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OB/GYN - ARDMS Registry > Ovaries > Flashcards

Ovaries Flashcards

1
Q

Describe the sonographic appearance of a normal ovary

A
  • Homogeneous parenchyma
  • Hypoechoic to mildly echogenic cortex
  • Paired, elliptical/ovoid/almond shaped
  • Multiple small follicles may be seen
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2
Q

Ovaries sonographic appearance changes based on ______ & _______ ________.

A

age
menstrual cycles (hormone levels).

-Depending on where the pt is in their menstrual cycle you may or may not see ovarian follicles

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3
Q

Ovaries artery originates from the______ aspect of the _____.

A

lateral
aorta

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4
Q

Right ovarian vein drains into the ____.
Left ovarian vein drains into the _____.

A
  • IVC
  • Left Renal Vein.
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5
Q

a syndrome resulting from hyperstimulation of the ovaries by fertility drugs; results in the development of multiple, enlarged follicular ovarian cysts.

A

Ovarian Hyperstimulation Syndrome

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6
Q

Frequency complication of ovulation induction (aka infertility treatments)

A

Ovarian Hyperstimulation Syndrome

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7
Q

linked to ovulation induction and theca-lutein cysts

A

Ovarian Hyperstimulation syndrome (OHS)

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8
Q

Ovarian Hyperstimulation Syndrome
- Mild form =
- Severe form =

A
  • mild = pelvic discomfort w/ moderately enlarged ovaries
  • severe = significant pelvic pain, abdominal distention, enlarged ovaries (>10cm)
    • Can also have ascites, pleural effusion, & numerous large thin-walled cysts throughout ovary.
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9
Q

SONO: Ovarian Hyperstimulation Syndrome

A
  • Enlarged ovaries (5cm -12cm)
  • Contain multiple large follicles known as theca-lutein cysts
  • May see ascites / pleural effusions
  • Similar SONO look to Theca- Lutein cysts. Key difference is that Ovarian hyperstimulation syndrome is caused by infertility treatment/ ovulation induction.
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10
Q

Explain the link between OHS & theca lutein cysts.

A

hCG is administered as part of ovulation induction, & theca-lutein cysts occur as a result of high hCG levels.
Therefore, a person w/ OHS will appear with bilateral theca-lutein cysts on their ovaries.

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11
Q

syndrome characterized by anovulatory cycles, infertility, hirsutism, amenorrhea, and obesity.

A

Polycystic Ovarian Syndrome (PCOS)
aka Stein Leventhal Syndrome

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12
Q

Endocrinologic ovarian disorder linked with infertility

A

Polycystic Ovarian Syndrome (PCOS)
aka Stein Leventhal Syndrome

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13
Q

What is the mc cause of hyperandrogenism?

A

Polycystic Ovarian Syndrome (PCOS)
aka Stein Leventhal Syndrome

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14
Q

Hyperandrogenism

A

excess of androgens

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15
Q

What is mc cause of androgen excess?

A

Polycystic Ovarian Syndrome (PCOS)
aka Stein Leventhal Syndrome

  • Hyperandrogenism= androgen excess
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16
Q

-
-

A
  • Oligomenorrhea or amenorrhea
  • Blood work indicative of hyperandrogenism
  • Sonographic findings consistent w/ PCOS
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17
Q

Pts can suffer from chronic anovulation due to hormonal imbalance

A

PCOS (aka Stein Leventhal Syndrome)

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18
Q

PCOS is most often seen in what age range?

A

late teens - 20s

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19
Q

may have an endocrine imbalance (Low LH or FSH)

A

PCOS (aka Stein Leventhal Syndrome)

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20
Q

S/S of PCOS … (5)

A
  • Amenorrhea or oligomenorrhea
  • Hirsutism
  • Infertility
  • Obesity
  • Possibly Acne
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21
Q

linked to anovulatory cycles in obese women

A

PCOS (aka Stein Leventhal Syndrome)

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22
Q

PCOS SONO…(3)

A
  • Multiple small cysts along the periphery of the ovary (“string of pearls” sign)
  • Or many small cysts throughout the ovary
  • Ovaries may be normal in size or enlarged
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23
Q

“string of pearls” sign

A

PCOS (aka Stein Leventhal Syndrome)

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24
Q

T/F: PCOS diagnosis is not made with ultrasound alone; mostly based on blood work (LABs).

A

true

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25
Q

Functional , ectopic endometrial tissue located outside the uterus.

A

Endometriosis

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26
Q

Ectopic endometrial tissue seen in the presence of endometriosis undergoes physiologic changes as a result of stimulation by the _______ of the menstrual cycle.

A

hormones

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27
Q

T/F: Ectopic endometrial tissue seen in the presence of endometriosis undergoes physiologic changes as a result of stimulation by the hormones of the menstrual cycle.
- ectopic tissue responds to hormones and bleeds during menses; causes inflammation and adhesions

A

true

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28
Q

Endometriosis - age group?

A

Most common b/t 30 - 40 y/o

(penny 25-35 y/o)

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29
Q

T/F: w/ endometriosis, ectopic endo tissue can implant anywhere in the pelvis

A

true

(however ovaries are the mc site)

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30
Q

What is the mc site for ectopic endo tissue (endometriosis) to implant in the pelvis?

