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Repro / GU > SM_222b: Ovary, Fallopian Tube, and Adnexal Mass > Flashcards

SM_222b: Ovary, Fallopian Tube, and Adnexal Mass Flashcards

1
Q

Adnexa is ____

A

Adnexa is ovaries, fallopian tubes, upper portion of broad ligament, meso-ovarium and mesosalpinx, round ligament, ovarian ligament, and remnants of embryonic Mullerian duct

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2
Q

Fallopian tube has four sections: ____, ____, ____, and ____

A

Fallopian tube has four sections:

  • Isthmus
  • Ampulla
  • Infundibulum
  • Fimbria
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3
Q

Describe reproductive function of ovaries

A

Reproductive function of ovaries

  • Produce immature female gametes (oocytes)
  • Secrete female sex hormones including estrogens and progestins during the menstrual cycle
  • Secrete inhibin, involved in the feedback control of pituitary FSH production
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4
Q

Describe endocrine function of ovary

A

Endocrine function of ovary

  • Estrogen production
  • Secondary target organs: bone, endothelium, and brain
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5
Q

Describe anatomy of the ovary

A

Ovary

  • Surface epithelium
  • Stroma: outer cortex containing follicles surrounded by granulosa and theca cells, inner medulla contains blood vessels and connective tissue
  • Blood supply: ovarian artery and vein, uterine artery and vein
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6
Q

Describe clinical framework for evaluation of an adnexal mass

A

Clinical framework for evaluation of an adnexal mass

  • Age of patient
  • Clinical characteristics and exam findings
  • Ultrasound imaging: size, simple, complex
  • Serum tumor markers: CA125, bHCG, AFP, LDH, inhibin A/B
  • Pertinent family history to suggest BRCA
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7
Q

Describe potential for malignancy in adnexa

A

Adnexa potential for malignancy

  • Premenarchal: abnormal, malignant, germ cell
  • Reproductive age: most common, benign, germ cell and epithelial
  • Menopause: abnormal, malignant, epithelial / germ cell / stromal
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8
Q

Describe clinical and pelvic findings that are benign vs malignant

A

Clinical and pelvic findings that are benign vs malignant

  • Benign: unilateral, cystic, mobile, smooth
  • Malignant: bilateral, solid, fixed, irregular, ascites, cul-de-sac nodularity, rapid growth
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9
Q

Simple adnexal mass is ____, ____, and ____ on ultrasound

A

Simple adnexal mass is unilocular, hypoechoic, and has thin walls on ultrasound

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10
Q

Complex adnexal mass has ____, ____, ____, and ____ on ultrasound

A

Complex adnexal mass has internal echoes, septations, intramural nodules, and solid components on ultrasound

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11
Q

Describe indications for surgery of adnexal mass

A

Indications for surgery of adnexal mass

  • Any adnexal mass > 10 cm
  • Complex adnexal cyst > 5 cm
  • Adnexal cyst > 5 cm with no resolution after 6-8 weeks
  • Solid ovarian lesions
  • Symptomatic for pain
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12
Q

Describe differential diagnosis for adnexal mass

A

Differential diagnosis for adnexal mass

  • Sex cord-stroma: fibroma, thecoma, fibrothecoma
  • Germ cells: teratoma, dysgenetic gonads, struma ovarii (thyroid tissue)
  • Surface epithelium-stroma: serous, mucinous, endometrioid
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13
Q

____ are the most common clinically detectable ovarian enlargements during the reproductive years

A

Functional ovarian cysts are the most common clinically detectable ovarian enlargements during the reproductive years

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14
Q

Describe types of functional ovarian cysts

A

Functional ovarian cysts

  • Follicular cyst: no ovulation
  • Corpus luteum: post-ovulation, could be hemorrhagic
  • Theca-lutein cyst: pregnancy
  • Polycystic ovaries: > 10 follicles
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15
Q

