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Terms in this set (114)
How many times does a woman ovulate in her reproductive years
How many follicles will be stimulated to varying degrees throughout the reproductive years?
The ovary is capable of producing more than ______ types of tumors, both benign and malignant
Precise diagnosis is usually not based on
How do we characterize masses?
cystic, complex, or solid
The majority of ovarian masses are
benign, simple cysts
Sonographic criteria of simple cysts
Thin smooth wall, Anechoic contents, Acoustic enhancement
In premenopausal women, simple cysts are usually
Differentials of simple cystic structures
Functional cyst, Hydrosalpinx, Paraovarian cyst, Cystadenoma, Cystic teratoma, Endometrioma, TOA (rare)
Any simple cyst that hemmorhages may appear as
a complex mass
Differentials of complex masses
Ectopic pregnancy, Cystadenoma, TOA, Endometriosis, PID, Dermoids and other benign tumors
The more sonographically ______ the tumor, the more likely it is to be _____, especially if associated with _______.
complex; malignant; ascites
What type of solid to cystic ovarian tumors are the most common?
The serous types; cystadenoma and cystadenocarcinoma
Differentials of a solid adnexal mass
Pedunculated fibroid, Dermoid, Fibroma, Thecoma, Granulosa cell tumor, Brenner tumor, Metastasis, TOA, Ovarian torsion, Hemmorhagic cysts, and Ectopic pregnancy
Functional ovarian cysts result from the
normal function of the ovary
What is the most common cause of ovarian enlargement in young women?
Functional ovarian cysts
Functional cysts include
Follicular, Corpus luteum, HEmmorhagic, Theca-lutein
Follicular cysts occur when a dominant follicle...
fails to ovulate
Usually simple, unilateral, asymptomatic, and less than 2 cm in size
Follicular cysts regress...
How to we discover follicular cysts?
Follicular cysts can sometimes become...
Corpus luteum cysts result from failure of _____ or excess _____ into a persistantly _____ corpus luteum
absorption; bleeding; mature
How big are corpus luteum cysts?
Usually less than 4cm
Corpus luteum cysts is usually found
Corpus luteum cysts are prone to
hemmorhage and rupture
What is the presenting feature for corpus luteum cysts?
What kind of pattern do corpus luteum cysts show on ultrasound?
Corpus luteum cysts sonographic appearance
Complex mass with central blood clot and/or echogenic septations
Corpus luteum cysts are difficult to distinguish from
ectopic pregnancy and endometriosis
Peripheral rim of color using color doppler (Ring of fire) is seen when scanning...
corpus luteum cysts
Corpus luteum cysts may accompany _____ because if an ovum is fertilized it can persist up to ______
IUP; 16 weeks
What may occur in follicular cysts, or more commonly in corpus luteum cysts?
A patient with hemmorhagic cysts may present with
acute onset of pelvic pain
Sonographic appearance of hemmorhagic cyst
Hyperechoic, sometimes mimics a solid mass
What may we see on a scan of a hemmorhagic cyst?
Diffuse low level echoes, fluid level
If cyst is ruptured or leaking in hemmorhagic cyst we may see...
Echogenic free fluid in CDS
Largest of the functional cysts
Theca- Lutein cysts appear as
very large, BILATERAL, multi-loculated cystic masses
Theca-Lutein cysts are associated with high levels of
Seen most frequently in association with gestational trophoblastic disease (molar pregnancy)
Frequent complication of ovulation induction
Ovarian Hyperstimulation Syndrome (OHS)
Ovarian Hyperstimulation Syndrome has what types of forms?
Mild, moderate, and severe
When treated usually resolves in 2-3 weeks
Ovarian Hyperstimulation Syndrome
Mild OHS causes
Mild OHS has what affect on ovaries?
Enlarged but measure less than 5 cm in diameter
Severe OHS causes
Severe pelvic pain, abdominal distension
What affect does severe OHS have on the ovaries?
Notably enlarged, measuring greater than 10 cm in diameter
Large, thing walled cysts throughout the periphery of the ovary
In severe OHS ______, _____ effusions possible
How is severe OHS treated?
How long does Severe OHS take to resolve?
Symptoms of PCOS
Obesity, Hirtsuism, Oligomennorhea, Infertility
An endocrine disorder associated with chronic anovulation
Imbalance of LH and FSH results in
abnormal estrogen and androgen production
In PCOS ____ level is high and ____ is low
In PCOS what level is elevated?
