Ovarian Pathology Flashcards
(177 cards)
1
Q
T/F? Ovaries are covered by a single layer of cells called the peritoneum.
A
FALSE, germinal epithelium
2
Q
This contains the ovarian follicles and corpus lutea.
A
cortex
3
Q
This is composed of ovarian fibrous tissue and blood vessels.
A
medulla
4
Q
T/F? An ovarian cyst is more than 3 cm long.
A
true
5
Q
T/F? An ovarian follicle is less than 2 cm long.
A
FALSE, 3 cm
6
Q
During the proliferative phase, many follicles increase in size until about day __ due to the stimulation by the __ hormones.
A
8 or 9, FSH and LH
7
Q
If the fluid in one of the non-dominant follicles is not reabsorbed…
A
a follicular cyst develops.
8
Q
The ovaries are bound __ by the umbilical artery.
A
anteriorly
9
Q
The ovaries are bound __ by the ureter and the iliac vessels.
A
posteriorly
10
Q
The fimbria of the fallopian tube lie __ to the ovary.
A
superior and lateral
11
Q
T/F? The ovarian ligaments are rigid and do not allow the ovary to be mobile.
A
FALSE, flexible and very mobile
12
Q
The right ovarian vein drains into the __.
A
IVC.
13
Q
The left ovarian vein drains into the __.
A
left renal vein.
14
Q
Three kinds of functional ovarian cysts…
A
- follicular
- corpus luteum
- theca-lutein
15
Q
This is the most common cause of ovarian enlargement in young women.
A
functional ovarian cyst
16
Q
Most functional cysts typically resolve within __ menstrual cycles.
A
1-2
17
Q
Follow up of larger functional cysts is usually __ weeks later to show changed appearance or resolution.
A
6
18
Q
This type of cyst can form when ovulation does not occur or when a mature follicle involutes.
A
follicular cyst
19
Q
Follicular cysts range from __ in size.
A
3 cm - 8 cm
20
Q
T/F? Follicular cysts are usually unilateral.
A
true
21
Q
This type of functional ovarian cyst occurs after an egg has been released from the dominant follicle.
A
corpus luteal
22
Q
These are less common than follicular cysts but tend to be larger and more symptomatic.
A
corpus luteal
23
Q
What is the major symptom of a corpus luteal cyst?
A
pain
24
Q
T/F? Corpus luteal cysts are usually unilateral.
A
true
25
The corpus luteum continues until what week of pregnancy?
16th
26
This hyperechoic structure results from the regression of a luteal structure from a previous cycle.
corpus albicans
27
Hemorrhage may occur in __ or __ cysts.
follicular, corpus luteum
28
The presence of __ helps confirm the diagnosis of a leaking or ruptured hemorrhagic cyst.
free fluid in the cul-de-sac
29
These are the largest of the functional ovarian cysts.
theca-lutein cysts
30
These ovarian cysts are associated with high levels of hCG.
theca-lutein cysts
31
These ovarian cysts typically occur in patients with GTD and infertility therapy.
theca-lutein cysts
32
Paraovarian cysts are also known as...
paratubal cysts.
33
These cysts are found in the broad ligament.
paraovarian cysts
34
These cysts are most common in the 3rd and 4th decades.
paraovarian cysts
35
These ovarian cysts occur predominantly in premenopausal women with a history of previous abdominal surgery or trauma.
peritoneal inclusion cysts
36
In patients with peritoneal adhesions fluid may accumulate and entrap the ovaries, resulting in...
a large adnexal mass.
37
__ are extra-ovarian and separate from the ovary whereas the ovary lies inside or in the wall of a __ cyst.
Paraovarian cysts and hydrosalpinx, peritoneal inclusion
38
The normal ovaries are usually identified __ to the anteflexed midline uterus.
laterally or posterolaterally
39
When the uterus lies to one side, the ipsilateral ovary lies ...
superior to the uterine fundus.
40
In a retroverted uterus, the ovaries tend to be located...
laterally and superiorly near the uterine fundus.
41
When the uterus is enlarged, the ovaries tend to be...
displaced more superiorly and laterally.
42
When the uterus is removed, the ovaries tend to be...
more medially and directly superior to the vaginal cuff.
