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Ob / Gyn 2 > Ovarian Pathology > Flashcards

Ovarian Pathology Flashcards

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1
Q

What are the 2 kinds of ovarian masses

A

Cystic masses and ovarian tumours

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2
Q

What are the 3 types of neoplastic ovaarian tumours

A

Epithelial
Germ cell
Sex cord or stromal

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3
Q

What are the 2 types of cystic ovarian masses

A

Simple

Bilateral/ multiple

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4
Q

What types of simple cystic ovarian masses are there

A 
Follicular 
Corpus luteum
Para ovarian 
Omental
Urachal
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5
Q

What are the types of bilateral and multiple cystic ovarian masses

A

Theca lutean
Polycystic ovaries
Ovarian torsion

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6
Q

follicular cyst

A

Normal cysts
Occur when LH and FSH stimulate the ovary to mature the oocyte
Can grow from 3-24mm in 10days
Evolve into corpus luteum after rupture

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7
Q

Corpus luteum cysts

A

Term after ovulation
Have an odd appearing shape, grow to 1-10cm, often with debris due to hemorrhage
If large it will resolve in 8weeks w/out pregnancy
With pregnancy it will resolve in 12-15 weeks

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8
Q

Persistent cysts

A

Follicular or corpus luteum
Can grow quite large before rupturing
Can cause pain

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9
Q

Paraovarian cysts

A

AKA cysts if morgani

Remnants of embryonic ducts or are also serosal cysts arising from Müllerian duct remnants
Have thin walls 
NEVER surrounded by ovarian tissue 
Do not change in size, 1-4cm 
Usually asymptomatic
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10
Q

Urachal cysts

A

Located @ midline in anterior abdominal wall, between umbilicus and bladder
Remnant from when the bladder developed

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11
Q

Omental cyst

A

Located along the omentum usually higher in the pelvis or abdomen

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12
Q

Theca lutean cysts

A

Multiple bilateral cysts on the ovaries
Can be several cm in size
Caused from excessive amounts of hCG

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13
Q

What are theca lutean cysts associated with and what can happen to the ovary

A

Multiple gestation
Molar pregnancy
Choriocarcinoma
Hyperstimulation syndrome

Ovary can undergo hemorrhage, rupture or torsion

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14
Q

What is hyperstimulation of the ovary

A

Theca lutean cyst with ascites

Typically caused by pergonal (a fertility drug taken in a IVF cycle)

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15
Q

PCOS and what can it be associated with

A

Polycystic ovarian syndrome or stein leventhal syndrome

Associated with endometrial ca

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16
Q

Who is affected by PCOS

A

Women between the age of 20 and 30 years of age

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17
Q

What is PCOS caused by

A

Unopposed estrogen with no surge in LH

And occurs when there is increased androgen segregation from the ovarian stroma

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18
Q

What happens in PCOS

A

Ovulation does not occur

There is many immature follicles that never rupture

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19
Q

What are the symptoms of PCOS and what can it be a precursor for

A

Obesity
Hirsutism
Infrequent menses
Infertility

Precursor for: diabetes

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20
Q

What is hirsustism and what is it caused by

A

Increased body hair

Caused by increased androgens

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21
Q

What is the most extreme form of PCOS called

A

Hyperthecosis or thecosis

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22
Q

How is PCOS diagnosed

A

Blood work; increased testosterone levels

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23
Q

Why are pelvic US often ordered for PCOS

A

To investigate for it but they are never the definitive diagnosis

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24
Q

What is the sonographic appearance of PCOS

A

Slightly enlarged ovaries with multiple small cysts around the periphery
~”string of pearls” appearance