A

ovaries

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31
Q

Endometriosis S/S.. (4)

A
  • Menometrorrhagia
  • Significant cyclic pain (dysmenorrhea)
  • Dyspareunia
  • Infertility
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32
Q

What are the 2 types of Endometriosis?

A

Diffuse
Localized (aka Endometrioma)

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33
Q

What is the mc type of endometriosis?

A

Diffuse

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34
Q

What type of endometriosis is more difficult to diagnose/see with US?

A

Diffuse

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35
Q

Tiny implants of endometrial tissue scattered throughout the pelvis

A

Diffuse endometriosis

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36
Q

Blood collects chronically into a localized site (Endometrioma)

A

Localized endometriosis

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37
Q

Localized endometriosis is aka __________

A

an Endometrioma

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38
Q

Endometriomas are aka _________ cysts

A

Chocolate cysts

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39
Q

  • Diffuse endometriosis may not be visible with ultrasound
A
  • Avascular nodular tissue along the periphery of the ovary or uterus
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40
Q

SONO: Localized Endometriosis (aka Endometrioma or chocolate cyst)…(4)

A
  • Well-defined, unilocular or multilocular cystic structure
  • Predominantly cystic with diffuse, homogeneous, low level echoes
    - Low level echoes may be present throughout the mass (top image)
    - Low level echoes may appear in the dependent portion, creating a fluid-to-fluid level or fluid-to-debris level. (bottom image)
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41
Q

Hemorrhage of the ectopic endometrial tissue often occurs, resulting in focal areas of bloody tumors known as_________.

A

endometriomas (aka chocolate cysts).

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42
Q

Endometriomas can be located anywhere in the pelvis but are mc in the _____.

A

ovaries.

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43
Q

an abnormality that results from the ovary twisting on its mesenteric connection, consequently cutting off the blood supply to the ovary

A

Ovarian torsion

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44
Q

Partial or complete rotation of the ovarian pedicle on its axis

A

Ovarian torsion

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45
Q

Ovarian torsion may also be refereed to as __________

A

Adnexal torsion

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46
Q

Ovarian torsion usually occurs secondary to a(n) __________.

A

ovarian mass/cyst

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47
Q

What is the mc cause of ovarian torsion?

A

ovarian mass/cyst

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48
Q

Ovarian torsion without the presence of a mass/cyst usually occurs in ______.

A

children

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49
Q

Results in the disruption of vascular outflow/inflow
-Ovaries become enlarged & edematous
- Loss of arterial perfusion to the ovary results in infarction

A

Ovarian torsion

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50
Q

Which ovary is most likely to torse?

A

Right ovary
- right is 3x more likely to torse than left

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51
Q

Ovarian Torsion (aka Adnexal Torsion) S/S…(5)

A
  • Acute unilateral pelvic pain
    or
  • Intermittent pain
  • Fever / Leukocytosis
  • N/V
  • Palpable mass (sometimes)
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52
Q

“Whirlpool” sign on color doppler

A

Ovarian torsion

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53
Q

In the presence of ovarian torsion, ______ flow is lost first, followed by ____ flow.

A

venous
arterial

  • w/ ovarian torsion you may see arterial flow in the ovary but no venous flow
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54
Q

Adnexal/ ovarian torsion is associated with a ______ _____ ____ or resulting from ______ ______of adnexal structures.

A

large ovarian mass
excessive mobility

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55
Q

SONO Ovarian Torsion…(6)

A
  • Loss of venous signal (arterial may or may not be present)
  • Enlarged, edematous ovary (>4cm; penny says >5cm)
  • Heterogeneous ovary
  • Peripherally located ovarian follicles
  • “Whirlpool” sign (color doppler)
  • FF
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56
Q

What does the “Whirlpool” sign indicate in the presence of ovarian torsion?

A

Whirlpool sign is an indicator of the torsed ovarian pedicle adjacent to the ovary, appearing as a round mass with concentric hypo-hyperechoic rings that demonstrates a swirling of color doppler signal.

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57
Q

What pathology is the image associated with?

A

Ovarian torsion

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58
Q

Benign or Malignant
1. Endometrioma
2. Follicular cysts
3. Mucinous Cysadenocarcinoma
4. Dysgerminoma
5. Corpus Luteum cysts

A
  1. B
  2. B
  3. M
  4. M
  5. B
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59
Q

Benign or Malignant
6.Serous Cystadenoma
7. Theca-Lutein cysts
8. Brenner (aka Transitional Cell tumor)
9. Serous Cystadenocarcinoma
10. Dermoid (aka Teratoma)

A
  1. B
  2. B
  3. B (rarely M)
  4. M
  5. B (if become M it would be termed an immature teratoma)
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60
Q

Benign or Malignant
11. Yolk Sac tumor (aka Endodermal sinus tumor)
12. Thecoma
13. Mucinous cystadenoma
14. Endometrioid
15. Immature Teratoma

A
  1. M
  2. B
  3. B
  4. M (sometimes B)
  5. M
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61
Q

Benign or Malignant
16. Mature Teratoma
17. Androblastoma (aka Sertoli-Leydig cell tumor)
18. Granulosa Cell tumor
19. Fibroma
20. Krukenberg tumor
21. Arrhenoblastoma

A
  1. B
  2. M
  3. B (rarely M)
  4. B
  5. M
  6. B (sometimes M)
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62
Q