43
A corpus luteal cyst results from the failure of absorption of the __ or from excess __ into the corpus luteum.
dominant follicle, bleeding
44
This is the presence of functioning endometrial tissue outside the endometrium and myometrium.
endometriosis
45
T/F? Endometriosis can occur everywhere except the bladder and bowel.
FALSE, can occur anywhere
46
The clinical signs of endometriosis?
1. chronic pain with menses
2. infertility
3. the 4 Ds
47
What are the 4 Ds?
1. dysmenorrhea
2. dyspareunia
3. dysuria
4. dyschezia
48
Localized endometriosis is also known as...
endometrioma or 'chocolate cyst'.
49
T/F? Localized endometriosis is the most common type.
FALSE, diffuse
50
Diffuse endometriosis causes dys__, dys__, and __.
dysmenorrhea, dyspareunia, infertility
51
T/F? Localized endometriosis is asymptomatic and frequently multiple.
true
52
This is caused from bleeding from abnormally implanted endometrial tissue.
localized endometriosis
53
How is endometrioma different from a hemorrhagic cyst?
Hemorrhagic cysts will resolve over time.
54
The main endometriosis treatment is...
surgery.
55
PCOS is also known as...
Stein-Leventhal syndrome
56
This is an endocrinologic disorder associated with chronic anovulation.
PCOS
57
PCOS is most commonly found in __ women.
adolescent girls and young women
58
T/F? Sonography is essential to PCOS diagnosis.
FALSE, diagnosis is serologic
59
Clinically, PCOS presents with...
1. hyperandrogenism
2. oligoamenorrhea
3. amenorrhea
4. hirsuitism
5. obesity,
6. infertility
60
Sonographically, PCOS appears with __lateral multiple cysts in a string of pearls sign.
bilateral
61
The risk factors for torsion are...
1. Pre-existing ovarian cyst or mass
| 2. Pregnancy
62
If the ovary is completely torsed, the Doppler will show...
All color flow will be absent.
63
If the ovary is partially torsed, the Doppler will show...
Absent venous flow and diminished arterial flow.
64
Whet happens to the size of the ovary during a torsion?
It becomes enlarged.
65
Name three clinical symptoms of ovarian torsion.
1. Severe pelvic pain
2. Nausea and vomiting
3. Palpable mass (usually on the right) mimicking appendicitis
66
This is the fourth leading cause of cancer death among women.
Ovarian cancer
67
Ovarian cancer has the highest mortality rate as a result of...
Late diagnosis.
68
Ovarian cancer comprises __% of all gynecologic malignancies.
25%
69
Women with __ are at increased risk of ovarian cancer.
A family history of ovarian ca
70
Women who have __ are at a reduced risk of ovarian cancer.
Used oral contraceptives
71
This lab test is used to follow women with ovarian cancer.
CA 125
72
T/F? CA 125 is a screening tool for ovarian cancer.
FALSE, is not
73
CA 125 detects __% of first stage ovarian cancer.
Less than 50%
74
What would make you highly suspicious that an ovarian mass was carcinoma?
If it was in a post menopausal women with elevated CA 125.
75
Ovarian mass dopplers tend to yield __ resistance and __ velocities.
Low, high
76
Ovarian rumors are named for the __ and whether or not the tumor is __.
Kind of cells it started from, benign or malignant
77
Tumors that start from cells that cover the outer surface of the ovary are called...
Epithelial-stromal tumors
78
Tumors that start from cells that produce the ova are called...
Germ cell tumors
79
Tumors that start from the sex cords of the embryonic gonad are called...
Sex cord-stromal tumors
80
T/F? Most epithelial-stromal tumors are malignant.
FALSE, benign
81
Name the five types of epithelial-stromal tumors.
1. serous cystadenoma
2. mucinous cystadenoma
3. endometrioid
4. clear cell
5. transitional cell (Brenner tumor)
82
These kinds of epithelial-stromal tumors are borderline malignant 10-15% of the time.
serous and mucinous cystadenoma
83
These tumors are common, accounting for 25-30% of all ovarian neoplasms.
serous tumors
84
Most serous tumors are benign, but serous cystadenocarcinomas account for __ of all malignant ovarian neoplasms.
40-50%
85
Benign serous tumors are bilateral __ of the time and occur in women __ yrs old.
12-20%, 40-50
86
Malignant serous tumors are bilateral __ of the time and occur in women who are__.
