Ovarian Pathology Flashcards
(175 cards)
1
Q
What is the order of follicle formation
A
Primordial follicle
Primary Follicle
Secondary follicle
Graafian Follicles
Ovulation
Corpus Luteum
Corpus Albican
2
Q
What are the 3 characteristics of an ovarian cyst
A
Thin, smooth walls
Anechoic
Posterior enhancement
3
Q
Maj11ority of ovarian masses are
A
Simple cysts
4
Q
What are functional ovarian cysts
A
Benign, cystic masses that respond to cyclic hormonal stimulation
5
Q
What is the most common cause of ovarian enlargement in young women
A
Functional ovarian cysts
6
Q
What are the 3 types of functional cysts
A
Follicular cyst
Corpus luteum cyst
Theca-lutein cyst
7
Q
True or False
Functional cysts regress by themselves without any type of intervention
A
True
8
Q
Fluid accumulation in the posterior cul-de-sac is due to
A
Physiology
9
Q
What are the complex cystic masses (Benign ovarian neoplasm)
A
Serous cystadenoma
Mucinous cystadenoma
Brener tumor
Dermoid cyst
Fibroma
Endometrioma
10
Q
Theca lutein cysts happen
A
Bilaterally
11
Q
What is the most common type of ovarian cyst
A
Follicular cyst
12
Q
Follicular cysts occur when a
A
Dominant follicle fails to ovulate and remains mature
13
Q
Signs and symptoms of follicular cyst
A
Asymptomatic
Dull adnexal pressure
Fullness/bloating
Pain on side of cyst
May lead to menstrual irregularities
Surgery may be needed
14
Q
True or False
Follicular cysts are smaller than dominant follicles
A
False - Larger than
15
Q
Follicular cysts can be become ___ and can ___
A
Large and can rupture
16
Q
What is the sonographic apperance of follicular cysts uni or bi
A
Unilateral
17
Q
What are the risk factors for follicular cysts
A
Women of reproductive age
18
Q
What are the differentials of follicular cysts
What are they?
A
Serous cystadenoma:
Epithelial tumor
Hydrosalpinx:
Fluid-filled fallopian tube
19
Q
Type of functional ovarian cyst that occurs when corpus luteum fails to regress
How long do they last?
A
Corpus luteum cysts
14 days
20
Q
What would happen to corpus luteum cyst if pregnancy occurs
A
Produces progesterone and will sustain the early stage of pregnancy, becomes corpus luteum of pregnancy
21
Q
What is the most common pelvic mass encountered during 1st trimester of pregnancy
A
Corpus luteum cyst
22
Q
True or False
Corpus luteum does not always indicate pregnancy
A
True
23
Q
How does a corpus luteum cyst of menstruation forms from
A
Normal 2-3 cm dominant cyst/Graafian follicle ruptures
24
Q
As corpus luteum cyst of menstruation regresses it becomes
A
Corpus albicans
25
Internal hemorrhage occurs into functional cysts of the ovary
Occurs most commonly in
Hemorrhagic corpus luteum cyst
Corpus luteum cyst
26
What are the signs and symptoms of a hemorrhagic corpus luteum cyst
Asymptomatic
Pelvic pain
Enlarged and tender ovary
Irregular menstrual cycle
Nausea/vomiting
27
What are the sonographic findings of corpus luteum cyst
Anechoic
Unilateral
Fluid in cul-de-sac or adjacent to ovary
Ovarian artieral flow-low resistant pattern
28
If a hemorrhage occurs with a corpus luteum cyst it will have what type of apperance
Fishnet apperance
29
Produces progesterone to support early pregnancy maintaining the decidualized endometrium
Corpus luteum of pregnancy
30
Sonographic apperance of corpus luteum of pregnancy - uni or bi
Unilateral
31
Caused by high levels of hormone, human chorionic gonadotropin
Theca Lutein cyst
32
Theca lutein cyst is a large ____
Functional cyst
33
Theca lutein cyst is associated with
Gestational trophoblastic disease
Normal pregnancy
Infertility drugs
34
Occurs when a sperm cell fertilizes an empty egg or 2 sperm cells fertilize normal egg cell
Gestational trophoblastic disease
35
What are the sonographic findings of theca lutein cyst
Bilateral
Multiloculated
Very large
Complications with hemorrhage, rupture, or torsion
36
Post surgical residual
Ovarian remnant syndrome
37
What are the signs and symptoms of ovarian remnant syndrome
Pelvic pain
Pelvic mass
Absence of menopause after oophorectomy
38
What is the sonographic apperance of ovarian remnant syndrome