Name the 8 malignant masses of the ovaries

A
  • Mucinous Cysadenocarcinoma
  • Serous Cystadenocarcinoma
  • Dysgerminoma
  • Yolk Sac tumor (aka Endodermal sinus tumor)
  • Endometrioid (sometimes benign)
  • Immature Teratoma
  • Androblastoma (aka Sertoli-Leydig cell tumor)
  • Krukenberg tumor

usually benign but sometimes malignant
- Brenner (aka Transitional Cell tumor)
- Granulosa Cell tumor
- Arrhenoblastoma

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63
Q

Name the 6 Epithelial tumors of the ovary

A
  • Serous Cystadenoma
  • Serous Cystadenocarcinoma
  • Mucinous Cystadenoma
  • Mucinous Cystadenocarcinoma
  • Endometrioid
  • Brenner (aka Transitional Cell Tumor)
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64
Q

Name the 4 Germ cell tumors of the ovary

A
  • Dermoid (Teratoma)
  • Immature & Mature Teratomas
  • Dysgerminoma
  • Yolk Sac tumor (Endodermal sinus tumor)
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65
Q

Name the 5 stromal (sex-cord) tumors of the ovary

A
  • Thecoma
  • Fibroma
  • Granulosa Cell tumor
  • Sertoli-Leydig Cell tumor (aka Androblastoma)
  • Arrhenoblastoma
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66
Q

Stromal ovarian tumors are aka _______ tumors

A

sex-cord tumors

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67
Q

Name the 3 functional cysts of the ovaries

A

Follicular cysts
Corpus Luteum cysts
Theca-Lutein cysts

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68
Q

Which of the following is typically seen in younger pts?
a. Epithelial tumors
b. Germ cell tumors
c. Stromal tumors

A

b. Germ cell tumors

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69
Q

Which of the following is most likely to be seen in peds pts?
a. Epithelial tumors
b. Germ cell tumors
c. Stromal tumors

A

b. Germ cell tumors

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70
Q

Which of the following is the most common type of ovarian tumor?
a. Epithelial tumors
b. Germ cell tumors
c. Stromal tumors

A

a. Epithelial tumors

  • most ovarian tumors are epithelial
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71
Q

Ovarian carcinoma is the ____ mc GYN malignancy
- ____ mc cancer in women

A

3rd
5th

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72
Q

Ovarian carcinoma associated findings …(4)

A

Ascites
Pleural effusions
Obstructions
Hepatic mets

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73
Q

Most ovarian cancers occur in women ages ___ to ___ y/o

A

40-60 y/o

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74
Q

T/F: ovarian cancer is usually not detected until later stages. (silent killer)

A

true

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75
Q

Ovarian carcinoma risk factors… (7)

A

Previous hx of breast or colon cancer
Family hx of ovarian cancer
Increasing age (>50y/o)
Nulliparity
Infertility
Uninterrupted ovulation
Late menopause

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76
Q

Ovarian Carcinoma Staging
Stage 1: limited to _____
Stage 2: limited to _____
Stage 3: Limited to _______
Stage 4: …

A
  1. ovaries
  2. pelvis
    -Spread to another pelvic structure
  3. abdomen
  4. Distant Metastasis outside of abdominal cavity
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77
Q

_________ cysts result from the normal function of the ovary & respond to hormonal changes

A

functional (aka physiologic cysts)

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78
Q

Mc cause of ovarian enlargement in young women

A

functional cysts (aka physiologic cysts)

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79
Q

May have elevated CA-125

A

ovarian carcinomas

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80
Q

Should the Graafian follicle fail to ovulate, it could continue to enlarge and result in a _______ cyst

A

follicular cyst

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81
Q

ovarian cyst that forms as a result of the failure of the Graafian follicle to ovulate

A

follicular cyst

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82
Q

Follicular cysts measure __ cm or larger

A

3 cm

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83
Q

the surgical removal of an ovarian cyst.

A

Ovarian cystectomy

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84
Q

Follicular cysts that contain blood are referred to as _______ cysts.

A

hemorrhagic

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85
Q

SONO: simple cyst in ovary

A

follicular cyst

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86
Q
A

follicular cyst

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87
Q

Physiologic (functional) cyst that develops after ovulation has occurred.

A

corpus luteum cyst

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88
Q

the corpus luteum that is maintained during early pregnancy for the purpose of producing estrogen and primarily progesterone.

A

corpus luteum of pregnancy

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89
Q

T/F: corpus luteum cysts typically regress spontaneously

A

true

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90
Q

May mimic ectopic pregnancy

A

corpus lutuem cyst
- due to peripheral vascularity aka “ring of fire”

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91
Q
A

corpus luteum cyst

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92
Q

SONO: Corpus Luteum Cyst
- simple
- Hemorrhagic
- Rupture
- Color Doppler

A
  • Simple = simple cyst in ovary (w/ peripheral vascularity)
  • Hemorrhagic = complex cyst (may have septations/internal debris)
  • Rupture = complex cyst (may have septations/internal debris) & FF in pelvis
  • Color doppler = rim hypervascularity (“ring of fire” )
93
Q

peripheral vascularity aka rim hypervascularity or “ring of fire”

A

corpus luteum cyst

94
Q

Large, Bilateral, multiloculated cysts
correlated w/ high levels of estrogen & excessive amounts of hCG.

A

Theca-Lutein cysts

95
Q

Theca-Lutein cysts are associated with high levels of ____ & _____.