50%, peri-/postmenopausal
87
Sonographically, benign serous tumors are __ marginated, usually __locular, with __ septations.
sharply, uni-, thin-walled
88
Sonographically, malignant serous tumors have __ projections, __ septations, and __.
multiple papillary, thick, ascites
89
Benign mucinous cystadenoma are __ bilateral and more common in women __ yrs old.
rarely, 30-50
90
Malignant mucinous cystadenoma are bilateral __ of the time and more common in women __ yrs old.
15-20%, 40-70
91
Rupture of a malignant mucinous tumor capsule results in...
pseudomyxoma peritonei (malignant ascites)
92
What kind of echoes does malignant mucinous cystadenoma have?
fine, gravity-dependent echoes
93
How big is a benign mucinous cystadenoma?
up to 50 cm in diameter
94
How big is a malignant mucinous cystadenoma?
15-30 cm in diameter
95
80% of these ovarian tumors are malignant (but have a better prognosis than either serous or mucinous carcinomas).
endometrioid
96
These account for a quarter of all ovarian carcinomas.
endometrioid tumors
97
30% of patients with this tumor have associated...
endometrial adenocarcinoma.
98
Sonographically, endometrioid tumors are a cystic mass with...
papillary projections.
99
These ovarian tumors are nearly always malignant, but are only 5-10% of epithelial-stromal tumors.
clear cell
100
Clear cell tumors are bilateral __ of the time and occur in women __ yrs old.
20%, 50-70
101
How big is a clear cell tumor?
up to 30 cm
102
Sonographically, clear cell tumors appear...
as a complex cyst.
103
Transitional cell tumors are bilateral __ of the time and occur in women __ yrs old.
6-7%, 40-80
104
Transitional cell tumors are also known as...
Brenner tumors
105
T/F? Transitional cell tumors are almost always benign.
true
106
How big is a transitional cell tumor?
smaller then 2 cm in diameter
107
Sonographically, transitional cell tumors appear as...
a hypoechoic solid mass.
108
T/F? Most germ cell tumors are benign.
true
109
In children and adolescents, more than 60% of ovarian neoplasms are __ origin and __ of them are malignant.
germ cell, 1/3rd
110
The most common germ cell malignancies...
1. teratomas
2. dysgerminoma
3. endodermal sinus tumors
4. choriocarcinoma
111
Cystic teratoma is also known as...
dermoid tumor.
112
Cystic teratoma tumors are bilateral __ of the time and occur in women who are...
15%, in their active reproductive years
113
The most common complication of cystic teratoma is...
ovarian torsion.
114
This kind of dermoid presents predominantly cystic mass with an echogenic mural nodule which typically casts an acoustic shadow.
dermoid plug
115
This kind of dermoid presents as a highly echogenic mass that shadows and obscures the posterior wall of the lesion.
'tip of the iceberg' sign
116
This kind of dermoid presents as multiple echogenic linear interfaces floating within a cystic mass (hair fibers).
dermoid mesh
117
Half of sex cord-stromal tumors are __ while most of the others are __.
Fibromas, granulosa
118
Name four kinds of sex cord-stromal ovarian tumors.
1. Fibroma
2. Thecoma
3. Granulosa
4. Sertoli-Leydig
119
Fibroma tumors are bilateral __ of the time and occur in women who are...
Rarely, Middle Age
120
How big is a fibroma tumor?
Range from Microscopic to large
121
This refers to ascites and pleural effusion and associated with an ovarian fibroma.
Meig's syndrome
122
Meig's syndrome refers to __ and __ and is associated with __.
Ascites, pleural effusion, fibromas
123
T/F? Meig's syndrome persists after the fibroma is excised.
FALSE, resolves
124
Sonographically, fibromas appear...
Like a fibroid.
125
Thecoma tumors occur in women who are __ and vary in size from __.
Post menopausal with signs of estrogen/androgen activity, tiny to 5-10 cm
126
Granulosa cell tumors occur in women who are __ and produce __.
50-55 yrs old, estrogen
127
Juvenile granulosa cell tumors result in...
Precocious puberty
128
Sertoli-Leydig is also known as...
Androblastoma
129
Sertoli-Leydig tumors are bilateral __ of the time and occur in women who are...
Rarely, under 30.
