Pathology Flashcards

Question

Ovulation causes what?

Answer 1

The corpus luteum or an abnormal unruptured follicle can persist as simple or complex cystic structure from 1-10 cm

Answer 2

If a cyst is greater than 6 cm for more than 8 weeks

Answer 3

A simple follicular cyst - benign **VERY IMPORTANT**

Answer 4

Anechoic, well defined borders, thin smooth walls, round or oval, through transmission

Answer 5

Small anechoic cysts may be seen Can disappear or change in size over time Surgery is recommended for postmenopausal cysts greater than 5 cm and for those contains internal septations and/or solid nodules

Answer 6

``` Follicular cyst Corpus luteum cyst with pregnancy Cystic teratoma Paraovarian cyst Hydrosalpinx Endometrioma Hemorrhagic cyst ```

Answer 7

Any simple cyst that hemorrhages as it involutes

Answer 8

Ectopic pregnancy Endometriosis Pelvic inflammatory disease (PID)

Answer 9

``` Cystadenoma Dermoid cyst Tubo-ovarian abscess Ectopic pregnancy Granulose cell tumor ```

Answer 10

Mixed solid to cystic ovarian masses

Answer 11

Cystadenoma | Cystadenocarcinoma

Answer 12

Fertile years - 1 in 15 After age of 40 - 1 in 3

Answer 13

Complex Malignant Ascites

Answer 14

Tubal in type May be one or multiple cysts

Answer 15

1/4 Tumors are large and offer fill pelvic cavity

Answer 16

Color Doppler Ovarian lesion vs pedunculated fibroid

Answer 17

``` Solid teratoma Adenocarcinoma Arrhenoblastoma Fibromyalgia Dysgerminoma Torsion ```

Answer 18

Potential cyst from adjacent vascular structures

Answer 19

Pulse Doppler - localized flow

Answer 20

First 10 days of the cycle

Answer 21

Avoids confusion with normal changes in intraovarian blood flow because high diastolic flow occurs in luteal phase

Answer 22

Greater than 0.4 as normal RI in nonfunctioning ovary Greater than 1 as normal PI

Answer 23

Intratumoral vessels, low resistance flow, and absence of normal diastolic notch in Doppler waveform Malignancies will have a lot more flow

Answer 24

Inflammatory masses, metabolically active masses (ectopic pregnancy), and corpus luteum cysts Mimicks cancer

Answer 25

Systolic peak - end diastolic --------------------------------- Mean velocity

Answer 26

Systolic peak - end diastolic --------------------------------- Systolic peak velocity

Answer 27

Neovascularity and likelihood of a malignancy

Answer 28

Complete absence or minimal diastolic flow Very elevated RI and PI values Diastolic notch in early diastole

Answer 29

Functional cysts

Answer 30

Ovarian enlargement in young women due to hormonal influences MOST COMMON

Answer 31

Follicular Corpus luteum Hemorrhagic Theca-lutein

Answer 32

Occur when dominant follicle does not succeed in ovulating and remain active though immature Unilateral Thin walled, translucent, have watery fluid Grow 1-8 cm Usually disappear spontaneously by resorption or rupture

Answer 33

Asymptomatic to dull Adnexal pressure and pain Abnormal ovarian function Torsion of ovary resulting in severe pain

Answer 34

Result from hemorrhage within persistently mature corpus luteum Filled with blood and cystic fluid Grows 1-10 cm ; complex May accompany intrauterine pregnancy (IUP)

Answer 35

Irregular menstrual cycle Pain Mimic ectopic pregnancy Rupture

Answer 36

"Cystic" type of lesion May have internal echoes secondary to hemorrhage and increased color

Answer 37

Internal hemorrhage may occur in follicular cysts or, more commonly, in corpus luteal cysts Will experience acute onset of pelvic pain

Answer 38

Blood clotting

Answer 39

Hyperechoic; may mimic a solid mass Smooth posterior wall and posterior acoustic enhancement Diffuse low level echoes Internal pattern becomes more complex

Answer 40

Large Bilateral Multiloculated Seen in 30% of patients with trophoblastic disease

Answer 41

High levels of hCG due to molar pregnancies

Answer 42

Clinical - nausea, vomiting Sonographic - multilocular cysts in both ovaries

Answer 43

Ovarian hylerstimulation Polycystic ovarian Ovarian remnant

Answer 44

A frequent iatrogenic complication of ovulation induction Ovaries enlarged - less than 5 cm

Answer 45

Mild - pelvic discomfort, no significant weight gain Severe - severe pelvic pain, ABD distention, notably enlarged ovaries greater than 10 cm

Answer 46

Ascites Pleural effusion Numerous THIN walled cysts throughout the periphery of ovary

Answer 47

Condition will resolve itself within 2-3 weeks

Answer 48

