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Flashcards in Ovarian disorders Deck (46)
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what is the most common ovarian mass?

follicular cyst


what is a follicular cyst?
-what happens if it ruptures?
-does it regress?
-best screening test?
-what if it's symptomatic?

non-neoplastic cyst (accumulation of fluid in a follicle, or previously ruptured follicle)
-rupture produces sterile peritonitis with pain
-most regress spontaneously
-US is best screening test
-surgical removal if symptomatic


what is the most common ovarian mass in pregnancy?

corpus luteum cyst


what is a corpus luteum cyst?
-does it regress?
-what if it's symptomatic?

non-neoplastic cyst (accumulation of fluid in CL during pregnancy; may be confused with amniotic sact)
-most regress spontaneously
-surgical removal if symptomatic


what is oophoritis?

may be a complication of mumps or PID


epidemiology of stromal hyperthecosis?

occurs primarily in obese postmenopausal women, causing bilateral ovarian enlargement
-hypercellular ovarian stroma (vacuolated/luteinized stromal hilar cells are present to make excess androgens)
-may cause hirutism or virilization


clinical findings of stromal hyperthecosis?

-hirutism or virilization
-association with acanthosis nigricans and insulin resistance (metabolic syndrome)


treatment of stromal hyperthecosis



epidemiology and pathogenesis of ovarian tumors

more likely benign in women <45 yo
-risk increases with age
-median age of presentation is 61 yo, and approx. 60% present with advanced disease
-peaks in late 70s


risk factors for ovarian tumors

1. nulliparity (increased number of ovulatory cycles increases risk for surface-derived ovarian tumors)
2. genetic factors (mutations of BRCA1/2 suppressor genes, Lynch syndrome, Turner's syndrome (increased risk for dysgerminoma), Peutz-Jeghers syndrome (increased incidence of sex cord tumors with annular tubules))
3. history of breast cancer
4. postmenopausal estrogen therapy, obesity (increased estrogen)


what decreases risk of surface-derived ovarian cancers?

OCPs/pregnancy (decreased number of ovulatory cycles)


surface-derived ovarian tumors

most common group (65-70% of ovarian tumors)
-derive from coelomic epithelium
-account for greatest number of malignant ovarian tumors, which commonly seed omentum


germ cell ovarian tumors
-how many are malignant?
-common benign and malignant types

account for 15-20% of ovarian tumors
-cancers similar to testicular cancer
-small number of tumors are malignant
-teratoma and dysgerminoma are most common benign and malignant, respectively


serous cystadenocarcinoma

most common ovarian cancer (surface-derived, serous tumor)
-benign, with psammoma bodies (dystrophically calcified tumor cells)
-most common malignant tumor that is bilateral


what do malignant surface-derived cancers commonly seed?

abdominal cavity


sex cord stromal tumors
-benign or malignatn?

3-5% of ovarian tumors
-derive from stromal cells
-may be hormone producing
-majority of tumors are benign


metastisized ovarian tumors?

5% of ovarian tumors
-common primary cancers metastasize to ovaries (breast, stomach)


clinical findings of ovarian tumors (6)

1. abdominal enlargement due to fluid (most common sign)
-malignant ascites most often due to seeding (induration of rectal pouch on digital rectal exam, and intestinal obstruction with colicky pain)
2. palpable ovarian mass in postmenopausal women (should NOT be palpable; cancer until proven otherwise)
3. malignant pleural effusion (common site for ovarian cancer metastasis)
4. cystic teratomas undergo torsion leading to infarction (radiographs show calcification from bone/teeth)
5. signs of hyperestrinism from estrogen-secreting tumors (bleeding from endometrial hyperplasia/cancer, 100% superficial squamous cells in cervical Pap smear)
6. Hirsutism or virilization from androgen-secreting tumors


ovarian tumor markers

increased serum cancer antigen 125
-only increased in surface-derived malignant tumors


treatment for ovarian cancer

surgery, chemotherapy, sometimes radiation


ovarian tumor prognosis

better if <65 yo
-overall 1 and 5 year relative survival rates are 75% and 45%


4 types of surface derived (serosal epithelium) tumors and if benign/malignant

1. serous tumors (benign cystaderoma to malignant adenocarcinoma)
2. mucinous tumors (benign cystaderoma to malignant adenocarcinoma)
3. endometrioid (malignant)
4. Brenner tumor (benign)


3 types of germ cell tumors and if benign/malignant

1. cystic teratoma (benign)
2. dysgerminoma (malignant)
3. yolk sac tumor (malignant)


4 types of sex-cord stromal tumors and if benign/malignant

1. thecoma-fibroma (benign)
2. granulosa-theca cell tumor (malignant)
3. Sertoli-Leydig cell (malignant)
4. gonadoblastoma


what is a Krukenberg tumor?

a tumor metastatic to ovary
-may affect both ovaries
-contains signet-ring cells from hematogenous spread of a gastric cancer


serous tumors characteristics
-most common type?

surface derived tumors
-most common group of primary benign and malignant tumors
-most common group of tumors that can be bilateral
-cysts are lined by ciliated cells (similar to fallopian tube)
-serous cystadenoma(carcinoma) is most common benign


mucinous tumors characteristics

surface derived tumors
-cysts lined by mucus-secreting cells (similar to endocervix)
-large, multiloculated tumors
-seeding produces pseudomyxoma peritonei
-mucinous cystadenoma (benign) may be associated with Brenner tumors
--mucinous cystadenocarcinoma


Brenner tumor characteristics

surface derived tumors
-usually benign
-contain Walthard rests (transitional-like epithelium)


endometrioid tumor

surface derived tumors
-malignant tumors associated with endometrial carcinoma (15-30% of cases)
-tumor resembles endometrial carcinoma
-commonly bilateral


cystic teratoma characteristic

most common benign germ cell tumor; less than 1% become malignant (usually squamous cancer)
-ectodermal differentiation (hair, sebaceous glands, teeth) most prominent
-most found in nipple-like structure in cyst wall (Rokitansky tubercle)
-immature malignant types contain mature and immature components (muscle, neuroepithelium)
-struma ovarii type has functioning thyroid tissue