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Ch 42 & 43

Terms in this set (119)

How many times in a woman's reproductive life does ovulation occur?
400
What are the 2 functions of the ovaries?
Production and ovulation of oocytes
The ovaries are attached to the _____ ligament by a short fold of peritoneum, called the mesovarium.
Broad
What are the two portions of the ovary?
The outer cortex- consists of cellular connective tissue stroma in which follicles are imbedded.
The medulla- composed of loose connective tissue containing blood vessels & nerves
What is the approximate size of a mature graafian follicle?
2.0-2.5 cm
What is the Prolate Ellipse Formula?
0.523 x length x width x height
What is the mean ovarian volume in an adult menstruating female?
9.8 +/- 5.8 cc
An ovarian volume of more than ______ is considered abnormal for a postmenopausal patient.
8 cc
What is the purpose of Doppler of the Ovary?
It helps to differentiate potential cysts from adjacent vascular structures.
Used to localize flow.
What are the basic characteristics of common cystic masses?
Anechoic, thin walled, increased through transmission
What are the four types of Functional cysts?
Follicular Cysts, Corpus Luteum Cysts, Hemorrhagic Cysts, & Theca-Lutein Cysts
What type of cyst is the most common cause of ovarian enlargement in young women?
Functional Cysts
Most cysts measure less than _____ in diameter.
5 cm
What type of cyst is usually unilateral and less than 2 cm in size. They also regress spontaneously.
Follicular Cyst
What are the clinical symptoms of a follicular cyst?
Asymptomatic to dull adnexal pressure or pain, abnormal ovarian function, ovarian torsion resulting in severe pain
How does a follicular cyst look on U/S
Like a simple cyst
What do corpus luteum cysts result from?
Failure of absorption or excess bleeding into the corpus luteum
What is the usual size of a corpus luteum cyst?
<4 cm
During what trimester of pregnancy are corpus luteum cysts common and when is their maximum size reached?
1st Trimester & @ 10 weeks with resolution by 16 weeks
What are the clinical symptoms & sonographic findings of a corpus luteum cyst?
S/S: Irregular menstrual cycle, pain, mimics an ectopic pregnancy, rupture
Sono Findings: Cystic type lesion; may have internal echoes secondary to hemorrhage
What is the nomenclature for prominent diastolic flow (related to corpus luteum cysts)
The "ring of fire"
Hemorrhagic cysts can occur in what type of cysts?
Follicular or Corpus Luteum
What are the clinical symptoms and sono findings of a hemorrhagic cyst?
S/S: may present with an acute onset of pelvic pain
Sono Findings: variable depending on timing and amount of hemorrhage and clot formation
What is the largest of the functional cysts?
Theca-Lutein Cysts
What is associated with high levels of hCG?
Theca-Lutein Cysts
What are theca-lutein cysts frequently associated with?
gestational trophoblastic disease aka molar pregnancy
What is a frequent iatrogenic complication of ovulation induction?
Ovarian Hyperstimulation Syndrome
What is OHS characterized by?
Multiple ovarian luteinized cysts leading to ovarian enlargement & secondary complications such as pain & abdominal distention
What is Stein-Leventhal Syndrome associated with?
PCOS
What endocrine disorder is associated with chronic anovulation?
PCOS
What are the S/S associated with PCOS?
infertility, oligomenorrheo (infrequent) or amenorrhea (absent menstruation) & hirsutism
What is a common cause of infertility & higher than usual rate of early pregnancy loss?
PCOS
When does PCOS usually occur and what are the clinical features and Sono findings?
Occurs in late teens through twenties; amenorrhea, obesity, infertility, hirsutism; multiple tiny cysts around ovarian periphery and the ovary may be normal size or enlarged.
What usually results in a technically difficult surgery in which a small amount of residual ovarian tissue has been unintentionally left behind?
Ovarian Remnant Syndrome
What is formed when adhesions trap peritoneal fluid around the ovaries and results in a large adnexal mass?
Peritoneal Inclusion Cysts
When do peritoneal inclusion cysts usually occur?
In premenopausal women with a history of abdominal surgery; may also occur in patients with a history of trauma, PID or endometriosis.
Where do Paraovarian Cysts arise?
From the broad ligament
Where are omental cysts located?
High in the abdomen
What is the most common form of endometriosis?
Diffuse Endometriosis
What is another name for an endometrioma?
A chocolate cyst
What age group does endometriosis usually affect?
Women in their 30's & 40's
What is the internal form of endometriosis also referred to as?