``` Includes Stein-Leventhal Syndrome Bilaterally enlarged polycystic ovaries Occurs in late teens through 20's Endocrine imbalance Diagnosed through lab values ```

Answer 49

Clinical - amenorrhea, obesity, infertility, hirsutism Sonographic - multiple tiny cysts around periphery, ovary may or may not be enlarged, "String of Pearls"

Answer 50

``` Peritoneal inclusion cysts Paraovarian cysts Fluid collections in adhesions Benign cysts in fetus & adolescents Simple cysts in postmenopausal women ```

Answer 51

Para ovarian cysts (sit adjacent to an ovary) | Endometrioma

Answer 52

``` Simple Can bleed or torse Wolffian duct remnant 10% of all adnexal masses Located in broad ligament ```

Answer 53

Clinical - asymptomatic Sonographic - simple cyst adjacent to ovary

Answer 54

Functioning endometrial tissue outside the uterus Endometrial tissue cyclically bleeds and proliferates May be found anywhere in the pelvis Affects women in 3rd & 4th decades DEPENDENT ON HORMONAL STIMULATION

Answer 55

Diffused Localized (endometrioma)

Answer 56

More common Endometrial plantings within endometrium Rarely diagnosed through US Disorganization of pelvic anatomy

Answer 57

``` Discrete mass (endometrioma, Sampson's cyst, chocolate cyst) May be found in multiple sites External/indirect form of endometriosis ```

Answer 58

Retrograde menstruation into Fallopian tubes and peritoneum Pelvic structures covered by tissue which responds to inflammation or hormonal stimulation

Answer 59

Severe dysmenorrhea Chronic pelvic pain from peritoneal adhesions Dyspareuria

Answer 60

Ovaries most common organ involved (2/3) Frequently bilateral Ovarian cysts with patterns ranging from hypoechoic to solid depending on amount of blood Ovaries may be adherent to posterior wall of uterus or stuck in cul de sac

Answer 61

Well defined Uni or multilocular Predominantly cystic mass with low level internal echoes Fluid may be seen

Answer 62

Based on history of symptoms and characteristic findings on internal exam Normal pelvic US does not exclude the presence of endometriosis

Answer 63

Partial or complete rotation of ovarian pedicle on its axis Compromises lymphatic and VENOUS drainage

Answer 64

Enlarged edematous ovary greater than 4 cm Classical - multiple tiny follicles around hypoechoic mass to completely solid adnexal mass

Answer 65

3% Acute ABD condition requiring prompt diagnosis & surgery

Answer 66

Fallopian tubes

Answer 67

Children and younger females with mobile adnexa, preexisting ovarian cyst or mass, or pregnancy

Answer 68

``` Usually associated with a mass Hypoechoic enlarged ovary w/ or w/o periphery follicles Absent blood flow on Doppler Free fluid in cul de sac Surgical emergency ```

Answer 69

Acute severe unilateral pain Fever Nausea Vomiting Palpable mass felt in more than 50% of patients RIGHT IS MORE 3x MORE LIKELY TO TORSE THAN LEFT