How does PCOS affect the ovaries?
They are rounded and usually 2-5 times the normal size (may appear normal in some patients)
PCOS has what affect on the follicles?
Increased number bilaterally, usually more than 5 in each ovary
PCOS can lead to
endometrial hyperplasia and endometrial carcinoma
PCOS is a common cause of
infertility and early pregnancy loss
What appearance does PCOS have?
"String of pearls"
How is PCOS diagnosed?
Through lab work
Endometrioma is a
Localized endometriosis is also called
Localized endometriosis can rupture or cause..
What symptoms does a patient with endometrioma have?
Are endometriomas single or can they be multiple?
They can be multiple
With endometrioma, ovaries may be adhered to the
posterior uterus or stuck in the cul-de-sac
Endometrioma may appear as ______ or ______ ovarian cysts
In imaging, endometriomas range from
anechoic to solid
Well defined uni or multi-locular cystic mass containing echoes
With endometrioma, small echogenic foci may be seen...
in the wall
What is the size range of endometrioma?
Less than 1 to greater than 10cm
Peritoneal Inclusion Cysts are formed when adhesions trap ________ around the _______, resulting in a large _________ mass.
peritoneal fluid; ovaries; adnexal
Most patients with Peritoneal Inclusion Cyst have a history of
Previous surgery, Trauma, PID, Endometriosis
Peritoneal Inclusion Cyst is also called
benign cystic mesothelioma or benign encysted fluid
Most patients with peritoneal inclusion cyst present with...
pain and/or a pelvic mass
What kind of mass is peritoneal inclusion cyst?
Multiloculated cystic adnexal mass
What must the diagnosis of peritoneal inclusion cyst include?
The presence of an intact ovary
An intact ovary helps to prove that
the cyst is not ovarian in nature
Peritoneal inclusion cyst fluid may contain ______ as a result of _____________
echoes; hemmorhage or proteinaceous material
Account for 10% of adnexal masses
Where do the paraovarian cysts arise from?
the broad ligament
Paraovarian cysts are most common in what ages?
30's and 40's
How is a paraovarian cyst diagnosed?
Only by demonstrating a normal ipsolateral ovary close to but seperate from the cyst
What are the symptoms of paraovarian cysts?
What happens to the paraovarian cyst during a menstrual cycle?
Where is the paraovarian cyst in relation to the uterine fundus?
Usually superior to the fundus
What is the size range for small, simple cysts?
What kind of cysts typically occur in fetuses and newborn girls due to maternal hormone stimulation?
small simple cysts
Cysts in postmenopausal women are seen in approximately how many patients?
Usually cysts in postmenopausal women are how big?
less than 3cm
Simple cystic lesions of less than 5 cm are
not likely to be malignant
What do we do when we see a cyst in a postmenopausal woman?
Follow it closely for regression/changes
Ovarian torsion is caused by
partial or complete rotation of the ovarian pedicle on it's axis
Ovarian torsion is common in association with
Ovarian torsion produces a
Large edematous ovary, usually greater than 4 cm in diameter
Ovarian torsion can mimic a
solid adnexal mass
What is often present in ovarian torsion?
What does doppler reveal about ovarian torsion?
absent blood flow
What flow is the first to be absent? Followed by?
Spontaneous de-torsion would show...
an enlarged/edematous flow with an extremely hyperemic ovary
What should we do when looking at an ovarian torsion?
Compare it to the other ovary
Rare by serious problem - accounts for 3% of gynecologic operative emergencies
Acute condition requiring prompt diagnosis and surgical intervention
If ovarian torsion is found 5-6 hours of onset of pain...
80-100% can be saved
If ovarian torsion is found 6-12 hours of onset of pain...
70% can be saved
If ovarian torsion is found >12 hours of onset of pain...
Only about 20% can be saved
Ovarian torsion typically involves
the ovary and the fallopian tube
Which ovary is more likely to torse?
The right ovary is 3X as likely
Why is the right ovary so much more likely to torse?
the presence of the sigmoid colon on the left
A patient with ovarian torsion would present with
THIS SET IS OFTEN IN FOLDERS WITH...
Ob 1/Ovarian Pathology Part 2
Pathology of the Ovaries Part 1 (Quiz)
OB/GYN Chapter 41
ob 1 midterm review
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