Follicular cyst is ____, has ____, is lined by ____, and is up to ____ in size

A

Follicular cyst is follicle that is not ovulated, has clear fluid, is lined by granulosa cells, and is up to 10 cm in size

  • Resolves in days to 2 weeks
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16
Q

Corpus luteum cyst is when ____, has ____, and there is a ____

A

Corpus luteum cyst is when ovulation occurs, has clear fluid or blood, and there is a variable delay in menses

  • Resolves in 6-8 weeks
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17
Q

Describe ovaries in PCOS

A

PCOS

  • Polycystic or sclerocystic ovaries
  • Multipl follicles (≤ 10) with hyperplasia and luteinization of theca interna surrounding cysts and atretic follicles
  • Thickened capsule
  • Size: 2-5 x normal
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18
Q

PCOS characteristics are ___, ___, and ___

A

PCOS characteristics are menstrual dysfunction, hyperandrogenism, and concurrent metabolic disorders such as dyslipidemia and insulin resistance

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19
Q

Describe benign ovarian neoplasms

A

Benign ovarian neoplasms

  • Classified by cell of origin: epithelial, germ cell, stromal cell
  • Reproductive age: 90% benign, 10% malignant
  • Postmenopausal: 25% malignant
  • Rarely resolve spontaneously
  • Often warrant surgery because of risk of ovarian torsion, desire for diagnosis (rule out malignancy)
  • Can be treated with fertility-sparing surgery
20
Q

Epithelial ovarian tumors are ____, ____, or ____

A

Epithelial ovarian tumors are serous, mucinous, or endometrioid

  • Serous cystadenomas are the most common epithelial neoplasm
21
Q

Serous cystadenoma is ____ and ____

A

Serous cystadenoma is unilocular or multilocular and sometimes bilateral

  • Most common epithelial neoplasm
22
Q

Mucinous cystadenoma is ____, ____, and ____

A

Mucinous cystadenoma is large, multicystic, and filled with mucin

23
Q

Endometrioma is ____, contains ____, and is called ____

A

Endometrioma is associated with endometriosis, contains thick brown tar-like fluid, and is called a chocolate cyst

24
Q

Sex cord stromal tumors occur ____ and can produce ____

A

Sex cord stromal tumors occur equally across age and can produce hormones

  • Estrogen producing: precocious puberty, irregular menses or postmenopausal bleeding
  • Androgen producing: hirsutism, virilization
25
Q

Fibroma is composed of ____ and has ____

A

Fibroma is composed of fibrous connective tissue and has solid masses

26
Q

Thecoma involves ____ and ____ and is ____

A

Thecoma involves stromal hyperplasia and hyperthecosis and is hormonally active

27
Q

Meig’s syndrome presents with ____, ____, and ____

A

Meig’s syndrome presents with ovarian mass (usually fibroma), ascites, and right sided pleural effusion

28
Q

Germ cell tumors are derived from ____ and may contain ____

A

Germ cell tumors are derived from primary germ cells and may contain relatively differentiated structures

  • Teratoma (hair, bone)
  • Struma ovarii (thyroid)
29
Q

____ is the most common tumor found in women of all ages

A

Teratoma is the most common tumor found in women of all ages

  • Contains differentiated tissue from 3 embryonic germ layers: ectoderm, mesoderm, and endoderm
  • Dermoid
30
Q

Describe ovarian carcinoma

A

Ovarian carcinoma

  • Second most common gynecologic cancer
  • Most lethal gynecologic cancer
  • 70% of patients are diagnosed at advanced stage: IIIc and IV
31
Q

Describe malignant ovarian neoplasms

A

Malignant ovarian neoplasms

  • Sex-stromal tumor: granulosa cell tumor, Sertoli-Leydig tumor
  • Germ cell tumor: dysgerminoma, choriocarcinoma, yolk sac tumor, immature teratoma
  • Epithelial ovarian cancer: serous, mucinous, endometrioid, and clear cell
32
Q