Answer 70

``` Greater than 4 cm Cystic to solid Varies in echogenicity Possible palpable mass MORE FREQUENT ON FIGHT SIDE May mimic acute appendicitis ```

Answer 71

Greater than 5 cm

Answer 72

Ovaries enlarged | May be mixed texture to solid with papillae within

Answer 73

Well defined anechoic lesions, unilocular or THINLY septated cysts - benign Lesions with irregular walls, THICK irregular septations, mural nodules, & solid echogenic elements - malignant Low resistive flow Malignant ascites possible Evaluate omentum, pertioneum, and liver for metastases

Answer 74

Normally - atrophic and no follicles HRT - normal sized ovaries Abnormal - enlarged & echogenic - malignant

Answer 75

Ovarian CA 4th leading cause of cancer death

Answer 76

Commonly not detected until advanced - has spread beyond capsule but still within pelvis (stage II) into ABD (stage III) 70% seen in advanced stages

Answer 77

CA 125 Has a lot of false neg/pos results Elevated levels found in 50% of stage III patients

Answer 78

Complex, cystic, or solid mass More likely predominantly cystic 20% bilateral

Answer 79

``` Endometriosis Hemorrhagic ovarian cyst Ovarian torsion PID Benign ovarian neoplasms ```

Answer 80

Less than 5 cm

Answer 81

Greater than 10 cm

Answer 82

Age Malignancy

Answer 83

Breast & colon cancer

Answer 84

``` Increasing age Nulliparity Infertility Uninterrupted ovulation Late menopause ```

Answer 85

``` Vague ABD pain Swelling Frequent urination Constipation Weight change (ascites) ```

Answer 86

Stage I - limited to ovary Stage II - limited to pelvis Stage III - limited to ABD Stage IV - hematogenous disease

Answer 87

Limited to 1 ovary Limited to 2 ovaries Positive peritoneal lavage (ascites)

Answer 88

Involvement of uterus/Fallopian tubes Extension to other pelvic tissues Positive peritoneal lavage (ascites)

Answer 89

Intraabdominal extension outside pelvis/retroperitoneal nodes/extension to small bowel/omentum

Answer 90

Spread beyond the ABD - liver parenchyma affected

Answer 91

Surface epithelium - MOST COMMON Germ cell Sex cord stroma Metastatic

Answer 92

Surface epithelial-stromal tumors

Answer 93

Serous tumors - MOST COMMON, 30% of all ovarian neoplasm Mucinous tumors - 20%-25% of ovarian neoplasms

Answer 94

``` Adenoma = benign Adenocarcinoma = malignant ```

Answer 95

Mucinous tumors

Answer 96

Intraperitoneal Direct extension to surrounding structures and lymphatic not uncommon

Answer 97

``` In endocervix & bowel 80%-85% mucinous tumors benign Women 13-45 yrs old Large - 15 to 30 cm, more than 100 lbs MOST COMMON CYSTIC TUMOR Unilateral, multilocular ```

Answer 98

75% of patients show simple or septate thin walled multilocular cysts Contain internal echoes with compartments differing in echogenicity caused by mucoid material

Answer 99

Pressure Pain Increased ABD girth

Answer 100

Women 40-79 yrs old 10% occur in menopausal women 5%-10% of all primary malignant ovarian neoplasms 15%-20% bilateral when malignant Causes lo ulster ascites with mass effect (rupture if benign)

Answer 101

Ascites appears as hypoechoic fluid with bright punctate echoes THICK irregular walls & septations

Answer 102

Usually unilateral Smaller than mucinous cysts Multilocular cysts with septations MOST COMMON BENIGN TUMOR OF OVARY (after dermoid)

Answer 103

Multilocular cyst May have nodules THIN septations

Answer 104

Pelvic pressure | Bloating

Answer 105

60%-80% of all ovarian carcinomas Over half bilateral Calcification Metastases to omentum, nodes, liver, lungs

Answer 106

Cystic structure with THICK septations and/or projections Internal/external papillomas usually present Ascites

Answer 107

Pelvic fullness | Bloating

Answer 108

``` Epithelial tumor Bilateral 1/3 associated w/ endometrial CA Malignant Postmenopausal ```

Answer 109

``` Epithelial tumor Malignant Müllerian duct origin Bilateral Postmenopausal ```