A

estrogen
hCG

96
Q

What pathology is associated with the following?
- Bilateral
- Large, multiloculated cysts
- high estrogen levels
- excessive amounts of hCG
- Associated with Gestational trophoblastic disease (molar pregnancy), Ovarian Hyperstimulation Syndrome, & multiple gestations.

A

Theca-Lutein cysts

97
Q

Theca-Lutein cysts are associated with… (3)

A
  • Molar pregnancy (Gestational trophoblastic disease)
  • Ovarian Hyperstimulation Syndrome (Infertility drug therapy)
  • Multiple gestations (high levels of hCG)
98
Q

associated with Molar pregnancy (Gestational trophoblastic disease)

A

Theca-Lutein Cysts

99
Q

Theca-Lutein SONO …(4)

A

Bilateral
Large cysts within large ovaries
Multilocular (thin walls/septations)
Anechoic w/ posterior enhancement

100
Q

seen bilaterally. What is the most likely diagnosis?

A

Theca-Lutein cysts

101
Q

Acute hemorrhage usually appears sonographically as ________ and can mimic a ____ ____.
Hemorrhagic cysts appear _______
during resolution.

New blood = ______
Old blood = ______

A

hyperechoic, solid mass
complex

New blood = hyper-echogenic
Old = Hypo - anechoic

102
Q

can mimic a solid mass

A

hemorrhagic cyst

  • bc new blood appears hyperechoic to echogenic
103
Q

Cyst adjacent to, but separate from ovary

A

paraovarian cyst

104
Q

Where are paraovarian cysts located?

A

in the broad ligament

105
Q

Large paraovarian cysts may cause ________.

A

ovarian torsion

106
Q

SONO: simple cyst adjacent to ovary

A

paraovarian cyst
-If hemorrhaged the cyst will appear complex

107
Q
A

paraovarian cyst
- If hemorrhaged the cyst will appear complex

108
Q

Blood containing tumor that forms from the implantation of ectopic endometrial tissue

A

Endometrioma

109
Q

Chocolate cyst

A

Endometrioma

110
Q
A

Endometrioma
aka Localized endometriosis or chocolate cyst

111
Q

SONO: Endometrioma

A
  • Well-defined cystic structure
  • Low-level echoes may be present throughout the mass (top image)
  • Low-level echoes may appear in the dependent portion, creating a fluid to fluid level or fluid to debris level. (bottom image)
112
Q

What type of ovarian tumor?
- older women
- typically large
- always level of cystic component
- arise from surface of ovary

A

Epithelial tumors

113
Q

Epithelial tumors are mc in _____ women

A

older
(however can occur in women 20+ y/o)

114
Q

Epithelial tumors are typically _____ in size and always have a level of ______ component

A

large
cystic

115
Q

mc type of ovarian neoplasm & mc type of ovarian carcinoma

A

epithelial tumors

116
Q

What is the mc epithelial tumor?

A

Serous cystadenoma

117
Q

________ & _________ comprise most neoplasms of the ovary.

A

Serous cystadenoma & Dermoid (Teratoma)

118
Q

Large, septated cyst w/ thin septations & irregular borders.
- May contain solid components and/or mural nodules.
- Benign
- usually bilateral
- Age group = 40s & 50s

A

Serous Cystadenoma

119
Q

Large, septated cyst w/ thin septations & irregular borders.
- May contain solid components and/or mural nodules.
- internal echoes
- Benign
- unilateral
- Age group = 13-45y/o

A

Mucinous Cystadenoma

120
Q

Compare / Contrast Serous cystadenoma & Mucinous Cystadenoma.

A

Similarities
- benign, epithelial tumors
- large, complex cystic structure (however, mucinous is typically larger)

Differences
- Serous = more common type
- Serous = more often bilateral
- Mucinous = usually larger
- Mucinous = often contains internal echoes

121
Q

Which is more frequently see bilaterally in the ovaries?
a. Serous cystadenoma /cystadenocarcinoma
b. Mucinous cystadenoma/cystadenocarcinoma

A

a. Serous cystadenoma /cystadenocarcinoma

122
Q

Both are very large tumors, however, which is typically larger?
a. Serous cystadenoma /cystadenocarcinoma
b. Mucinous cystadenoma/cystadenocarcinoma

A

b. Mucinous cystadenoma/cystadenocarcinoma

123
Q

Which is more common?
a. Serous cystadenoma
b. Mucinous cystadenoma
c. Serous cystadenocarcinoma
d. Mucinous cystadenocarcinoma

A

a. Serous cystadenoma

124
Q

Which is most likely to present sonographically with internal echoes?
a. Serous cystadenoma /cystadenocarcinoma
b. Mucinous cystadenoma/cystadenocarcinoma

A

b. Mucinous cystadenoma/cystadenocarcinoma

125
Q

Which is most likely to present with papillary projections & thick septations?
a. Cystadenoma (Serous & Mucinous)
b. Cystadenocarcinoma (Serous & mucinous)

A

b. Cystadenocarcinoma (Serous & mucinous)

126
Q

Compare / Contrast Serous Cystadenocarconoma & Mucinous Cystadenocarcinoma

A

Similarities
- Malignant, Epithelial tumors
- Large complex cystic structure
- may have papillary projections
- THICK walls/septations
- may have elevated CA-125

Differences
- Mucinous = Associated with Pseudomyxoma Peritonei.
- Serous = more common & more often bilateral

