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Flashcards in Pathology of the ovaries Deck (88):
0

Where do the ovaries lie in an anteflexed uterus position?

lateral or posteriolateral

1

for a normal ovary, will you see blood flow IN it?

Yes...not just on the periphery on a normal ovary

2

review cyclic changes of the ovary

do it now!

3

3 phases of menstrual cycle

menstrual days 1-6

proliferative days 7-14

secretory days 15-28

4

What is the cumulus oophorus?

visualization of the cumulus oophorus within the mature follicle

gts this

5

when will you find fluid in the cul-de-sac during the menstrual month?

commonly seen after the ovulation and peaks in early luteal phase

6

what is the normal ovarian volume for a menstruating female?

large as 22 cc

mean: 9.8+/- 5.8 cc

7

What is a simple cystic mass on the ovary?

larger than 2.5 cm

8

What is a complex cystic structure in the ovary?

when you see an abnormal unruptured follicle

size 1-10cm

complex echogenicity

9

What is the most common pathology of the ovary?

simple cyst

10

When is surgery considered on a simple cyst?

when it's >6m and persists for more than 8 weeks

check slide 18

11

What do postmenopausal ovaries look like?

small anechoic cysts may be seen

can disappear or change in size over time

12

What happens if you see a cyst that is > than 5cm on a postmenopausal woman?

surgery generally recommended

for those containing internal septations and/or soild nodules

13

When would you do serial sonographic studies on a postmenopausal patient?

when a cyst starts to change or is too large to begin with

will want to document any changes

larger is a problem not smaller

14

ovarian masses usually grow ______?

quickly

15

WHat is the most common mass you will see on an ovary?

follicular cyst

16

What is a complex mass?

not completely anechoic

has debris

solid portions in it

can be predominantly cystic but has other stuff in it

17

When does a simple cyst become complex?

when it hemorrhages as it involutes

18

What are classic differential considerations of complex adnexal masses?

ectopic pregnancy (with positive pregnancy test, but nothing in uterus)

endometriosis

pelvic inflammartory disease

19

What can a dermoid appear as?

complex mass on the ovary

20

most masses on the ovary are _____?

benign

21

What are the complex masses?

cystadenoma

dermoid cyst

tubo-ovarian abscess

ectopic pregnancy

granulosa cell tumor

22

if you do not have a completely anechoic structure you need to identify it ______?

accurately - it matters as does a complete patient history

these things will sway the doctor one direction or another

23

What age frames would you most likely find solid tumors?

during peak fertile years: only 1 in 15 malignant

after age 40: ratio becomes 1 in 3

24

Mixed solid to cystic ovarian masses typical of all __________ovarian tumors.

epithelial

25

how can you tell a solid mass from gas?

can you reproduce it at different times in the scan in two planes

does it move?

a solid mass won't move

26

What are the keys to malignancies?

ascites

complex-ness of mass

age of patient

27

The more sonographically ________the tumor, the more likely to be ________.

complex

malignant

*especially with ascites*

28

What are the symptoms of ovarian cancer?

typically asymptomatic until its too late

29

When would you consider a large ovary abnormal?

when it is twice the volume of the opposite ovary

30

When you see a pedunculated fibroid what do you need to do?

investigate...you have to be able to determine where and what it is!

31

why would you use doppler on the ovary?

to differentiate potential cysts from adjacent vascular structures

32

What can be obtained on all ovarian masses?

localized flow with pulsed doppler

33

What is performed to determine resistive index or pulsatility index?

Pulsed doppler

interrogation of adnexal branch of uterine artery, ovarian artery, intratumoral flow

34

What are some doppler signs that might be worrisome for malignancy?

intratumoral vessels

low-resistance flow

absence of normal diastolic notch in doppler waveform

35

What are the cut-off values for PI and RI?

PI: 1.0

RI: 0.4

36

if a mass shows complete absence or minimal diastolic flow is it malignant or benign?

typically benign

37

What are functional cysts?

result from normal function of the ovary

38

What is the most common cause of ovarian enlargement in young women?

functional cysts

39

What do functional cysts include?

follicular

corpus luteum

hemorrhagic

theca-lutein cysts

40

When does a follicular cysts occur?

when the dominant follicle does not succeed in ovulating na dremains active through immature

41

Are follicular cysts unilateral?

yes, usually

42

What are thin-walled, translucent, have watery fluid and may project above or within surface of ovary?

folllicular cysts

43

How large can a follicular cyst grow?

1-8cm

44

How do you treat a follicular cyst?

usually disappears spontaneously by resorption or rupture

45

What are the clinical signs or a follicular cyst?

asymptomatic to dull

adnexal pressure and pain

abnormal ovarian function

torsion of ovary resulting in severe pain

46

What is a corpus luteum cyst?

result from hemorrhage within persistently mature corpus luteum

47

What is a corpus luteum cyst filled with?

blood and cystic fluid

48

How large to corpus luteum cysts grow?

may grow 1-10cm in size

often complex

49

What may accompany a corpus luteum cyst/

intrauterine pregnancy (IUP)

50

What are hemorrhagic cysts?

a cyst that has bled into itself

could have debris or fluid level in it

may occur in follicular cysts or MORE COMMONLY in corpus luteal cysts

51

What are the clinical signs for a hemorrhagic cyst?

acute onset of pelvic pain

52

What are theca-lutein cysts?

large, bilateral, multiloculated cysts

high levels of hCG

seen in 30% of patients with trophoblastic disease

clinical: nausea and vomiting

sonographic: multilocular cysts in both ovaries

53

What are the ovarian syndromes?

ovarian hyperstimulation

polycystic ovarian syndrome

ovarian remnant

54

What is ovarian hyperstimulation syndrome?