Answer 110

``` Epithelial tumor Benign Unilateral 40-70 yrs of age Uncommon Associated w/ cystic neoplasms in ipsilateral ovary ```

Answer 111

Derive from primitive germ cells of embryonic gonad Benign cystic teratomas approx 95% Rare-MOST COMMON ovarian malignancy in adolescents Associated w/ alpha fetoprotein & hCG Unilateral

Answer 112

Pelvic and/or ABD pain | Palpable mass

Answer 113

``` Teratomas - cystic, solid, malignant Dysgerminoma Embryonal cell carcinoma Choriocarcinoma Endodermal sinus tumor - yolk sac ```

Answer 114

Small to 40 cm Unilateral Round or oval mass Contains fatty, sebaceous material, hair, teeth, bone MOST COMMON OVARIAN NEOPLASM - 80% in childbearing yrs

Answer 115

Asymptomatic to ABD pain Enlargement & pressure Pedunculated Subject to torsion

Answer 116

Cystic, complex, solid mass Echogenic components Acoustic

Answer 117

Rare malignant tumor Bilateral Women less than 30 yrs old Sono - hyperechoic solid mass w/ areas of hemorrhage & necrosis, speckled pattern of calc

Answer 118

Dysgerminoma Serous cystadenoma

Answer 119

``` Known as "yolk sac" tumor Women less than 20 yrs old Unilateral Increased serum AFP Poor prognosis 2nd most common Sono - looks like a dysgerminoma ```

Answer 120

Solid adnexal masses that arise from embryonic gonadal and/or ovarian stroma Functional & feminizing = granulosa cell tumor, thecoma, fibroma Masculinization = sertoli-leydig cell tumors (androblastoma), arrhenoblastoma Hyperechoic & appear cystic, but NO THROUGH TRANSMISSION

Answer 121

Fibromas & thecomas

Answer 122

Thecoma = thecal cells Fibroma = fibrous tissue

Answer 123

``` Rare Postmenopausal Asymptomatic until larger Symptoms - increasing pressure & pain Ascites with Fibromas greater than 5 cm Referred to as MEIGS SYNDROME ```

Answer 124

``` Ascites Pleural effusion Ovarian tumor Removal is the cure Associated w/ Fibromas & thecomas ```

Answer 125

Unilateral Small to melon size Hypoechoic mass w/ posterior attenuation seen from homogeneous fibrous tissue Lager tumors pedunculated & prone to torsion, edema, & cystic degeneration

Answer 126

Feminizing neoplasm MOST COMMIN HORMONE - active estrogenic tumor of ovary Menopausal (50%), reproductive ages (45%), adolescents (5%) Leads to Meigs Syndrome if torsed/ruptured

Answer 127

Precocious puberty- Vaginal bleeding & full breasts Pain Pressure Fullness

Answer 128

Variable Mass w/o torsion Similar to endometrioma or cystadenoma If torsion occurs, multilocular cyst contains blood or fluid Solid masses may have echogenicity similar to uterine fibroids

Answer 129

Ovaries affects more than any other pelvic organ Mimics stage II to III ovarian CA Arises from breast, upper GI tract, & other pelvic organs by direct extension or lymphatic spread Krukenberg tumors - "drop" metastases to ovaries

Answer 130

Bilateral Ascites Completely solid or solid w/ "moth-eaten" cystic patterns occur when necrotic

Answer 131

Diffuse & disseminated; bilateral Sono - mass appears solid, hypoechoic; similar to lymphoma elsewhere in the body

Answer 132

Least common gyne malignancy Adenocarcinoma most common histological Postmenopausal w/ pain, bleeding, mass Distal end of tubes more common than entire tube

Answer 133

Sausage shaped Complex mass Papillary projections Similar to ovarian CA clinically & sono

Answer 134

``` Pelvic kidneys Omental cysts Feces in colon Distended bladder Hydroureters Colonic CA or masses Abscesses Retroperitoneal masses Ectopic pregnancy ```

Answer 135

Location Size Consistency Source of adnexal masses

Answer 136

Identify uterine connection & search for ovaries

Answer 137

Make histologist diagnosis

Pathology Flashcards

(173 cards)