Peritoneal Inclusion Cysts, PCOS, Endometriosis, Ovarian Remnant Syndrome (Lecture 6b)

What are peritoneal inclusion cysts? Who does this usually occur in?

- Cysts formed by peritoneal adhesions trapping peritoneal fluid in ovaries

- Reproductive age women; history of surgery, trauma, PID, or endometriosis

What are the sonographic features of peritoneal inclusion cysts?

Spiderweb appearance - intact ovary with loculated fluid (suspended/pushed to side)

TRUE or FALSE: The ovaries are still functional with peritoneal inclusion cysts.

TRUE

What are differential diagnoses for a peritoneal inclusion cyst? (HINT: 2)

- paraovarian cyst

- hydrosalpinx.

What is PCOS?

Polycystic Ovarian Syndrome

- Pts are insulin resistant, making pts produce more insulin to overcome this

- Insulin stimulates ovaries to make androgens, leading to granulosa cells converting androgens to estrogen → unopposed estrogen

What is Stein-Leventhal Syndrome?

Another name for Polycystic Ovarian Syndrome (PCOS)

What are symptoms of severe PCOS? (HINT: 4)

Amenorrhea, infertility, obesity, and hirsutism.

TRUE or FALSE: You can normally menstruate if you have PCOS.

TRUE: Pts with mild forms of PCOS can have normal menstruation

What are the cancer risks for PCOS pts?

Increased risk for endometrial and breast cancer.

Why is there anovulation in pts w/ PCOS?

Since there is always increased levels of estrogen, they skip the first half of the cycle (don't make a dominant follicle) b/c FSH is not secreted = no ovulation

What are the sonographic features of PCOS? (HINT: 3)

- Bilateral large ovaries

- Peripheral small follicles (string of pearls appearance)

- Increased echogenicity of ovarian stroma

TRUE or FALSE: Pts with PCOS can present with normal ovaries on U/S examination.

TRUE: Up to ⅓ of pelvic U/S demonstrate normal ovaries

What is endometriosis?

Functional endometrial tissue located outside the uterus.

What are symptoms of endometriosis? (HINT: 3)

Dysmenorrhea, dyspareunia, and infertility.

TRUE or FALSE: Endometriosis can cause adhesions.

TRUE

What are endometriomas?

Localized cyst that bleeds internally, known as chocolate cyst.

What is the kissing ovaries sign? What condition is this associated with?

- Both ovaries adjacent due to adhesions in pelvis

- Associated with endometriosis/endometriomas

What are the sonofeatures of endometriomas? (HINT: 4)

- Diffuse, homogenous, low level echoes

- Posterior enhancement

- No flow within

- Kissing ovaries sign

What is a differential diagnosis for endometriomas?

Hemorrhagic cyst

What is ovarian remnant syndrome? What does it look like sonographically?

- Small amount of residual functional ovarian tissue leftover after an oophorectomy (single/bilateral), responding to cyclic changes, creating small cysts

- SF: multiple cysts, complex appearance