Pathology of the ovaries

During early proliferative phase, many follicles develop and increase in size until about day ____ or ____ of cycle due to stimulation by both _______ and ________ hormone

8;9; FSH (follicle stimulating hormone); luteinizing hormone (LH)

Dominant follicles measures ____ cm at ovulation

2.0 - 2.5 cm

What may occasionally be detected as an eccentrically located, cyst-like, 1 mm internal mural protrusion in the ovary?

cumulus oophorus

Visualization of ______ indicates a _____ follicle and imminent _______ no reproducible sonographic sign reliable

cumulus; mature; ovulation

A ____ ____ develops if the fluid in the nondominant follicles is not reabsorbed

Follicular cyst

Usually, the dominant follicle disappears immediately after rupture at ovulation. Occasionally, the follicle decreases in size and develops a wall that appears _____

Crenulated (scalloped)

What are types of ovarian cysts?

Follicular

Corpus luteum

Hemorrhagic

Theca lutein cysts

Most ovarian cysts measure less than ____ in diameter and regress during next menstrual cycle

5 cm

What is the most common cause of normal ovarian enlargement?

Functional cysts

What can be used to treat ovarian cysts when necessary?

Birth control pills or cystectomy

A follicular ovarian cysts forms when a ______ _______ fails to ______ or ________ post-ovulation

Mature follicle; ovulate; involute

Follicular cysts are ______, ______ and less than _____ but can be as large as _____ in diameter

unilateral; asymptomatic; 2 cm; 20 cm

Corpus luteum cysts is the failure of ______ or excess ______ into the corpus luteum

resorption; bleeding

Corpus luteum cysts are less than _____ and ______

4 cm; unilateral

Corpus luteum cysts are prone to _____ and ______

hemorrhage; rupture

Corpus luteum cysts usually appear as _____ masses with central _____ _____ and _____

complex, blood clot, septations

Corpus luteum cysts are commonly seen up to _____ weeks of pregnancy

16

What sonographic appearance does a corpus luteum have with doppler?

Ring of Fire

Corpus luteum cysts have a similar appearance to ____

Ectopics

What is most commonly seen in corpus luteal cysts?

Hemorrhagic cysts

An acute hemorrhagic cyst is usually _______ and may mimic a ____ _____. It appears with a ______ posterior wall and ______

hyperechoic; solid mass; smooth; enhancement

A chronic hemorrhagic cyst appears _____ with _____ clotted blood and _____ level

complex; echogenic; fluid

Intraperitoneal fluid results from _____ or ______ of the hemorrhagic cyst. This may mimic a ruptured ______

rupture; leakage; ectopic pregnancy

What is the largest functional cyst?

Theca-Lutein cysts

What is the sonographic appearance of a Theca-Lutein cyst?

Bilateral; Multiloculated cystic masses

Theca-Lutein cysts are associated with high levels of _____

hCG

_____ of Theca-Lutein cysts occur alongside gestational trophoblastic disease

30%

Theca-Lutein cysts may undergo _____, ______ and _____

hemorrhage, rupture, torsion

Patients with Theca-Lutein cysts may experience _____, _____ , ______

nausea; vomiting; pelvic fullness

What is a frequent iatrogenic complication of ovulation induction?

Ovarian Hyperstimulation syndrome

Symptoms of mild OHSS are?

Pelvic discomfort; no weight gain; ovaries measure less than 5 cm

What are symptoms of severe OHSS?

Severe pelvic pain; abdominal distention; ovaries measuring greater than 10 cm

Ovarian hyperstimulation syndrome is associated with _____, _______, and numerous ______

ascites; pleural effusions; ovarian cysts

What was polycystic ovarian syndrome previously called?

Stein-Leventhal syndrome

Polycystic ovarian syndrome has an increased number of _____ but __________

follicles; anovulation

PCOS affects ____ or ____ ovaries

one; both

PCOS occurs in late ____ through ____; common cause of ____ and early _______

teens; 20s; infertility; pregnancy loss

What are the clinical symptoms for PCOS?

• Infertility

• Oligomenorrhea - infrequent periods

• Obesity

• Hirsutism - Growing hair, high levels of testosterone

What are the sonographic findings for PCOS?

Normal or enlarged ovaries

“String of pearls”

What presents as a cystic mass after bilateral oophorectomy?

