functional = can develop into malignancies and complications

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19
Q

Although ovarian cysts can form at any age, when are they most common?

A
  • during reproductive years
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20
Q

What is the difference between a simple and mixed cyst?

A
  • simple = fluid filled cysts

- mixed = can be fluid and solid, or completely solid

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21
Q

Cysts can be simple or mixed cysts:

  • simple = fluid filled cysts
  • mixed = can be fluid and solid, or completely solid

Which is more dangerous?

A
  • mixed cysts are more likely to become malignant
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22
Q

What is the MOST important independent risk factor for developing ovarian cysts?

A
  • age
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23
Q

If we find any form of cyst in a post-menopausal woman is this dangerous?

A
  • yes
  • highest risk of becoming malignant
  • require proper follow up
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24
Q

What are some of the most common risk factors for developing ovarian cysts?

Study These Flashcards
A
  • infertility treatment
  • tamoxifen
  • pregnancy
  • hypothyroidism
  • maternal gonadotropins
  • smoking
  • tubal ligation sterilizations
25
Why is it difficult to identify the prevalence of ovarian cysts?
- most women don't have any symptoms so don't know they have them - normally a random finding in an examination
26
In the follicular development of the menstrual cycle, which hormone is key for the development of follicles? 1 - LH 2 - FSH 3 - testosterone 4 - oestrogen
- FSH | - also drives the formation of the dominant follicle
27
Which hormone is key for driving ovulation? 1 - LH 2 - FSH 3 - testosterone 4 - oestrogen
1 - LH
28
Follicular cysts can grow and become >2.5cm in diameter. These follicular cysts contain granulosa cells. What do granulosa cells secrete which is able to decrease the frequency of menstruation (normal vaginal bleeding)?
- oestradiol - strongest form of estrogen - estrogen should normally drop allowing the secratatory phase to take over, but does not occur here and estrogen continues to be produced
29
If pregnancy doesn't occur, what is the general life span of the corpus luteum?
- 14 days
30
If an egg is fertilised the corpus luteum will continue to produce progesterone for how long?
- 14 weeks
31
Generally the following occurs with the corpus luteum: - fertilised egg = corpus luteum last up to 14 weeks - non fertilised egg = corpus luteum lasts 14 days If the corpus luteum does not dissolve (disappear) what form of cyst can this form?
-luteal cyst
32
Are corpus luteal cysts common?
- yes - always occur in pregnancy, but resolve by 1st trimester - normally asymptomatic and resolve without treatment
33
If there is an overproduction of human chorionic gonadotropin (hCG) levels, what kind of cyst can this lead to? 1 - follicular cyst 2 - theca lutein cyst 3 - haemorrhagic cyst 4 - paraovarian cyst
2 - theca lutein cyst
34
If there is an overproduction of human chorionic gonadotropin (hCG) levels, a theca lutein cyst can form. Who is this most likely to occur in?
- pregnant women - Gestational trophoblastic disease - Multiple gestation - Ovarian hyperstimulation
35
What are neoplastic cysts?
- cysts arising from inappropriate overgrowth of cells within the ovary - can be malignant or benign
36
There are 3 types of benign neoplastic cysts, what are they?
- serous - mucinous - cystadenomas
37
What is a teratoma?
- a rare type of germ cell tumour | - may contain immature or fully formed tissue, including teeth, hair, bone and muscle
38
A teratoma is a rare type of germ cell tumour. It may contain immature or fully formed tissue, including teeth, hair, bone and muscle. What is a teratoma cyst?
- cyst that forms containing a teratoma | - can contain all 3 layers of trilaminar disc
39
A teratoma is a rare type of germ cell tumour. It may contain immature or fully formed tissue, including teeth, hair, bone and muscle. A teratoma cyst is a cyst that forms containing a teratoma and can contain all 3 layers of trilaminar disc. What is a struma ovarii?