Simple to complex
Thin rim
Free fluid
39
Paraovarian cysts arise from
Gartner's duct remnant or Hydatid of Morgagni
40
Paraovarian cysts are most commonly found within the
Lies ___ to ovary and is separate from ___
Is a non___ cyst
Broad ligaments
Lies adjacent to ovary, separate from ovary
Non-functional cyst
41
What are sonographic findings of paraovarian cyst
Thin walled
Anechoic
Posterior enhancement
Small to 15 cm
42
Predominantly in patients with a history of previous abdominal surgery
Peritoneal inclusion cyst
43
Peritoneal inclusion cyst is a result of
Trauma
PID
Endometriosis
44
In peritoneal inclusion cysts if peritoneal adhesions present with accumulation of fluid it will
Entrapped in ovaries
45
What is the main source of peritoneal fluid in women
Ovaries
46
What is the sonographic apperance of peritoneal inclusion cyst
Anechoic fluids may containing echoes
Fluid & septations surround an intact ovary
47
Development of uterine's inner lining tissue outside of the uterus
Endometriosis
48
Endometriosis is found in which 2 cavities
Abdominal and pelvic
49
What are the main symptoms of endometriosis
Pain
Menstrual irregularities w/ excessive bleeding
Bloating/nausea
Infertility
50
Dysmenorrhea
Painful period
51
Dyspareunia
Pain during intercourse
52
What are the causes of endometriosis
Retrograde menstruation
Surgical scar implantation
Immune system disorder
53
What are the risk factors of endometriosis
Never giving birth
Menses at early age
High levels of estrogen
1+ relative with endometriosis
54
What are the treatment options of endometriosis
Hormones
Excision surgery
55
Endometrioma is also known as
Chocolate cyst
56
Cystic mass filled with blood in the ovary as
Endometrioma or chocolate cyst
57
Endometriomas are a result of
Localized endometriosis
58
Endometriomas are most common in
Women of reproductive age
59
Endometriomas may be classified as what 2 types
Diffuse or localized
60
Most common form of endometriosis
Diffuse endometriosis
61
Endometrial tissue on one or both ovaries
Localized endometriosis
62
In endometrioma the ovarian tissue may be
Partially or completely replaces by endometrial tissue
63
Internal content of endometrioma may consist of
Old blood
Fresh
Hemorrhage
Clots
64
What are the signs and symptoms of endometriomas
Dysmenorrhea
Dyspareunia
Metromenorrhagia
Infertility
65
What is the sonographic apperance of endometriomas
Well defined
Homeogenous
Thought to represent cholesterol deposits
66
Ovarian torsion is also known as
Adnexal torsion or tubo-ovarian torsion
67
Partial or complete rotation of the ovarian pedicle on its axis
Ovarian torsion
68
Mobile adnexal structures allow torsion at the
Mososalpinx
69
In ovarian torsion there is a decrease in
Lymphatic and venous drainage
70
Ovarian torsion has the rotation of the ___ and portion of the ___ on supplying ___ pedicle
Ovary, fallopian tube, vascular
71
For ovarian torsion has eventual loss of ___ perfusion and results in ___
Loss of arterial perfusion
Results in infraction
72
Clinical findings of ovarian torsion
Sudden or severe pelvic pain
Nausea/vomiting
Palpable adnexal mass & tenderness
Surgical emergency
73
What are the lab values of ovarian torsion
Elevated WBC
74
The sonographic findings of ovarian torsion is variable on:
Variable on:
Duration
Degree
Existence of mass
75
Other sonographic findings of ovarian torsion
Peripherally displaced follicles with hyperechoic central stroma
Free pelvic fluid
Ovary tender to transducer
76
What are the Doppler findings of ovarian torsion
Decrease/absent blood flow
Absent/reversed diastolic flow
Whirlpool sign
77
Poly-cystic ovary syndrome is also known as
Stein-leventhal syndrome
78
A complex endocrinologic disorder resulting in oligomenorrhea and chronic anovulation
Polycystic ovary syndrome
79
In polycystic ovary syndrome there is an imbalance in:
Resulting from:
LH & FSH
Due to abnormal estrogen and androgen production
80
PCOS will have follicles but they may fail to
Regulary release eggs
81
PCOS is most common in
PCOS is most common cause of