Ovarian remnant syndrome

Ovarian remnant syndrome results from _____ _____ _____ after a difficult surgery

residual ovarian tissue

With ovarian remnant syndrome, the ovarian tissue can become ______

functional

Peritoneal inclusion cysts are formed when _______ trap ________ ____ around the ovaries

adhesions; peritoneal fluid

Peritoneal inclusion cysts are _____ ____ ______

Benign cystic mesothelioma

Peritoneal inclusion cysts occur in the _____ and cause _____ _____

adnexa; pelvic pain

Peritoneal inclusion cysts are ______ cystic _____ masses

multiloculated; adnexal

Peritoneal inclusion cysts predominantly occur in _________ women, _____, _____, ______, ______

Premenopausal

abdominal surgery

history of trauma

PID

Endometriosis

Peritoneal inclusion cysts can reoccur up to ____ of the time

50%

Paraovarian cysts account for approximately _____ of all adnexal masses

10%

Paraovarian cysts arise from _______ ______ or _____ _____

fallopian tubes; broad ligament

Paraovarian cysts are _____ from the ovary and ______ change in size with cycle

separate; do not

Paraovarian cysts are usually simple with _____, _____ walls _____ to the ovary

thin, deformable, adjacent

Fluid collections in adhesions create cystic structures with ____ shaped throughout the _____

odd; abdomen

Benign cysts in fetuses and adolescents are stimulated by _____ hormones and may cause ______ puberty

maternal; precocious

Simple cysts in postmenopausal women are considered normal if ______ but suspicious if CA-125 is _____

less than 5cm; elevated

Endometriosis is a common condition in which functioning endometrial tissue is present ______ the uterus

outside

Focal endometriosis consists of a mass called ________ or _______

endometrioma; chocolate cyst

Diffuse form of endometriosis is more ____ but rarely diagnosed by sonography

common

Endometriosis can be found:

• Ovaries

• Uterus

• Peritoneum

• Bladder

• Kidneys

Chocolate cysts are “___” and _____ to the uterus, cul de sac, or rectosigmoid

sticky; adhere

Ovarian torsion is caused by _____ or _____ rotation of the ovarian pedicle on its axis

partial; complete

Ovarian torsion usually occurs in _____ or ______

childhood; adolescence

Once torsion has occurred, there is a ___ increased risk to occur in _________ ovary

10%; contralateral

What are sonographic findings of ovarian torsion?

Enlarged ovary greater than 4cm

Solid adnexal mass

Free fluid

No flow

Ovarian torsion requires prompt _____ and _____ intervention

diagnosis; surgical

What is usually the cause of ovarian torsion?

Solid mass

The _____ ovary is 3 times more likely to torse than the _____

right; left

Only ____ of ovarian cysts less than ____ are malignant

3%; 5cm

Cysts greater than ____ are recommended for surgical removable

5cm

Any change in ovarian _______ or volume of more than ____ should be considered suspicious

echogenicity; 20ml

Abnormal ovaries suggestive of malignancy defined as _____ , _____ ovaries

enlarged; echogenic

Ovarian ______ is the leading cause of death from gynecologic malignancy (____)

carcinoma; 25%

ovarian carcinoma is _____ in early stages

asymptomatic

_____ of ovarian carcinoma is detected at stage ___

50%; 3

Ovarian carcinoma is ______, 20% of the time

bilateral

Ovarian cancer can present as either a ____, ____, or _____ mass

complex; cystic; solid

Masses greater than _____ are more likely to be malignant.

10cm

Ovarian cancer incidence increases with history of _____ or ______ cancer

breast; colon

Ovarian carcinoma risk factors are:

Increasing age; nulliparity; infertility; uninterrupted ovulation; late menopause

Symptoms of ovarian cancer:

Abdominal pain; swelling; indigestion; frequent urination; constipation; weight change with ascites

Stage 1 ovarian cancer is limited to _____

ovary

Stage 2 ovarian cancer is limited to _____

Pelvis

Stage 3 ovarian cancer includes pelvis, _____, and ______

abdomen; small bowel

Stage 4 ovarian cancer includes pelvis, abdomen, small bowel, ____ and _______

liver; beyond

All stages of ovarian cancer have ____

ascites

CA-125 is a marker for _____ _____

Epithelial tumors account for ____ of all ovarian malignancies

90%

What tumor is more common and accounts for 30% of ovarian neoplasms?

Serous tumors

What is the most common cystic tumor measuring 15-30cm, thin-walled, filled with gelatin-like material and multilocular spaces?

Mucinous cystadenoma

Mucinous cystadenoma is found in women between the ages ___ - ___ years old

13-45

Mucinous cystadenoma is a benign tumor lined by the mucinous elements of the ______ and ______

endocervix; bowel

Mucinous cystadenocarcinoma is found in _____ women between the ages ___-____

older; 40-70

Mucinous cystadenocarcinoma is likely to rupture causing _______ ________ and _________ ________

Pseudomyxoma peritonei and loculated ascites

Serous cystadenoma is the _____ most common benign tumor of the ovary. Commonly seen in ______

second; pregnancy

What is the most common benign tumor of the ovary?

Dermoid

Serous cystadenomas are _____ than mucinous cysts, measuring up to ______

smaller; 20 cm

Serous cystadenocarcinoma is usually ______

bilateral

Serous cystadenocarcinoma can contain _____

calcifications

Endometrioid clear cell is the ____ most common epithelial malignancy.

second