abnormal female pelvis (ovaries)

What size is normal ovarian cysts

<3 cm diameter

What is a low malignancy potential

unilocular, <5 cm, no septations, no solid component

When does. the cyst require surgery

>5 cm, septation, solid components

What is the Most common cause of ovarian enlargement

functional cysts

What are the types of functional ovarian cysts

Follicular, Corpus Luteum with/without pregnancy, Theca-Lutein, Hemorrhagic

what is a Mature follicle fails to ovulate or regress after ovulation and fills with serous fluid

follicular cysts

follicular cysts typically can grow up to

8 cm

What are the follicular cysts symptoms

Asymptomatic or dull adnexal pain, Unless rupture occurs-painful, Can cause torsion of ovary

Follicular cysts are __lateral

uni

sonographic appearance of follicular cysts are

Unilocular, Anechoic, Well-defined thin walls, Posterior acoustic enhancement, “Simple cyst”

Corpus Luteum secretes ___ to maintain ___

progesterone; endometrium

What happens to corpus luteum cysts

Dominant follicle ovulates but rather than regressing after 14 days it continues to grow or hemorrhage

What are the size of corpus luteum cysts

rarely exceeds 4 cm (unilateral )

what cysts are prone to hemorrhage and cause pain

corpus luteum cysts

What are the symptoms of corpus luteum cysts

Symptoms and sonographic appearance can mimic ectopic pregnancy, hCG results absolutely necessary

What is the sonographic appearance of corpus luteum cysts

Unilocular to septated, Anechoic to hypoechoic, Possible solid appearance or cystic with echogenic material, Well-defined thicker, crenulated walls, Posterior acoustic enhancement, “Ring of fire”, **can mimic ectopic pregnancy*

How is corpus luteum cysts of pregnancy maintained

presssence of hCg

How large can corpus luteum cysts of pregnancy get

as large as 10 cm

When do corpus luteum cysts of pregnancy usually regress

by 14 weeks

How do corpus luteum cysts of pregnancy usually appear

as a simple cyst

What is the largest functional cysts

Theca-Lutein Cyst

what cyst is associated with high levels of hCG

Theca- Lutein cyst

What are Theca-Lutein cysts associated with

Gestational trophoblastic disease (30%), Ovarian hyperstimulation (infertility), Multiple gestations

What are people prone to who have Theca-Lutein cysts

Prone to torsion, rupture, & hemorrhage

What is the sonographic appearance of Theca-Lutein cysts

Bilateral, Thin-walled, Multilocular, Very large, Range from 3-20cm, Clinically present with n/v

What cyst is Most common to hemorrhage is corpus luteum

hemorrhagic cyst

What is the sonographic appearance of an acute hemorrhagic cyst

Hyperechoic, Diffuse low level echoes, Smooth wall, Posterior acoustic enhancement

What are the clinical symptoms of a hemorrhagic cyst

acute onset of pelvic pain

What is the sonographic appearance of a sub acute hemorrhagic cyst

Complex internal echoes, Septations, Clot formation

What patients have ovarian remnant syndrome

people who have oophorectomy

What is Small amount of residual ovarian tissue left behind-unintentionally. Tissue becomes functional and produce cysts

ovarian remnant syndrome

What cyst is most common in women 40-50 years old

paraovarian cyst

Where are paraovarian cysts located

Near ovary but arising from the broad ligament

What cyst may undergo torsion or rupture if they grow large and not influenced by hormones

paraovarian cyst

What is the presence of functioning endometrial tissue outside the uterus- ectopic

endometrial tissue

endometriosis

Where are the locations of endometriosis

Ovary, Fallopian tube, Pelvic ligaments, Posterior cul-de-sac, Pelvic peritoneum

What are the two forms of endometriosis

diffuse and localized

Endometriosis most commonly affects what race

caucasians

What are the symptoms of endometriosis

4 D’s : dysmenorrhea, dysuria, dysparaunia, and dyschezia , infertility, and chronic pain

The severity and stage of endometriosis is based on

location, amount, depth, and size of the endometrial implants: Extent of the spread of the implants, Involvement of pelvic structures in the disease, Extent of pelvic adhesions, Blockage of the fallopian tubes

