Ovarian Pathology Flashcards
(85 cards)
1
Q
Pelvic Ultrasound should begin with a ___________ and look for _______ and _________.
A
Transabdominal Ultrasound
Large Masses
Document
2
Q
If no masses are seen in a Transabdominal Ultrasound:
A
Take Sagittal images and measurements of:
Uterus
Cervix
3
Q
When measuring the uterus transabdominal, how should you measure the uterus?
A
Sagittal: measure Long and Anterior Posterior
Transverse: measure transverse of uterus
4
Q
Are you supposed to measure ovaries or endometium with transabdominal ultrasound.
A
NO!!!!
5
Q
After completing a transabdominal ultrasound then you should do a _____________, in every pelvic ultrasound.
A
Transvaginal Ultrasound
6
Q
What are the 3 contradictions in not doing a transvaginal ultrasound?
A
- Virginity
- 3rd trimester bleeding
- Postmenopausal vaginal stenosis (due too lack of estrogen)
7
Q
When doing a transvaginal ultrasound what needs to be evaluated?
A
Evaluate the uterus first in sagittal and transverse.
Document any uterine masses.
8
Q
When measuring the endometrium in a sagittal plane how do you measure the endometrium.
A
Measure the endometrium from the anterior to posterior wall.
9
Q
After evaluating the uterus transvaginal what needs to be evaluated next?
A
Evaluate the Adnexa, right first, then left (be systemetic).
10
Q
How should you measure each ovary with transvaginal ultrasound?
A
Measure each ovary sagittal and transverse.
11
Q
Don’t measure any simple cyst unless _______.
A
greater ( > 3cm)
12
Q
True or False. Should you measure all solid or complex cysts?
A
True
13
Q
What is “The Big Six” ovarian pathologies?
A
- Physiologic/Functional Cysts
- Corpus Lutea
- Hemmorrhagic cyst
- Endometriomas
- Polycystic ovaries
- Mature Cystic Teratomas
14
Q
What ovarian pathology is: during the Follicular Phase (proliferative phase for the uterus), transverse ultrasound will show a developing follicle as a thin walled, round/oval avascular, simple cyst?
A
Physiologic / Functioning cyst
15
Q
What is the normal diameter of a dominate follicle at ovulation?
A
1.7 - 2.8 - 3.0 cm
16
Q
What ovarian pathology is: Immediately before ovulation, a tiny peripheral curved line may be visible, indicating that the ovum is surrounded by a cumulus oophorus, within the mature follicle?
A
Follicular Cyst
17
Q
A __________ develops when ovulation fails to occur and the follicle continues to enlarge, but remains simple.
A
Functional cyst
18
Q
Functional Cysts can measure _______. Followup if cyst is __________.
A
3 - 8 cm
greater ( > 5cm)
19
Q
Sonographic features of a simple cyst.*
these sono features are for anywhere in the body!
A
- Anechoic
- Thin Wall
- Through Transmission
20
Q
“Yellow Body,” secretes progesterone, occurs after ovulation.
A
Corpus Lutea
21
Q
________ is the crater which remains after ovulation and may be fluid filled with blood.
A
Corpus Lutea
22
Q
*** ____________ is the dominant hormone of the luteal phase. **
A
progesterone
23
Q
What are the sono findings of the corpus lutea?
A
- measures up to 3 cm
- appearance can vary from a thick walled cyst with irregular margins to a more collapsed, solid appearance cyst
- low resistance, lush flow around it is the bodies way of trying to keep it alive to keep it secreting progesterone
24
Q
How many weeks does it take for the corpus lutea to resolve?
A
8 - 12 weeks
25
If ___________, the BHC6 from the fetus keeps it present until __________ weeks when the placenta takes over secretion of _________.
pregnant
10 - 16 weeks
progesterone
26
Most corpus lutea are asymptomatic but if large:
- causes pain from stretching ovaries
- can rupture / bleed / leak cause irritation of peritoneum and then pain
- if > 5 cm there is is risk of torsion
27
Any _________ solid or cystic may cause torsion if > 5 cm.
ovarian mass
28
True or False. Doctors miss ovarian torsion more often then dectect.
True.
29
What is a complete or partial twisting of ovarian pedicle on its axis. Lymphatic and venous drainage is compromised and leads to edema of the ovary. Eventually, the swelling results in loss of arterial flow which causes infarction, pain and fever?
ovarian torsion
30
What are the sono findings of ovarian torsion?
- enlarged ovary is the one definite finding in all
- may look like a solid mass
- may look like multi tense cysts
- venous flow is gone 1st, so if no venous, enlarged, tell the radiologist you suspect torsion if there is pain
- arterial flow is present in the early stages then gone in the late stages
31
What ovarian pathology is due to bleeding into a corpus leuteum. Ultrasound appearance depends on if the hemorrhage is acute or later?