Adenomyosis
What are the symptoms of endometriosis?
dysmenorrhea, irregular bleeding, chronic discomfort
What is caused by partial or complete rotation of ovarian pedicle on its axis?
Ovarian Torsion
When does Ovarian Torsion usually occur?
Childhood/ adolescence
What produces an enlarged edematous ovary greater than 4 cm in diameter?
Ovarian Torsion
What are the clinical symptoms of ovarian torsion?
Acute, severe unilateral pain, fever, nausea, vomiting, palpable mass (in 50% of patients)
Which ovary is more likely to experience ovarian torsion?
The right ovary
What can ovarian torsion mimic?
Acute appendicitis
What kills more women than cancer of uterine cervix & body combined?
Ovarian Carcinoma
How does ovarian carcinoma present?
Can present as either a complex, cystic, or a solid mass, but more likely predominantly cystic
If a mass if less than 5 cm in the long axis, it is more likely to be _______.
Benign
If a mass is larger than 10 cm, it is more likely to be _________.
Malignant
What are the clinical symptoms of ovarian carcinoma?
vague abdominal pain, swelling, indigestion, frequent urination, constipation & weight change (ascites).
What does ovarian carcinoma primarily arise from?
Epithelial Tumors
What is Ovarian Carcinoma Stage I limited to?
Ovaries and ascites
What is Ovarian Carcinoma Stage II limited to?
The pelvis (Involvement of uterus/fallopian tubes, extension to other pelvic tissues, ascites)
What is Ovarian Carcinoma Stage III limited to?
Abdomen (intraabdominal extension outside pelvis/retroperitoneal nodes/extension to small bowel/omentum)
What is Ovarian Carcinoma Stage IV?
Hematogenous disease (liver parenchyma/spread beyond abdomen)
What are the sonographic findings of Ovarian Carcinoma?
Presents with adnexal mass; Lesions with irregular walls; thick, irregular septations; mural nodules; & solid echogenic elements; associated with pelvic ascites
What is the most frequent presentation of Ovarian Carcinoma
Mixed cystic & solid masses
Abnormal tumor vascularity is worrisome for _______.
Malignancy
What has a generally high diastolic flow?
Malignancy
What arises from the outer most layer and covers the ovary?
Epithelial Tumors
What are the 2 most common types of epithelial tumors?
Serous & Mucinous
What is the normal age range for a mucinous cystadenoma
Ages 13-45
What are the clinical features and sono findings of a mucinous cystadenoma?
Clinical Features: pressure, pain, increased abdominal girth
Sono Findings: simple or septated thin walled multilocular cysts; Ascites appears as hypoechoic fluid with bright punctate echoes.
What is the 2nd most common benign ovarian tumor?
Serous Cystadenoma
What is the most common benign ovarian tumor?
Teratoma or Dermoid Cyst
What are the clinical features and sono findings of serous cystadenomas?
Clinical Features: pelvic pressure, bloating
Sono Findings: Uni or Multi locular cyst- may have nodules; Cystic structure with septations and/or papillary projections; internal and external papillomas usually present
What are the 4 less common epithelial tumors?
Endometrioid, Clear Cell, Brenner & Undifferentiated Carcinoma
What are the peak age ranges for Brenner tumors?
40-70 years
What are the germ cell tumors?
Dysgerminoma, Yolk Sac, Embryonal Carcinoma, Choriocarcinoma, & teratoma
What is normally produced by the fetal yolk sac, gastrointestinal tract & eventually by the fetal liver?
AFP
What are the clinical features and Sono findings of a teratoma?
Clinical Features: asymptomatic to abdominal pain, enlargement & pressure; pedunculated, subject to torsion
Sono Findings: cystic/complex/solid mass, echogenic components; acoustic shadowing
What is the nomenclature that describes ill-defined acoustic shadowing that obscures the posterior wall?
"Tip of the Iceberg"
What is a dysgerminoma?
A rare malignant tumor that is an entirely solid mass in women less than 30 y/o.
What are the sono findings of a dysgerminoma
Hyperechoic solid mass with areas of hemorrhage & necrosis; may show a speckled pattern of calcifications
What tumor is sonographically similar to a dysgerminoma? It also is rapidly growing, almost always unilateral, occurs in women under age 20, Increased serum AFP and has a poor prognosis?
Endodermal Sinus Tumor or Yolk Sac tumor
What are the sono findings of a yolk sac tumor?
Hyperechoic solid mass with areas of hemorrhage and necrosis. may show a speckled pattern of calcification.
What is the most common Stromal Tumor or Sex cord-stromal tumor?