Women age 20-30
Infertility
82
Signs and symptoms of PCOS
Polycystic & enlarged ovaries
Infertility
Oligomenorrhea or amenorrhea
Hirsutism
83
Excess facial and body hair androgenism
Hirsutism
84
Sonographic apperance of PCOS
Enlarged ovaries (> 10 cubic cm)
Multiple, small, peripheral follicles
Bilateral
12+ follicles (2-9mm)
85
In PCOS the follicles located peripherally are known as the
String of perals
86
Equation to calculate ovarian volume
0.5 x L x W x Thickness of ovary
87
Cystic teratoma is also known as
Dermoid cyst
88
Dermoid is composed of
Dermal and epidermal elements
89
Termatomas composed of
Mesodermal and endodermal
90
Cystic teratoma is most common in
Is the most common
Most common site is
Common in young women of repro age
Most common benign tumor
Site is level of superior to the uteruine fundus
91
75% of all dermoid cyst are
Unilateral
92
Germ cell that is retained within the egg sac
Cystic teratoma
93
Cystic teratoma is filled with
Sebaceous material of hair, teeth, bone, thyroid, fibrous tissue and fluid
94
What are the clinical findings of cystic termatoma
Mild-acute abdominal pain
Adnexal fullness
Pressure-like symptoms
95
Sonographic findings of cystic termatoma
Posterior shadowing
"Tip of iceberg"
Cystic to complex
96
Common solid masses
Solid teratoma
Brenner tumor
Fibroma
Dysgerminoma
Thecoma
97
Rare, malignant, mainly in children and young adults
Solid teratoma
98
Sono findings of solid teratoma
Unilateral
Poor prognosis
99
Brenner tumor is also known as
Most common in
May be associated with
Transitional cell carcinoma
Postmenopausal women (50-60)
Meig's syndrome
100
Meig's syndrome
Ascities and pleural effusion
101
Clinical findings of Brenner tumor
Asymptomatic and found incidentally
102
Solid, abnormal growth on the ovary
Brenner tumor
103
Most Brenner tumors are ___
5% are ___
Benign
5% are malignant
104
What are the sonographic findings of Brenner tumor
Solid
Confused with pendunculated fibroids
Hypoechoic
50% calcifications
Unilateral (Can be bilateral)
Small
Equal to or >10cm
105
Benign ovarian tumor of sex cords
Ovarian fibroma
106
Fibromas arise from
Stroma and sex cords
107
90% of fibromas are ___
Big as ___cm
Mainly found in
Most common tumor associated with
Unilateral
25cm
Postmenopausal or perimenopausal women (50-60)
Meig's syndrome
108
Clinical findings of fibroma
Small - Asymptomatic
Large - Pelvic pain
Pressure symptoms
Abdominal enlargement
109
Sono findings of fibroma
Solid
Hyperechoic
Have torsion
110
Rare maligant tumor and 75% occur between 10-30 years of age
Dysgerminoma
111
Symptoms of dysgerminoma
90% __
Pelvic pain
Irregular vaginal bleeding
Unilateral
112
Sono findings of dysgerminoma
Solid
Homogenous
Poor prognosis
113
Thecoma is also known as
Are uni or bi
Most common in
Theca cell tumor
Unilateral
Menopausal or postemenopausal women
114
Malignant thecomas are
Rare
115
Clinical symptoms of thecoma
Pelvic pain
Pressure symptoms
116
Sono findings of thecoma
Posterior shadowing
Foci or calcifications
Necrosis
Cystic degeneration
117
Common adnexal masses
Cystadenoma (Serous & Mucinous)
Cystadenocarcinoma (Serous & Mucinous)
Brenner Tumor
Granulosa cell tumor
118
Benign ovarian cystic tumor lined by a serous epithelium
Serous cystadenoma
119
Most common epithelial tumor
Serous cystadenoma
120
Second most common benign tumor of the ovary
Serous cystadenoma
121
Serous cystadenoma has peak incidence in the
4th & 5th decades
122
Signs and symptoms of serous cystadenoma
Nausea/vomiting/bloating
Fatigue
Low abdominal pain/pressure
123
Sono findings of serous cystadenoma
Papillary projections
Unilateral
124
Treatment for serous cystadenoma
Surgical excised
125
Most common type of ovarian cancer
Serous cystadenocarcinoma
126
Clinical manifestations of serous cystadenocarcinoma
Pain
Abdominal distension
Bowel obstruction
Nausea/vomiting
Easy satiety
Cachexia
127
Sono findings of serous cystadenocarcinoma
Papillary projection
Thick septations
Irregular borders
Components and septations demonstrate blood flow
128
Second most common epithelia tumor