Hemorrhagic cysts
32
Clotted blood, intensley echogenic, avascular, homo or heterogeneious and nonshadowing. Ovary is tender to transducer palpation. Echogenic free fluid in pelvis if bleeding still going on look in Morisons pouch. May bleed enough to result in patient going to operating room.
Acute Hemorrhage
33
Avascular clot will retract from cyst wall. Since clot is soft and gelatinous it will jiggle with transducer. "LACY" "COBWEB." Irregular, fine lines.
Sub Acute
34
"Chocolate Cysts," abnormal implantation of endometrial tissue which undergoies cystic changes of bleeding and proliferated just like the normal endo cavity.
endometriomas
35
What is the "signature" appearence of endometriomas by ultrasound?
- smooth walled
- uni or multi loculated cyst with homogenous low level echoes.
- 15 % of the time, findings are not classic and may have irregularities due to adherent mural clot or fibrin.
36
What is polycystic ovarian syndrome known as?
- PCOD
- PCO Morphology
- Stein Levanthal Syndrome
37
What is an endocrine disorder association with chronic annovulation. Diagnosed in young women based on clinical findings and serologic (blood tests).
Polycystic Ovarian Syndrome
38
What are the clinical signs of polycystic ovarian syndrome (PCOD).
- obese
- hirsut - facial hair, hyperandrogenism
- ammenorrhea
- infertiltity
39
What are the sono findings of PCOD according to the 2003 consensus report?
- 12 or more follicles measuring 2 - 9 mm, recently they have increased this number to 19 follicles due to improvement ultrasound.
- increased ovarian volume > 10 cm^3
40
What is also known as a dermoid. They are common benign avascular ovarian neoplasms. Is a germ cell of the ovary. Accountss from 15 - 25 % of ovarian neoplasms and is bilateral 15 % of the time.
Mature cystic teratomas
41
What are the symptoms of a mature cystic teratoma?
- pain, with ovarian swelling or torsion
| - palpable adnexal mass
42
What are the complications of a mature cystic teratoma?
1. Torsion - mostly if > 5 cm
| 2. Rupture which can turn into peritonitis
43
What are the 3 germ cell layers of a dermoid?
1. Endoderm
2. mesoderm
3. ectoderm
44
Mature cystic teratomas also known as dermoids many contain what?
- hair, teeth, nails
- sebum, oil
- calcified nodule also known as "Rokitonsky nodule"
45
What are the ultrasound features of a mature cystic teratoma.
The ultrasound features vary depending on what is inside of the dermoid.
1. Focal ecogenic nodule (hyperechoic), "Dermoid Plug"
2. Fluid filled structure
3. When hairball floats in sebum, easy to miss "Tip of the Iceberg" sign
4. "Dermoid Mesh" sign if hair in dermoid is dispersed in fluid, "speckled"
* **see sheets***
46
What are tumors arising from the surface epithelium that covers the ovary. They account for 65 - 75 % of all ovarian neoplasms and 90 % of ovarian malignancies.
Epithelial Tumors
47
What are the 5 types of epithelial tumors? These tumors can be benign, atypical (borderline) or malignant.
1. Serous
2. Mucinous
3. Endometroid - 80 % malignant
4. Clear cell - nearly always malignant!
5. Brenner - transitional cell (almost always benign).
48
This type of epithelial tumor is common, accounts for 30 % of all ovarian neoplasms.
Serous epithelial tumor
49
What are the two types of serous epithelial tumors?
1. Benign serous cystoadenoma which has a 20 % chance of being bilateral.
2. Malignant serous cystadenocarcinomas which accounts for 50% and occurs in postmenopausal women and is usually bigger. "Big is Bad"
50
What are the ultrasound findings of a serous epithelial tumor.
- benign cyst, anaechoic, sharp margins, unilocular with possible thin walled septations
- malignant, multilocular, multipapillary projections, thick septations, ascites, may have echogenic material within
51
These epithelial tumors are filled with a thick mucus like material. The benign type are more common in 30 - 50 yr old women and are not bilateral. The malignant type occur in 40 - 70 yr old women and are 20 % bilateral.
Mucinous Epithelial Tumor
52
What are the ultrasound findings of a mucinouscystadenoma (benign).
- multilocular with ticker, more numerous septations than serous.
- fine, gravity dependent echos, may see them move
- up to 50 cm in diameter!
53
What are the ultrasound findings of a mucinouscystadenocarcingoma (malignant).
- multiloculated; thick septations
- echogenic material inside
- measure 15 - 30 cm
- papillary ? **see sheet***
54
A complication with either benign or malignant mucinous tumors. Rupture of the tumor, spilling mucinous, gelatinous material into the peritoneal cavity. Looks like ascites with thick septations inside.
Pseudomyxoma Peritonei
55
This epithelial tumor has identical tissue to endometrical carcinoma. 30 % of patients already have endometrial carcinoma. 80 % of these are malignant.