- teratoma cyst containing mainly thyroid tissue
40
Dermoid cysts are generally benign, what % can become malignant?
- 1-2%
41
What is polycystic ovary syndrome?
- dysfunction in the hypothalamic-pituitary-ovarian axis - causes infrequent or prolonged menstrual periods or excess male hormone (androgen) levels - ovaries may develop numerous small collections of fluid (follicles) and fail to regularly release eggs and ovaries appear large
42
Polycystic ovary syndrome (PCOS) is a dysfunction in the hypothalamic-pituitary-ovarian axis. This causes infrequent or prolonged menstrual periods or excess male hormone (androgen) levels. The ovaries may develop numerous small collections of fluid (follicles) and fail to regularly release eggs. What is the incidence of PCOS?
- 5-10% of women in reproductive age
43
What are 2 diseases that are heavily associated with Polycystic ovary syndrome?
- diabetes mellitus | - cardiovascular disease
44
Endometriosis is a condition where tissue similar to the lining of the womb starts to grow in other places, such as the ovaries and fallopian tubes. Can this lead to the formation of ovarian cysts?
- yes one of the most common sites is the ovaries | - can form endometriomas (chocolate cysts)
45
Ovarian cysts can be symptomatic or asymptomatic. If a patient becomes symptomatic, what are the most common symptoms?
- unilateral pain or pressure in the lower abdomen (sharp or dull) - rupture or ovarian torsion (acute severe pain and nausea) - irregular menstrual cycle (abnormal vaginal bleed)
46
Can a physical examination (bimanual) of a females ovaries useful?
- it can help identify the location, shape, size and tenderness of ovaries - BUT not diagnose the type of ovarian cyst
47
The management of ovarian cysts depends on what 2 key factors"
1 - age | 2 - of woman is post-menopausal
48
In the management of ovarian cysts if a woman has been confirmed as non pregnant, what would be the next evaluation?
- imaging using ultrasound | - MRI and CT are generally not used initially
49
In the management of ovarian cysts if a woman has been confirmed as non pregnant and had an imaging scan. What further analysis could be performed?
- full blood count - urinalysis (rule out urinary tract infection and kidney stones) - endocervical swabs (assess for pelvic inflammatory disease) - cancer antigen 125 (CA125)
50
Cancer antigen 125 (CA125) can be used to assess the risk of ovarian cancer from ovarian cysts. What are the diagnostic levels of CA125?
- < 35U/ml is normal - > 35U/ml found in 85% of patients with epithelial ovarian cancer - > 35U/ml found in 50% of patients with stage I ovary cancer
51
What type of ultrasound is used to assess ovarian cysts?
- Transvaginal Ultrasonography | - abdominal ultrasound may be useful
52
If a patient presents with ovarian cysts up to the size of 10cm, but she is asymptomatic, what would treatment involve?
- monitor the patient with serial transvaginal ultrasound
53
If a patient presents with ovarian cysts that do not resolve after several menstrual cycles or if the patient has symptoms what would the treatment involve?
- unlikely to be a functional cyst - monitored using sonograms (same as during pregnancy) until surgery - surgery (endometriomas or dermoid cysts)
54
What are the 4 main indications for surgery in ovarian cysts?
1 - suspected ovarian torsion 2 - persistent adnexal mass 3 - acute abdominal pain 4 - suspected malignancy
55
In all patients who have surgery for ovarian cysts, in addition to ensuring any malignancies are removed, what is another key aim following the surgery?
- to maintain fertility for the patient
56
What % of follicular ovarian cysts resolve spontaneously?
- 70-80%
57
What is ovarian torsion?
- twisting of the ovary and/or fallopian tube on its vascular and ligamentous supports - suspensory ligament contains blood vessels and nerves - blocks adequate blood flow to the ovary
58
Ovarian torsion is a twisting of the ovary and/or fallopian tube on its vascular and ligamentous support that blocks adequate blood flow to the ovary. is this dangerous?
- yes if more than 3 hours ovaries become necrotic | - medical emergency

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