  • SONO: Mucinous = Pseudomyxoma Peritonei (complex ascites) & internal echoes (mucoid material)
  • SONO: Serous = ascites (simple?)
127
Q

Large, septated cyst w/ thick septations & irregular borders.
- may contain solid components/ mural nodules
- may have papillary projections
- Malignant
- ascites
- often bilateral

A

Serous Cystadenocarcinoma

128
Q

Large, septated cyst w/ thick septations & irregular borders.
- may contain solid components/ mural nodules
- may have papillary projections
- Malignant
- Associated with Pseudomyxoma Peritonei (complex ascites)
- internal echoes

A

Mucinous Cystadenocarcinoma

129
Q

Compare/Contrast Cystadenoma & Cystadenocarcinoma

A

Similarities
- Large, complex cystic structures
- Epithelial tumors

Difference
- Cystadenoma = benign
- Cystadenocarcinoma = Malignant

  • Cystadenoma = THIN walls/septations
  • Cystadenocarcinoma = THICK
    walls/septations, papillary projections, & ascites.
  • Cystadenocarcinoma = more likely to rupture
130
Q

Which of the following is most likely the diagnosis in this benign ovarian tumor?
a. Serous cystadenoma
b. Mucinous cystadenoma
c. Serous Cystadenocarcinoma
d. Mucinous Cystadenocarcinoma

A

b. Mucinous cystadenoma

  • bc of internal echoes & its benign
131
Q

Which of the following is most likely the diagnosis in this benign ovarian tumor?
a. Serous cystadenoma
b. Mucinous cystadenoma
c. Serous Cystadenocarcinoma
d. Mucinous Cystadenocarcinoma

A

a. Serous cystadenoma

  • bc it lacks internal echoes and is benign
132
Q

The following tumor presents with complex ascites. What is the most likely the diagnosis in this malignant ovarian tumor?
a. Serous cystadenoma
b. Mucinous cystadenoma
c. Serous Cystadenocarcinoma
d. Mucinous Cystadenocarcinoma

A

d. Mucinous Cystadenocarcinoma

  • bc of internal echoes, papillary projections, complex ascites & malignant
133
Q

The following tumor presents with ascites. What is the most likely the diagnosis in this malignant ovarian tumor?
a. Serous cystadenoma
b. Mucinous cystadenoma
c. Serous Cystadenocarcinoma
d. Mucinous Cystadenocarcinoma

A

a. Serous cystadenoma

  • bc lack of internal echoes
  • has papillary projections
  • ascites (simple?)
  • is malignant
134
Q

associated with Pseudomyxoma Peritonei (complex ascites)

A

Mucinous Cystadenocarcinoma

135
Q

intraperitoneal extension of mucin-secreting cells that results from the rupture of a malignant mucinous ovarian tumor or possible a malignant tumor of the appendix.

A

Pseudomyxoma Peritonei

136
Q

Pseudomyxoma Peritonei is caused by the rupture of mucinous cells from either a malignant ______ ____ or possibly a malignant tumor of the _____.

A

ovarian tumor
appendix

137
Q

Intraperitoneal extension of mucin-secreting cells that results from the rupture of a mucinous tumor may be associated with ovarian carcinoma or cancer of the:
a. appendix
b. rectum
c. stomach
d. fallopian tube

A

a. appendix

(Penny ch 18 review question #15)

138
Q

Brenner tumor is aka …

A

Transitional cell tumor

139
Q

Brenner tumor- age group?

A

40 - 70 y/o

140
Q

Brenner tumor is associated with _____ syndrome

A

Meigs

141
Q

describes a condition having a benign ovarian tumor with ascites and pleural effusion.

A

Meigs syndrome

142
Q

Describe the 3 characteristics of Meigs Syndrome

A
  • ovarian tumor
  • ascites
  • pleural effusions
143
Q

Endometrioid - age group?

A

postmenopausal (50s & 60s)

144
Q

associated with hx of endometrial carcinoma or hyperplasia & endometriosis.

A

Endometrioid

145
Q

Mc cancer to originate within an endometrioma

A

Endometrioid

146
Q

Endometrioid
1. benign or malignant?
2. associated w/…(3)
3. age group?
4. SONO:

A
  1. M
  2. endo carcinoma or hyperplasia, endometriosis
  3. postmenopausal (50s & 60s)
  4. (SONO simialr to cystadenocarcinoma)
    - complex mass (solid & cystic components)
    - may have papillary projections
147
Q

What type of tumor is associated with high AFP & hCG and is often seen in younger pts (<30 y/o) ?

A

Germ cell tumor

148
Q

Germ Cell tumors - age group

A

younger pts (< 30 y/o)

149
Q

Germ cell tumors are associated with high levels of ____ & _____.

A

AFP & hCG

150
Q

High AFP & hCG

A

Germ cell tumors

151
Q

Mc benign ovarian tumor
- Mc ovarian neoplasm

A

Dermoid (aka Teratoma)

152
Q

May contain bone, hair, teeth, sebum, fat, and/or cartilage.

A

Dermoid (aka Teratoma)

153
Q

Dermoid is aka … (3)

A

Teratoma
Dermoid cyst
Cystic Teratoma

154
Q

Dermoid - age group?

A

reproductive/ childbearing years

(however can still be seen in postmenopausal women)

155
Q

Rupture of a dermoid can lead to ______.

A

peritonitis.