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25
Ovarian torsion
A acute sharp pain Rare in normal ovaries Normally associated with ovarian masses
26
What are the 2 types of ovarian torsion
Incomplete | Complete
27
What is incomplete ovarian torsion
Large, edematous ovaries with multiple cyst (fluid retention due to: congestion)
28
What is complete ovarian torsion
Increased or decreased echotexture; due to infarct or hemorrhage
29
How is ovarian torsion assessed
With colour and spectral Doppler
30
Early Dx of ovarian torsion may help do what
Salvage the ovary
31
What are the 7 types of epithelial tumors
``` Serous cystadenoma Serous cystadenocarcinoma Mucinous cystadenoma Mucinous cystadenocarcinoma Endometrioid Clear Cell Carcinoma Brenner’s Tumor ```
32
Serous cystadenoma
Simple cystic tumor, common and benign Has thin walls, variable in size and can have multiple septations Occurs in the menstruating age group
33
Serous cystadenocarcinoma
May be cystic w/ irregular texture and walls Ascites will be present, look for para-aortic lymph nodes Large >10cm Most common malignant ovarian ca
34
Mucinous cystadenoma
Benign, unilateral cystic mass with low-level echoes (mucin) or complex appearance Very large; 15-30cm Can rupture due to size
35
Mucinous cystadenocarcinoma
Rare; when compared to benign counterpart Malignant Complex appearance with associated ascites; has greater chance to rupture Has a risk of pseudomyxoma peritonei
36
What is pseudomyxoma peritonei
Massive adhesions from the mucin in the ascites
37
Endometrioid carcinoma
Usually malignant Effects the menopausal age group; >60years Large; 10-15cm, Complex or solid appearance Associated w/ endometrial ca
38
Clear cell carcinoma
AKA mesonephroid Müllerian duct origin Complex mass Malignant Variant of endometrioid ca *name comes from how the cells appear under a mircoscope*
39
Brennan’s tumor
AKA transitional cell tumor ``` Rare Benign Solid Variable in size; up to 30cm Unilateral ```
40
What are the 4 germ cell tumors
Cystic teratoma Solid teratoma Dysgerminoma Endodermal sinus tumor
41
Cystic teratoma
AKA dermoid or mature teratoma Usually benign, 2% can become malignant Viable “tip of the iceberg” appearance; predominately complex w/ fat and fluid layers, calcifications (teeth/hair) Effects all ages Ovary can undergo torsion
42
What is ROkitansky nodule
A very hyperechoic discrete rounded protuberance within the mass
43
Solid teratoma
AKA immature teratoma Effects young children/ young women Benign-highly malignant Soli mass, can have complex internal echoes
44
Dysgerminoma
Rare Found ink young women Solid, areas of necrosis Malignant/highly radiosensitive Associated with choriocarcinoma; increased hCG levels
45
What is the male counterpart of dysgerminoma called
Seminoma
46
What is choriocarcinoma the malignant form of
Persistent trophoblastic disease
47
Endodermal sinus tumor
AKA yolk sac tumor Malignant Rapid growth Solid Poor prognosis, high reoccurrence rate Increases AFP
48
What are stromal tumors
Stromal: sex cord Are Connective cell tumors
49
What are the 3 stromal tumors
Granulosa cell tumor Sertoli-leadings cell Fibroma/fibrosarcoma
50
Granulosa cell tumor
AKA theca luteal cell tumor or thecoma Solid Usually benign Precocious puberty in children Irregular cycles in adults Produces estrogen Causes increased risk for endometrial ca
51
Why do granulosa cell tumors cause irregular cycles in adults
Because the increased levels in estrogen will stimulate the endometrium to thicken
52
Sertoli-leadings cell tumor
AKA androblastoma or arrenoblastoma Occurs in adolescence Produces androgens; masculinization Solid and unilateral Necrotic 10-12% become malignant Usually benign
53
What is the difference between a fibroma and a fibrosarcoma
Fibrosarcoma is the malignant form of a fibroma
54
Fibroma
Unilateral Effects postmenopausal women Solid; similar to fibroid
55
What is a fibroma associated w/
Meigs’ syndrome
56
What is meigs’ syndrome
Hydrothorax and ascites with an ovarian mass
57
What happens to meig’s syndrome when the mass is removed
The syndrome resolves
58
Secondary ovarian tumors
Caused by the mesastatic spreading from a primary carcinoma of a different organ to the ovary ~ usually from GI or breast Common Large complex masses
59
Krukenberg’s tumor
Bilateral metastatic ovarian tumors that produce mucin
60
Ovarian ca
4th leading cause of death due to ca in women Silent killer Increased in nulliparous women Typically occurs in women 60-70 yrs in age
61
Risk factors for ovarian ca
``` Nulliparous Low parity Delayed childbearing Early onset of menses Late menopause HRT >10yrs Family Hx of breast or ovarian ca ```
62
There is a direct relationship of the number of years of ovulation and
Epithelial ovarian ca
63
Over 90%of sporadic ovarian ca occurs in women
>50
64
Breast and ovarian ca are
Strongly associated w/ one another
65
Women who have had breast ca have a 2x higher risk of developing what kind of ovarian ca
Primary
66
Women with ovarian ca have a 3-4x high risk of developing what kind of ca
Breast
67
Mutation of what genes may increase the risk of a patient developing ovarian and breast ca
BRCA 1 | BRCA 2
68
If any pelvic abnormality is seen what type of further scanning should be considered for charaterizing ovarian masses
Endovaginal
69
What do you look for sonographically when assessing for ovarian pathology
``` Irregular wall Thick septations >5cm size Ascites Distal Mets ``` If the mass is fixed or invading other organs Doppler mass
70
Ca 125 is an antibody used to detect what kind of ca
Ovarian
71
What is bloodwork helpful for
Detecting recurrence
72
What is the most sensitive tumor to bloodwork
Nonmucinous
73
CHEETAH
``` Cystadenoma Hemorrhagic cyst Ectopic Endometrioma Teratoma Abscess Hydrosalpinx ``` *acronym for ovarian masses with similar appearances

Ob / Gyn 2 (8 decks)

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