Endometroid
56
What are the ultrasound finds of an endometroid.
- mixed solid / cystic
- predominently solid with areas of hemorrhage and necrosis
- look for thick endo
57
This epithelial tumor is nearly always malignant?
Clear Cell Carcinoma
58
What are the ultrasound findings of clear cell carcinoma?
complex, solid mass
59
What epithelial tumor is rare and only 1 - 2 % of all ovarian tumors. This tumor is small, only 2 - 10 cm, unilateral and almost always benign?
Brenner Tumor also known as:
| Transitional cell and Fibroepithelioma
60
What are the ultrasound findings of a Brenner tumor?
- hypoechoic solid mass
| - +/- cystic spaces
61
What is not from epithelium of the ovary, but instead is derived from premative germ cells of the embryonic gonad?
Germ Cell Tumors
***see sheet****
62
What are the 3 layers of a germ cell?
- endoderm
- mesoderm
- ectoderm
63
What are the 3 types of germ cell tumors?
1. benign cystic teratomas
2. dysgermenioma
3. endodermal sinus tumor = yolk sac tumor
64
What type of germ cell tumor occurs in women < 30 yrs old, homologous to testicular seminomas. This tumor is multilobulated solid mass, highly malignant and highly radio-sensitive?
Dysgerminoma
65
What type of germ cell tumor is the 2nd most common germ cell malignancy, after dysgerminoma, unilateral, highly malignant and metastasizes to surrounding structures. Patients have increased levels of serum alphafetoprotein (AFP). It appears as a solid mass with necrosis.
Endodermal Sinus = Yolk Sac Tumor
66
What kind of tumor arises from the sex cords of the embryonic gonad, or ovarian stroma?
Sex Cord Stormal Tumors,
67
What are the 4 types of sex cord stromal tumors?
1. Fibromas
2. Granulosa Cell tumors
3. Theconmas
4. Sertoli-Leydig Tumors
68
What sex cord tumor accounts for 50 % are benign and ascites in 15 % and > 10 cm?
Fibroma
69
What sex cord tumor is low grade malignancy and produce estrogen?
Granulosa Cell Tumor
70
What sex cord tumor produces estrogen and usually benign.
Thecoma
71
What sex cord tumor is 20 % malignant and is androgen producing?
Sertoli-Leydig Tumor also called: arrhenoblastoma and androblastoma.
72
These tumors account for 5 - 10 % of ovarian tumors, are bilateral, solid and most commonly from the GI Tract "dropped mets" and may be direct extended from endometrial carcinoma, colon carcinoma.
Metastatic Tumors
73
Can carry malignant cells to ovaries from anywhere in peritoneal cavity.
Peritoneal fluid
74
Can carry malignant cells from distant sites.
Blood and lymphatic vessels
75
What specific type of ovarian metastatic tumor comes from a GI primary, usually gastric carcinoma and can come from the appendix and colon. It is usually bilateral and is solid, hypoechoic masses and usually ascites too?
Krukenberg tumor
76
Know This! With ovarian hyperstimulation there are usually large cysts which are ____. They are called _____ cysts and __ ___ produce hormones.
benign; Theca-lutein; DO NOT
77
The 5th leading cancer and cancer death in females in the US is due to ____ ____. It is also clinically silent so it is usually found _____.
Ovarian carcinoma; late
78
Name 3 risk factors for ovarian cancer.
Uninterupted ovulation... nulliparous (no pregnancies to term)..... BRCA I/II gene deletions=Family history of ovarian cancer
79
Using ____ for even 6 months in your lifetime can lower your risk of ovarian cancer?
Birth control pills, OCP
80
What test used to be believed to indicate an affinity toward having ovarian cancer?
Ca125 -- serum marker elevated in women with ovarian cancer-- also it was eventually found to be in women with endometriosis and fibroids also, which then dampened the effectiveness of the test.
81
Know this! Any female with a suspicious ovarian mass should also be evaluated for what for things?
Ascites and peritoneal mets.....,lymph nodes.....liver.....pleural spaces/pleural effusions
82
Doppler of malignant ovarian tumors have ___ ___ flow and ____ ____ velocities.
low resistance (lush), high diastolic
83
Cancer depends on angiogenesis. Explain what that means.
Abnormal vessels without smooth muscular walls are created to "feed" the growing cancer. They are low resistance vessels as they are pulling any and all flow they can get to the tumor. They include lots of arterio-venous shunting.
84
Para-ovarian cysts are also known as ___ ___ cysts, and they result from the remnants of the ____ duct, not the ovary.
Pelvic inclusion; Wolfian
85
Para-ovarian (pelvic inclusion cysts) cysts are usually ___ ___ cysts adjacent to the ovary are are _____ seen.
simple, benign; commonly