Describe etiology of ovarian cancer

A

Etiology of ovarian cancer

  • Incessant ovulation theory: epithelial damage and repair of surface with ovulation
  • Increased risk with increased number of cycles: late menopause, early menarche, nulliparity, infertility
  • Genetics (10%): BRCA, Lynch syndrome
33
Q

Describe risk factors for ovarian cancerr

A

Risk factors for ovarian cancerr

  • Increase risk: age, family history of ovarian / breast cancer, infertility / low parity, and personal history of breast cancer
  • Decrease risk: OCPs, pregnancy, tubal ligation, and breast feeding
34
Q

Ovarian cancer usually presents with ____ symptoms

A

Ovarian cancer usually presents with non-specific symptoms

  • Bloating
  • Indigestion
  • Pelvic / abdominal pain
  • Abdominal distention (ascites in 75%)
  • Constipation
  • SOB (pleural effusion)
35
Q

Describe evaluation of suspected ovarian cancer

A

Evaluation of suspected ovarian cancer

  • History and physical exam
  • Pelvic exam
  • Tumor markers: epithelial ovarian cancer (CA125), germ cell tumors (AFP, LDH, HCG), sex cord stromal tumors (inhibin)
  • CT c/a/p
  • Paracentesis if ascites
  • Thoracentesis if pleural effusion
36
Q

Exploratory laparotomy for ovarian cancer is used for ____, ____, ____

A

Exploratory laparotomy for ovarian cancer is used for establishing the diagnosis, staging, and tumor debulking

37
Q

Describe FIGO ovarian cancer staging

A

FIGO ovarian cancer staging

  • Stage I: confined to ovaries
  • Stage II: limited to pelvis
  • Stage III: spread to upper abdomen or lymph nodes
  • Stage IV: distant spread (lungs)
38
Q

____ is used to treat advanced stage ovarian carcinoma

A

Debulking is used to treat advanced stage ovarian carcinoma

  • To remove as much tumor as possible: bowel resections, splenectomy, stripping of diaphragm
  • Goal: residual disease less than 1 cm (survival advantage)
39
Q

Advanced stage ovarian carcinoma is also treated with ____

A

Advanced stage ovarian carcinoma is also treated with chemo

  • Response rates are favorable but recurrence rates are high
40
Q

Germ cell tumors occur at ____ age and are described as ____

A

Germ cell tumors occur at younger age (16-20 years) and are solid rapidly enlarging masses

41
Q

Describe germ cell tumor markers

A

Germ cell tumor markers

  • Dysgerminoma: LDH
  • Yolk sac tumor: AFP
  • Choriocarcinoma: HCG
  • Immature teratoma: mixed
42
Q

Describe sex cord stromal tumors

A

Sex cord stromal tumors

  • Older age (mean 52)
  • Solid / cystic
  • 95% unilateral
  • Hormonally active: abnormal uterine bleeding, endometrial hyperplasia / cancer, virilization
  • Sertoli-Leydig tumor
  • Granulosa cell tumor
43
Q

____ are ____ tumor suppressor genes implicated in hereditary breast and ovarian cancer syndrome

A

BRCA1 and BRCA2 are tumor suppressor genes implicated in hereditary breast and ovarian cancer syndrome

  • DNA repair by homologous recombination
  • Autosomal dominant inheritance with high penetrance
44
Q

____ of ovarian cancer cases are attributable to an inherited syndrome

A

5-10% of ovarian cancer cases are attributable to an inherited syndrome

45
Q

_____ is associated with a 95% reduction in the risk of ovarian / fallopian tube carcinoma and 50% reduction in risk of breast cancer

A

Prophylactic bilateral salpingo-oophorectomy is associated with a 95% reduction in the risk of ovarian / fallopian tube carcinoma and 50% reduction in risk of breast cancer

  • Patients with BRCA1 or BRCA2 mutation
  • After age 35 or when reproductive wishes completed

Repro / GU (46 decks)

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