156
Q

T/F: Dermoids are capable of malignant degeneration (squamous cell carcinoma), however, this is rare.

A

true

157
Q

Dermoid (aka Teratoma) SONO:

A
  • Complex mass (solid & cystic components)
  • Dermoid plug (produces posterior shadowing)
  • “Tip of the iceberg” sign
  • Dermoid mesh (hair)
  • Fluid to Fluid level in which case there is a clear distinction between serous fluid and sebum.
  • Fat -fluid levels
158
Q

associated with “tip of the iceberg” sign

A

Dermoid (aka Teratoma)

159
Q

Immature teratomas are ______ while mature teratomas are ______.

A

malignant
benign (so a dermoid is usually a mature teratoma?)

160
Q

Immature teratoma - age group?

A

10-20 y/o

161
Q

Imature teratomas
1. benign or malignant?
2. Age group?
3. predominantly _____
4. elevated _____ in 50% of cases
5. ______ _____

A
  1. M
  2. 10-20 y/o
  3. solid
  4. AFP
  5. Rapid growth
162
Q

Mc ovarian malignancy found in childhood

A

Dysgerminoma

163
Q

Children with dysgerminoma present with… (3)

A
  • Precocious puberty
  • Elevated Serum Lactate Dehydrogenase (tumor marker for dysgerminoma)
  • Possible Elevated hCG levels
164
Q

Tumor marker for dysgerminoma

A

Serum Lactate Dehydrogenase

165
Q

Dysgerminoma- age group?

A

younger women (<30y/o )

166
Q

Dysgerminoma
1. Benign or Malignant?
2. Elevated _________ & possible elevated _____.
3. Age group?
4. associated w/ __________ in children
5. SONO (3)

A
  1. malignant
  2. Serum Lactate Dehydrogenase & possibly hCG
  3. <30 y/o
  4. Precocious puberty
    • Ovoid, solid mass in ovary
    • Hyperechoic w/ areas of hemorrhage & necrosis
    • Calcifications may be present
167
Q

Yolk Sac tumor (Endodermal sinus tumor)
1. Benign or Malignant?
2. Elevated _________
3. Age group?
4. ______ ______
5. SONO (3)
- sonographically similar to _______

A
  1. M
  2. AFP
  3. <20 y/o
  4. Rapid growth
  5. SONO: similar to Dysgerminoma
    - Ovoid, solid mass in ovary
    - Hyperechoic w/ areas of hemorrhage & necrosis
    - Calcifications may be present
168
Q

Yolk sac tumors (aka Endodermal Sinus tumor) is associated with elevated _____ & _______ growth.

A

AFP
rapid

169
Q

Stromal (sex-cord tumors)
- typically _____ adnexal masses
- some are ______ producing.
- SONO: ________ (almost cystic) without through transmission
- occur at any age

A
  • solid
  • hypoechoic
  • estrogen
170
Q

Stromal tumor with an abundance of thecal cells

A

Thecoma

171
Q

Thecomas are associated with ____ syndrome

A

Meigs syndrome

172
Q

Thecoma
- B or M?
- ______ tumor.
- Age group?
- Frequently ______ producing. Therefore pts present with ____________.
- SONO: … (2)

A
  • Benign
  • Stromal
  • Postmenopausal
  • estrogen, Postmenopausal bleeding
  • SONO:
  • hypoechoic solid mass …
  • w/ posterior attenuation
  • (my appear similar to a pedunculated leiomyoma)
173
Q

Feminizing neoplasm

A

Granulosa Cell tumor

174
Q

Most common estrogenic tumor
- aka mc estrogen producing tumor?

A

Granulosa Cell tumor

175
Q

Granulosa Cell tumor is associated with ______ ______ in children & ____________ in postmenopausal women.

A

precocious puberty
Postmenopausal bleeding

(bc it is an estrogen producing tumor?)

176
Q

Granulosa Cell tumor
1. B or M?
2. mc _______ tumor
3. _________ neoplasm
4. associated with _______ in peds
5. associated with _______ in postmenopausal women.
6. SONO: (3)

A
  1. B (M is rare)
  2. estrogenic
  3. Feminizing
  4. precocious puberty
  5. postmenopausal bleeding
  6. SONO:
    - solid
    - hypoechoic
    - large
177
Q

Benign, stromal tumor with an abundance of fibrous tissue

A

Fibroma

178
Q

T/F: fibromas are estrogen producing

A

FALSE
- Fibroms are NOT estrogen producing like some other stromal tumors

179
Q

Fibromas are associated with _____ syndrome

A

Meigs

180
Q

Fibroma
1. B or M?
2. _____ tumor
3. Age group?
4. associated w/ ____ syndrome
5. SONO:
6. NOT estrogen producing

A
  1. B
  2. stromal (sex-cord)
  3. middle aged women
  4. Meigs
  5. SONO
    - hypoechoic
    - solid
    - posterior attenuation
    - may contain calcifications
    - (may mimic pedunculated leiomyomas)
181
Q

Sertoli-Leydig Cell tumor is aka …

A

Androblastoma

182
Q

Sertoli-Leydig Cell tumor (aka Androblastoma)
1. B or M?
2. ______ tumor.
3. Age group?
4. _____ producing
5. S/S = ________
6. SONO:

A
  1. B (sometimes M 20% cases)
  2. Stromal (sex-cord)
  3. <30 y/o
  4. estrogen (Lower estrogen in comparison to granulosa cell tumor & thecomas)
  5. S/S = Virilization (Thus may present with abnormal menstruation & hirsutism bc of androgen production)
  6. SONO
    - solid
    - hypoechoic
    - may be partially cystic
183
Q

Virilization

A

Sertoli-Leydig Cell tumor (aka Androblastoma)

184
Q

changes within a female that are typically associated with males; caused by increased androgens and may lead to deepening of the voice and hirsutism.

