ovary pathology

Question 1

ovarian symptoms

Answer 1

pain
swelling
endocrine effects

Question 2

types of ovarian cysts

Answer 2

follicular 
luteal
endometric
epithelial 
mesothelial

Question 3

why might follicular cysts form

Answer 3

when ovulation doesn’t occur - follicle doesn’t rupture but becomes a cyst

Question 4

pathology of follicular cyst

Answer 4

thin wall

lined by granulosa cells

Question 5

many follicular cysts in

Answer 5

PCOS

Question 6

clinical triad of PCOS

Answer 6

hyperandrogenism
oligomenorrhoea
polycystic ovaries on USS

Question 7

associations with PCOS

Answer 7

obesity 
metabolic syndrome (hypertension, dyslipidaemia, insulin resistance)

Question 8

other presentations of PCOS

Answer 8

acne
subfertility
hirsutism
acanthosis nigrans (darkened skin on neck and flexures - hyperinsulinaemia)

Question 9

criteria for PCOS diagnosis

Answer 9

Rotterdam criteria: 2/3 must be present
polycystic ovaries (12+follicles or ovarian volume >10cm3)
oligo/anovulation
clinical/biochemical signs of hyper androgenism

Question 10

what should be excluded before diagnosis of PCOS is made

Answer 10

thyroid disease
hyperprolactinaemia 
adrenal hyperplasia
androgen secreting tumours
cushing's

Question 11

management of PCOS

Answer 11

weight loss
smoking cessation
treat metabolic diseases

Question 12

what is endometriosis

Answer 12

endometrial glands and stroma outside the uterine body

Question 13

common sites of pathological endometrial tissue

Answer 13

ovary
pouch of douglas 
peritoneum
cervix/vulva/vagina
bladder and bowel

Question 14

clinical manifestation of PCOS

Answer 14

pelvic inflammation
infertility
pain (including dysuria, dyspareunia, pain on defaecation)

Question 15

what are endometrial cysts in ovary called

Answer 15

chocolate cysts

Question 16

why does endometriosis affect women of reproductive age

Answer 16

oestrogen driven

Question 17

what is adenomyosis

Answer 17

endometrial tissue in myometrium

Question 18

why might pain be cyclical in endometriosis

Answer 18

response of endometrial tissue to menstrual cycle (oestrogen)

Question 19

why might pain be constant in endometriosis

Answer 19

formation of adhesions

chronic inflammation

Question 20

signs of endometriosis on speculum exam

Answer 20

visible lesions

fixed retroverted uterus

Question 21

complications of endometriosis

Answer 21

cysts/adhesions
infertility
ectopic pregnancy
malignancy

Question 22

investigations for endometriosis

Answer 22

transvaginal ultrasound (ovarian disease)
laparoscopy with biopsy is gold standard

Question 23

treatment for endometriosis

Answer 23

COCP/progesterone empirically without definitive treatment if fertility not an issue
NSAIDs for pain
surgery if medical treatment fails

Question 24

types of ovarian cancers

Answer 24

epithelial
germ cell (teratoma)
sex-cord/stromal
metastatic 
miscellaneous

Question 25

most common ovarian cancer

Answer 25

epithelial

Question 26

cell of origin in epithelial tumours

Answer 26

``` unknown, can be from: serous mucinous endometrioid clear cell brenner ```

Question 27

classification of epithelial tumours

Answer 27

benign borderline malignant

Question 28

benign epithelial tumour pathology

Answer 28

no cytological abnormalities proliferative activity absent/scant no stromal invasion

Question 29

borderline epithelial tumour pathology

Answer 29

cytological abnormalities proliferative no stromal invasion

Question 30

difference between borderline and malignant epithelial tissue

Answer 30

borderline - no invasion | malignant - stromal invasion

Question 31

where do high grade serous epithelial tumours come from

Answer 31

tubal disease

Question 32

what epithelial cancer is associated with endometriosis

Answer 32

clear cell

Question 33

what are brenner tumours

Answer 33

epithelial | transition areas

Question 34

brenner tumours are usually malignant/benign

Answer 34

benign

Question 35

most common type of germ cell tumour

Answer 35

dermoid cyst - benign

Question 36

what does dermoid cyst contain

Answer 36

tissue from endoderm, mesoderm and ectoderm usually contain fat may contain sebum and hair thyroid tissue - thyrotoxicosis

Question 37

other types of germ cell tumour

Answer 37

``` immature teratoma dysgerminoma yolk sac tumour choriocarcinoma mixed ```

Question 38

germ cell tumour found in children and young women

Answer 38

dysgerminoma

Question 39

types of sex cord/stromal tumours

Answer 39

fibroma/thecoma (benign) granulosa cell tumour (malignant) - precocious puberty sertoli-leydig cell tumour

Question 40

what might sex cord tumours produce

Answer 40

oestrogen | androgens

Question 41

commonest places for tumours to metastasise from

Answer 41

stomach colon breast pancreas

Question 42

stage 1A ovarian cancer

Answer 42

cancer in one ovary

Question 43

stage 1B in ovarian cancer

Answer 43

cancer in both ovaries

Question 44

stage 1C ovarian cancer

Answer 44

involves ovarian surface/rupture

Question 45

stage 2A ovarian cancer

Answer 45

involves uterus/tubes

Question 46

stage 2B ovarian cancer

Answer 46

spread to other pelvic intra-peritoneal organs (eg bladder, bowel)

Question 47

stage 3a ovarian cancer

Answer 47

retroperitoneal lymph node involvement

Question 48

stage 3B ovarian cancers

Answer 48

macroscopic peritoneal mass <2cm

Question 49

stage 3C

Answer 49

macroscopic peritoneal mass >2cm

Question 50

stage 4

Answer 50

distant metastases

Question 51

what is salpingitis

Answer 51

infection of fallopian tubes

Question 52

presentation of ovarian cancer

Answer 52

``` bloating pelvic mass vaginal bleeding abdo pain weight loss bowel/bladder symptoms ```

Question 53

what tumour marker is raised in ovarian epithelial cancers

Answer 53

Ca125

Question 54

what age group are mostly affected by ovarian cancers

Answer 54

older women - 75-84

Question 55

risk factors for ovarian cancer

Answer 55

nulliparity early menarche/late menopause BRCA 1 and 2 lynch syndrome

Question 56

what is protective of ovarian cancer

Answer 56

pregnancy breastfeeding COCP tubal litigation

Question 57

investigations for ovarian mass

Answer 57

TVS CXR - for staging CT abdo/pelvis

Question 58

management for benign tumours

Answer 58

pre-menopausal - rescan in 6 weeks, if <5cm or asymptomatic then leave. if >5cm/symptomatic/dermoid/endometriosis then remove post-menopausal - manage risks. may need to remove

Question 59

what are the 2 types of functional cysts

Answer 59

follicular | luteal

Question 60

management of functional cysts

Answer 60

resolve spontaneously

Question 61

what is meig's syndrome

Answer 61

benign fibroma | pleural effusion