Benign or malignant
Mucinous cystadenoma
Benign
129
Signs and symptoms of mucinous cystadenoma
Increase abdominal girth
Pelvic pressure
Bloating
130
Sono findings of mucinous cystadenoma
Large
Low-level echoes
Thin septations
Unilateral
131
Second most common epithelial ovarian cancer
Most common in
Mucinous cystadenocarcinoma
Menopausal women
132
What are the clinical findings of mucinous cystadenocarcinoma
Pelvic pressure
Bloating
133
Sono findings of mucinous cystadenocarcinoma
Similar to serous cystadenocarcinomas
134
Rare type of ovarian cancer
Most common in
Uni or Bi
Granulosa cell tumor
Adults
Unilateral
135
Most common sex cord-stromal tumor
Granulosa cell tumor
136
Granulosa cell tumor does what to women
Higher than normal levels of estrogen
137
Symptoms of granulosa cell tumor
Irregular menstruation cycles
138
Treatment for for granulosa cell tumor
Fertility-sparing surgery
139
Metastatic disease can affect the ovary from
Breast
GI Tract
Lymphatic spread
Other pelvic organs
140
Metastatic malignancy of the ovary from stomach, biliary tract, GB, pancreas
Krukenberg tumors
141
Sono findings of metastatic disease
Bilateral
Ascites
Complex
Necrotic
Solic
Hypoechoic
142
Types of inflammatory Diseases
PID
Pyosalpinx
Hydrosalpinx
Chronic salpinitis
Tubo-ovarian abscess
Peritonitis
143
2 types of PID consequences
Gonorrheal
Nongonorrheal
144
Nongonorrheal PID consequences result from retained products of
Conception
Appendicitis
Sigmoiditis
Prolonged use of IUD
145
PID may lead to
Parametritis
146
Chronic PID
Widespread fibrosis and adhensions
147
Associated with PID and use of IUD
Actinomycosis
148
Conditions that mimic PID
Endometriosis
Ectopic pregnancy
Hemorrhagic cyst
Multicystic ovarian disease
149
Clinical findings of PID
Fever
Leukocystosis
Rapid pulse rate
Vaginal discharge
150
For PID sonographically you always look for
Peristalsis
151
Inflammation of the fallopian tube that fills and swells with pus
Pyosalpinx
152
Acute pyosalpinx is shaped like a
Sausage
153
Clinical findings of pyosalpinx
Fever
Pelvic pain
Dyspareunia
154
Lab values of pyosalpinx
Leukocytosis
155
Sonographic findings of pyosalpinx
Distended fallopian tubes
156
Post reabsorption of the inflammation the tube becomes weak and thin
Hydrosalpinx
157
Clinical findings of hydrosalpinx
bhCG titers will prove difference
Colicky pain
158
Sono findings of hydrosalpinx
Anechoic fluid filled
Sausage-shaped
Beads of string sign
159
Adnesions and fibrosis may involve the peritoneal surfaces and bowel
Chronic salpingitis
160
Clincial findings of chronic salpinitis
Painful defecation
Dyspareunia
Intermenstrual pain
Hysterosalpingoraphy
161
Purulent material spills from Fallopian tube to the ovary
Tubo-ovarian abscess
162
Tubo-ovarian abscess is one of many later complications of
PID
163
Tubo-ovarian abscess can be life-threatening if the abscess
Ruptures and results in sepsis
164
Consists of encapsulated or confined pocket of pus with defined boundaries that forms during an infection of a fallopian tube and ovary
Tubo-ovarian abscess
165
Clinical findings of tubo-ovarian cyst
Nausea/vomiting
Abdominal & pelvic pain
Fever/chills
RUQ pain
Right sided pleuritic pain
166
Fitz-hugh-curtis syndrome
RUQ pain, right sided pleuritic pain
167
Lab values associated with tubo-ovarian abscess
High ESR
168
Sono findings of tubo-ovarian abscess
Local areas of tubal distention with pus and debris
Multiple loculations
Septation
Difficult to identitfy ovary
169
Inflammation of peritoneum
Peritonitis
170
Peritoneum covers and supports most
Abdominal organs
171
Peritonitis usually caused by
Infection from bacteria or fungi
172
What can happen if peritonitis is left untreated
Spread into blood (Sepsis) and to other organs
173
Peritonitis results in multiple
Organ failure and death
174
First symptoms of peritonitis
Poor appetite
Nausea
Dull abdominal ache
175
Other signs and symptoms related to peritonitis
Abdominal tenderness/distension
Chills/fever
Fluid in abdomen
Not/less passing urine
Difficult to pass gas/bowel movement
Vomiting