OHS is frequent iatrogenic complication of ovulation induction

in mild form: patient presents with pelvic discomfort but no significant weight gain

ovaries enlarged, measure < 5cm in diameter

55

how does a patient present with severe OHS?

severe pelvic pain

abd distention

notably enlarged ovaries measuring >10cm in diameter

associated ascites, pleural effusions, numerous large thin walled cysts thoughout the

56

What is polycystic ovarian syndrome?

**Stein-Leventhal Syndrome***

bilaterally enlarged polycystic ovaries

occurs in late teens through 20's

may have endocrine imbalance

clinical: amenorrhea, obesity, infertility, hirsutism

sonographic: multiple tiny cysts around periphery of ovary, ovary may be normal size or enlarged

CLASSIC SIGN: STRING OF PEARLS ****

57

WHAT ARE THE BENIGN OVARIAN CYSTS?

peritoneal inclusion cysts

paraovarian cysts

fluid collections in adhesions

benign cysts in fetuses

58

What are para-ovarian cysts?

usually simple

can bleed or torse

woliffian duct remnants

10% of all adnexal masses

located in broad ligament

clinical: asymptmatic

sonographic: simple cyst adjacent to ovary

59

what is endometriosis?

functioning endometrial tissue outside the uterus (can be any where)

may be found anywhere in the pelvis: ovary, Fallopian tube, broad ligament, cul-de-sacs

***dependant on hormonal stimulation*** causes discomfort where ever this tissue is

affects women in the 3rd and 4th decades

60

what does endometriosis look like in its diffuse form?

leads to disorganization of pelvic anatomy with appearance similar to PID or chronic ectopic pregnancy

two forms: diffuse and localized ***(endometrioma)***

61

What is endometriosis diagnosis based on?

patient history of symptoms

***a normal pelvic ultrasound does not exclude the presence of endometriosis***

62

what is ovarian torsion?

is caused by partial or complete rotation of ovarian pedicle on its axis

produces enlarged edematous ovary...usually >4cm in diameter

63

What does ovarian torsion classically look like?

multiple tiny follicles around hypoechoic mass to completely solid adnexal mass

free fluid often present

doppler examination usually reveals absent blood flow to torsed ovary.

64

When would you look for ovarian torsion?

when patient presents with acute, severe abd pain

medical emergency

venous drainage goes first, artery flow second

65

in the ovaries, which side typically has torsion first?

right side

66

what percentage of ovarian cysts <5cm are malignant?

3%

67

neoplasm is __________?

excessive growth....not necessarily cancer

68

What is Meigs syndrome frequently associated with?

fibroma

ovarian Ca

69

What volume of the ovary is abnormal for a post menopausal woman?

8.0 cc

70

The ovary synthesizes __________ and converts them to ________.

androgens

estrogens

71

Name the 5 complex masses

cystadenoma

dermoid cyst

tubo-ovarian abscess

ectopic pregnancy

granulosa cell tumor

72

What are the 7 common cystic or complex ovarian masses?

follicular cyst

corpus luteum cyst of pregnancy

cystic teratoma

paraovarian cyst

hydrosalpinx

endometrioma (low level echoes)

hemorrhagic cyst

73

an ovary with volume twice that of the opposite side generally considered ________

abnormal

74

What are the 6 common solid masses?

solid teratoma

adenocarcinoma

arrhenoblastoma

fibroma

dysgerminoma

torsion

75

What can be obtained on all ovarian masses?

localized flow with pulsed doppler

76

Why would you doppler the ovary?

to differentiate potential cysts form adjacent vascular structures

77

What are some doppler signs that raise concern for malignancy?

intratumoral vessels

low-resistance flow

absence of normal diastolic notch in doppler waveform

78

What is NOT a senstitive indicator of malignancy?

RI

79

What are some masses that cause abnormal waveforms on doppler?

inflammatory masses

metabolically active masses (including ectopic pregnancy)

corpus luteum cysts

80

What does increased diastolic flow suggest?

neovascularity and the likelihood of malignancy

81

masses showing complete absence or minimal diastolic flow (very elevated RI and PI values) usually means what?

the mass is benign

82

What is a sign of benign disease in early diastole?

diastolic notch

83

What are functional cysts a result of?

normal function of ovary

84

What is the most common cause of ovarian enlargement in young women?

functional cysts

85

What are the four cysts that are included in functional cysts?

follicular

corpus luteum

hemorrhagic

theca-lutein cysts

86

What are the three ovarian syndromes?

ovarian hyperstimulation

polycystic ovarian syndrome

ovarian remnant

87

What are the two non-functioning cysts?

para-ovarian cysts

endometrioma