A

Virilization

185
Q

Masculinizing tumor

A

Arrhenoblastoma

186
Q

Arrhenoblastoma
1. B or M?
2. Age group ?
3. S/S? (2)
4. SONO…

A
  1. B (sometimes M 22% of cases)
  2. 15-65 y/o (peak age = 25)
  3. Amenorrhea & Infertility
  4. solid mass with cystic components
187
Q

Metastasis to the ovaries usually comes from… (3)

A

Common primaries include..
- GI
- Other pelvic organs
- Breasts

188
Q

Malignant ovarian tumor that likely metastasized from the GI tract

A

Krukenberg

189
Q

Presence of “signet-ring” cells

A

Krukenberg

190
Q

Hx of gastric, colon, etc cancer

A

Krukenberg

191
Q

Krukenberg SONO (6)

A
  • Smooth walled
  • Solid (may have cystic degeneration)
  • hypoechoic or hyperechoic tumors
  • often bilateral
  • may present with ascites.
  • “Moth-eaten” appearance in that it can be a solid mass containing scattered cystic spaces
192
Q

SONO: “Moth-eaten” appearance

A

Krukenberg

193
Q

add VCU test questions & Ch 18 review questions to brainscape

A
194
Q

What formula is used to calculate volume of a mass?

A

L x W x H x 0.5233

195
Q

a condition that is thought to result from the compression of the LRV at the origin of the superior mesenteric artery, a condition known as nutcracker syndrome.

A

Pelvic Congestion Syndrome (PCS)

196
Q

Pelvic Congestion Syndrome results from _________ syndrome

A

Nutcracker

197
Q

S/S: persistent lower abdominal/back pain after standing for long periods of time, dysparunia, dysmenorrhea, AUB, chronic fatigue, bowel issues.

A

Pelvic Congestion Syndrome (PCS)

198
Q

_________ is the chosen imaging modality to confirm PCS.

A

Venography

199
Q

  • (Spectral doppler)
A
  • multiple tortuous and dilated venous structures adjacent to the uterus & ovaries that measure greater than 4-5 mm in diameter. (The ovarian vein itself typically exceeds 6 mm.)
  • These dilated veins yield a slow flow velocity with spectral doppler.
200
Q

W/ PCS veins adjacent to the uterus and ovaries measure greater than __to __ mm in diameter. The ovarian vein itself usually exceeds __ mm in diameter.

A

4 to 5 mm
6 mm

201
Q

Which of the following would be least likely associated with PCS?
a. right renal vein entrapment
b. dysfunctional venous valves
c. AUB
d. fatigue

A

a. right renal vein entrapment

  • bc with nutcracker syndrome (syndrome that causes PCS) the LRV is compressed (not the RRV).

(Penny ch 18 review question #1)

202
Q

results from ovarian tissue being left behind following a salpingo-oophorectomy, thus leading to stimulation of that ovarian tissue by circulating hormones.
- a complication of bilateral-salpingo-oophorectomy

A

Ovarian Remnant Syndrome

203
Q

Ovarian Remnant Syndrome is a complication of what pelvic procedure?

A

a complication of bilateral-salpingo-oophorectomy

204
Q

Which of the following would be least likely associated with an increase for developing ovarian cancer?
a. Nulliparity
b. Late menarche
c. Delayed childbearing
d. Age over 50 y/o

A

b. Late menarche
(Penny ch 18 review question #3)

205
Q

What mass would least likely appear as a solid adnexal mass?
a. Thecoma
b. Fibroma
c. Dermoid
d. Brenner tumor

A

c. Dermoid
(Penny ch 18 review question #6)

206
Q

Which of the following would be associated with an elevated CA-125?
a. Fibroma
b. Thecoma
c. Dysgerminoma
d. PCS

A

c. Dysgerminoma
(Penny ch 18 review question #17)

207
Q

Which of the following is not true concerning ovarian carcinoma?
a. Pts tend to have ovarian cancer familial incidence
b. Pts tend to have a hx of familial breast cancer
c. Pts tend to present early in the disease
d. Sonography does not serve as a best screening mechanism for ovarian cancer.

A

c. Pts tend to present early in the disease

(Penny ch 18 review question #18)

208
Q

What germ cell tumor contains elements of the ectoderm, mesoderm, and endoderm?
a. Brenner tumor
b. Cystic Teratoma
c. Fibroma
d. Theca cell tumor

A

b. Cystic Teratoma
(Penny ch 18 review question #19)

209
Q

An endometrioma most likely appears as a:
a. simple, anechoic mass with through transmission
b. complex mass with internal shadowing
c. mostly cystic mass with low-level echoes
d. solid, hypoechoic shadowing mass.