130
How big is a Sertili-Leydig tumor?
5-15 cm
131
T/F? Sertili-Leydig tumors are very common.
FALSE, rare
132
Sertili-Leydig patients present with symptoms of...
Masculinization
133
The most common sites of ovarian mets are from the...
Breast and GI tract (stomach cancer)
134
Metastatic tumors are bilateral __ of the time.
Most
135
Dysgerminoma tumors are bilateral __ of the time and occur in women __ yrs old.
15%, under 30
136
This malignant germ cell tumor comprises 3-5% of ovarian malignancies.
dysgerminoma
137
This germ cell tumor is highly radiosensitive with a five year survival rate up to 90%.
dysgerminoma
138
Sonographically, dysgerminoma appears as...
a multi-lobulated, solid, echogenic mass.
139
Endodermal sinus tumor are also known as...
yolk sac tumor.
140
Yolk sac tumors are bilateral __ of the time and occur in women __ yrs old.
almost never, 20-30
141
How big is a yolk sac tumor?
3-30 cm in diameter
142
This is the second most common malignant ovarian germ cell neoplasm.
yolk sac tumor
143
What lab value helps diagnose endodermal sinus tumors?
increased serum AFP
144
Sonographically, an endodermal sinus tumor appears...
like a dysgerminoma.
145
Half of these tumors are fibromas while most of the others are granulosa cell tumors.
sex cord-stromal tumors
146
Name four kinds of sex cord-stromal tumors.
1. fibroma
2. thecoma
3. granulosa
4. Sertoli-Leydig
147
Fibroma tumors are bilateral __ of the time and occur in women __ yrs old.
rarely, middle age
148
How big is a fibroma?
from microscopic to large
149
This refers to ascites and pleural effusion and associated with fibroma.
Meig's syndrome
150
Meig's syndrome refers to __ and __ and associated with __.
ascites, pleural effusion, fibroma
151
T/F? Meig's syndrome persists after the removal of the tumor.
FALSE, resolves
152
Sonographically, fibromas appear...
like a fibroid (hypoechoic with posterior acoustic attenuation).
153
Thecoma tumors occur in women __ yrs old.
postmenopausal women who present with clinical signs of estrogen or androgen activity
154
How big is a thecoma?
tiny to 5-10 cm
155
Granulosa tumors occur in women __ yrs old.
50-55
156
How big is a granulosa?
small (and solid)
157
Granulosas produce...
estrogen.
158
Juvenile granulosa cell tumors result in...
precocious puberty.
159
Most granulosa cell tumors happen in...
adults.
160
Sertoli-Leydig tumors are also known as...
androblastoma.
161
Sertoli-Leydig tumors are bilateral __ of the time and occur in women __ yrs old.
rarely, under 30
162
T/F? Sertoli-Leydig tumors are very common.
FALSE, rare
163
Patients with Sertoli-Leydig may present with symptoms of...
masculinization.
164
How big is a Sertoli-Leydig tumor?
5-15 cm
165
The most common primary sites of ovarian mets are from the...
1. breast
| 2. GI tract (stomach cancer)
166
How does a metatstatic tumor spread?
1. direct invasion
2. peritoneal fluid
3. blood and lymphatics
167
This specific type of metastatic ovarian cancer most commonly arises from gastric carcinoma.
krukenberg tumor
168
Krukenberg tumors are bilateral __ of the time.
all
169
Sonographically, krukenberg tumors appear as...
solid ovarian masses with possible ascites.
170
These very rare tumors typically affect girls and young women, spreading rapidly, but sensitive to chemotherapy.
choriocarcinoma
171
T/F? Choriocarcinoma is more likely to start from the placenta than from the ovary.
true
172
Describe a stage one ovarian malignancy.
growth limited to one ovary, no ascites
173
Describe a stage two ovarian malignancy.
growth involving one or both ovaries with pelvic extension
174
Describe a stage three ovarian malignancy.
growth involving one or both ovaries with pelvic extension and/or retroperitoneal nodes, limited to the true pelvis
175
Describe a stage four ovarian malignancy.
growth involving one or both ovaries with distant mets, possible pleural effusion
176
Most ovarian cancer patients are diagnosed with...
advanced stage III or IV.
177
Ovarian cancer patients with stages I or II will...
develop a recurrence of the disease.