Thecomas & fibromas
What are the sonographic findings of sex cord-stromal tumors?
Often hypoechoic as to appear cystic, but there is lack of through-transmission
What is clinically presented as Meigs' syndrome?
Fibromas
What is a feminizing neoplasm composed of cells resembling a graafian follicle?
Granulosa
What are the clinical symptoms of a granulosa?
Precocious puberty or vaginal bleeding & full breasts, pain, pressure & fullness may also be present.
What is an androblastoma also known as?
Sertoli-Leydig Cell Tumor
How does an androblastoma appear sonographically?
Appears as solid hypoechoic masses
What is a masculinizing ovarian tumor that occurs in females 15-65?
Arrhenoblastoma
What is the least common of all gynecologic malignancies?
Carcinoma of the Fallopian Tube
What is the most common histologic findings?
Adenocarcinoma
What age group does carcinoma of fallopian tube usually affect?
Postmenopausal women with pain, vaginal bleeding & pelvic mass
How does Carcinoma of the Fallopian Tube appear sonographically?
Sausage-shaped, complex mass with cystic & solid components often with papillary projections
What type of tumors arise from surface epithelium?
Epithelial Tumors
What are the different types of Epithelial tumors?
Mucinous cystadenoma (benign)
Mucinous Cystadenocarcinoma
Serous cystadenoma (benign)
Serous Cystadenocarcinoma
What are the 4 germ cell tumors?
Teratoma (Dermoid)
immature and mature Teratomas
Dysgerminoma
Endodermal Sinus Tumor (Yolk Sac Tumor)
What are the 5 different Stromal Tumors?
Fibroma & Thecoma
Granulosa
Sertoli-Leydig Cell Tumor
Arrhenoblastoma
Metastatic Disease
What are the risk factors for PID?
early sexual contact, multiple sex partners, history of STD, IUDs, & douching
What is almost always found as bilateral collection fluid & pus within the pelvic cavity?
PID
What are the clinical symptoms of PID?
Presents clinical as pelvic pain with a history of infertility; vaginal discharge, abnormal bleeding, possible large palpable mass, increased risk of ectopic pregnancy, elevated WBCs & fever
What are some differentials for PID?
Hematoma, dermoid cyst, ovarian neoplasm, endometriosis
What is the most common form of infection of PID?
Sexual transmission
What syndroma is defined as perihepatic inflammation that spreads up right flank from the pelvis?
Fitz-Hugh-Curtis Syndrome
What is PID?
Infection spread via mucosa pelvic organs through cervix into uterine endometrium (endometritis), out fallopian tubes (salpingitis) to area of ovaries & peritoneum
What are the clinical signs of salpingitis?
Clinical signs range from asymptomatic to pelvic fullness or discomfort and/or low grade fever
What are the sonographic findings of salpingitis?
May present as echogenic fluid or fluid-debris levels indicating infection; appears as a complex mass
PID is associated with ______ & _______.
infertility, endometriosis
What nomenclature is associated with PID and occurs at swollen end of tube near the isthmus?
"Pointed Beak"
What is thickening or fluid in endometrium?
Endometritis
What is known as enlarged ovaries with multiple cysts and indistinct margins?
Periovarian Inflammation
What is known as nodular thickening, irregularity of tube with diverticula?
Salpingitis
What is fluid filled irregular fallopian tube with or without echoes?
Pyosalpinx or Hydrosalpinx
What is known as a complex mass with septations, irregular margins & internal echoes, usually in the cul-de-sac
Tubo-Ovarian Abscess
What can a pelvic abscess involve?
It can involve ovary alone or fallopian tube & ovary as TOA
What is adhesive, edematous, & inflamed serose and may further adhere to ovary and/or other peritoneal surfaces?
Tubo-Ovarian Abscess
How does a TOA appear sonographically?
Appears as a complex mass in posterior cul-de-sac; complex hypoechoic adnexal mass with sepatations, irregular margins & fluid-debris levels; Ovaries are often difficult to recognize separate from the mass; usually bilateral but may be unilateral if an IUD is present.
What is defined as inflammation of peritoneum, serous membrane lining, abdominal cavity & covering viscera?
Peritonitis
What can peritonitis involve?
Bladder, ureter, bowel & adnexal area possible
How do endometriomas appear sonographically?
Bilateral or Unilateral ovarian cysts with patterns ranging from anechoic to solid, depending on amount of blood; ovaries are typically adherent to posterior uterine surface or stuck in cul-de-sac
What kind of complications can pain & masses after pelvic surgery indicate?
postoperative bleeding, hematomas or abscess formation
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