A

c. mostly cystic mass with low-level echoes
(Penny ch 18 review question #21)

210
Q

With what ovarian tumor is Meigs Syndrome most likely associated?
a. Dysgerminoma
b. Cystic Teratoma
c. Fibroma
d. Yolk Sac tumor

A

c. Fibroma
(Penny ch 18 review question #22)

211
Q

Sonographically, which of the following would most likely be confused for a pedunculated fibroid bc of its solid-appearing structure?
a. Serous cystadenoma
b. Mucinous cystadenoma
c. Fibroma
d. Theca lutein cyst

A

c. Fibroma
(Penny ch 18 review question #23)

212
Q

During a pelvic sonogram, you see a small cyst located adjacent to the ovary. What is the most likely diagnosis?
a. Dermoid cyst
b. Ovarian cystadenoma
c. Endometrioma
d. Paraovarian cyst

A

d. Paraovarian cyst
(Penny ch 18 review question #24)

213
Q

The most common benign ovarian tumor is the:
a. cystic teratoma
b. mucinous cystadenoma
c. fibroma
d. Sertoli-Leydig cell tumor

A

a. cystic teratoma
(Penny ch 18 review question #25)

214
Q

The ovarian cysts that are most often bilateral and are associated with markedly elevated levels of hCG are the:
a. Corpus luteum cysts
b. Paraovarian cysts
c. Granulosa cell cysts
d. Theca lutein cysts

A

d. Theca lutein cysts
(Penny ch 18 review question #27)

215
Q

The cystic mass commonly noted with a pregnancy is the:
a. Corpus luteum cysts
b. Dermoid cysts
c. Dysgerminoma
d. Serous cystadenoma

A

a. Corpus luteum cysts
(Penny ch 18 review question #28)

216
Q

The sonographic appearance of an ovarian dermoid tumor in which the anterior elements of the mass can be seen, while the greater part of the mass is obscured by shadowing is consistent with:
a. Whirlpool sign
b. Tip of the iceberg sign
c. Dermoid mesh sign
d. Dermoid plug sign

A

b. Tip of the iceberg sign
(Penny ch 18 review question #29)

217
Q

After the Graafian follicle rupture, the remaining structure is termed:
a. graafian remnant
b. corpus albicans
c. corpus luteum
d. medulla

A

c. corpus luteum
(Penny ch 18 review question #31)

218
Q

Which of the following sonographic findings would NOT increase the liklihood of an ovarian malignancy?
a. septation measuring greater than 3 mm in thickness
b. irregular borders
c. solid wall nodule
d. anechoic components with acoustic enhancement

A

d. anechoic components with acoustic enhancement
(Penny ch 18 review question #33)

219
Q

Normal ovarian flow is said to be:
a. low resistant during menstruation and high resistant during proliferative phase
b. high resistant during menstruation and low resistant at time of ovulation.
c. low resistant
d. high resistant

A

b. high resistant during menstruation and low resistant at time of ovulation.

(Penny ch 18 review question #34)

220
Q

What would be a predisposing condition that would increase the risk for suffering from ovarian torsion?
a. Hirsutism
b. Excessive exercise
c. Ovarian mass
d. Sonohysterography

A

c. Ovarian mass
(Penny ch 18 review question #35)

221
Q

The malignant ovarian tumor with gastrointestinal origin is the:
a. Brenner tumor
b. Krukenberg tumor
c. Yolk sac tumor
d. Granulosa cell tumor

A

b. Krukenberg tumor
(Penny ch 18 review question #36)

222
Q

The malignant ovarian mass that is associated with pseudomyxoma peritonei is the:
a. Dysgerminoma
b. Sertoli-Leydig cell tumor
c. Serous cystadenocarcinoma
d. mucinous cystadenocarcinoma

A

d. mucinous cystadenocarcinoma
(Penny ch 18 review question #37)

223
Q

All of the following adnexal masses may appear sonographically similar to a uterine leiomyoma except:
a. Thecoma
b. Paraovarian cyst
c. Fibroma
d. Granulosa cell tumor

A

b. Paraovarian cyst
(Penny ch 18 review question #38)

224
Q

What ovarian mass is associated with virilization?
a. Krukenberg tumor
b. Cystic teratoma
c. Serous cystadenoma
d. Sertoli-Leydig cell tumor

A

d. Sertoli-Leydig cell tumor
(Penny ch 18 review question #42)

225
Q

Which of the following is an estrogen producing ovarian tumor?
a. Cystic teratoma
b. Fibroma
c. Thecoma
d. Endoemetrioma

A

c. Thecoma
(Penny ch 18 review question #44)

226
Q

A 55 y/o pt present to the ER with a history of pelvic pressure, abdominal swelling, & AUB. A pelvic sonogram reveals a large, multiloculated cystic mass with papillary projections. What is the most likely diagnosis?
a. Serous cystadenocarcinoma
b. Cystic teratoma
c. Androblastoma
d. Dysgerminoma

A

a. Serous cystadenocarcinoma
(Penny ch 18 review question #46)

227
Q

A pt with an ovarian mass presents with an elevated serum AFP. Which of the following would be the most likely diagnosis?
a. Ovarian fibroma
b. Ovarian thecoma
c. Cystic teratoma
d. Yolk sac tumor

A

d. Yolk sac tumor

(Penny ch 18 review question #47)

228
Q

Which of the following is the mc malignancy of the ovary?
a. Cystic teratoma
b. Serous cystadenocarcinoma
c. Krukenberg tumor
d. Sertoli-Leydig cell tumor

A

b. Serous cystadenocarcinoma
(Penny ch 18 review question #50)

OB/GYN - ARDMS Registry (9 decks)

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