What is the sonographic appearance of endometrioma

Avascular, Well-defined unilocular or multilocular, Diffuse homogeneous, low-level, internal echoes, Diffuse form is rarely detected by ultrasound

Imbalance of LH & FSH = abnormal estrogen & progesterone levels

PCOS

What are the symptoms of PCOS

Mild signs of hyperandrogenism in thin, normally menstruating

women, Oligo- or amenorrhea, Hirsutism – excessive hair (male-like hair growth), Obesity, Infertility, Chronic pregnancy loss

What is the sonographic appearance of PCOS

Always bilateral, Increased # follicles, 12 or more 2-9 mm in size, Bilaterally enlarged & rounded ovaries with multiple follicles lined up around the periphery- “string of pearls” sign, Ovarian volume > 10 cm

Ovarian Torsion is an ___ condition

acute

T/F: ovarian torsion requires prompt surgery

true

What age group does ovarian torsion occur in

children & young females (Increased risk during pregnancy)

What are the clinical symptoms of ovarian torsion

Severe pelvic pain (right side can mimic appendicitis), Nausea, Vomiting, Palpable mass

How does ovarian torsion appear sonographically

NO FLOW in affected ovary, Enlarged, hypoechoic ovary (follicles may not be seen), May see absent venous flow in the presence of arterial flow, Cyst or mass on the ovary or adjacent to it, Compare to other ovary, > 4 cm and hypoechoic in presence of normal contralateral ovary suggests abnormality

What is the fourth leading cause of cancer death in U.S Women

ovarian cancer

Why is ovarian cancer so deathly?

patients are asymptomatic and its undetectable in early stages.

What is the “silent killer” of 60-70% of women

ovarian cancer

What are the risk factors of ovarian cancer

family history, infertility or unsuccessful pregnancies, average age 50-59, uninterrupted ovulation, late menopause, oral contraceptive use has been shown to reduce the risk of ovarian cancer, CA 125 marker

What is elevated if someone has ovarian cancer

CA 125 marker

What are the clinical symptoms of ovarian cancer

vague abdomen pain, swelling, indigestion, frequent urination, constipation, weight change (ascites) 60-70%

What is ovarian cancer stage 1

limited to ovary, ascites

What is ovarian cancer stage 2

limited to the pelvis, involvement of fallopian tubes/uterus, ascites

What is ovarian cancer stage 3

intra abdominal extension outside the pelvis/ retroperitoneal nodes/ extension to small bowel/ omentum

What is ovarian cancer stage 4

hematogenous disease, liver parenchyma/ spread beyond the abdomen

Mass + increased CA125 + postmenopausal =

highly suggestive of cancer

well defined, anechoic, few or no septations=

suggests benign

thick, irregular walls, multiple septations, mural nodules=

suggest cancer

what is the second most common benign tumor of ovary

serous cystadenoma

What population is affected by serous cystadenoma

40-50 year old peri&postmenopausal women

is serous cystadenoma unilateral or bilateral

unilateral

What is the sonographic appearance of a serous cystadenoma

large, thin walled, unilocular, may have thin septations

What is the sonographic appearance of a serous cystadenocarcinoma

large, multilocular, echogenic foci within, multiple papillary projections, thick septations and walls, ascites

what is a common ovarian malignancy

serous cystadenocarcinoma

Is a serous cystadenocarcinoma bilateral or unilateral

bilateral (50% of the time)

What is the 2nd most common ovarian epithelial tumor

mucinous cystadenoma and cystadenocarcinoma

What percentage of mucinous are benign

80-85%

What are the clinical signs of a benign mucinous

30-50 years old and unilateral

What percentage of mucinous cystadenocarcinoma are malignant

5-10%

What are the clinical signs of malignant mucinous cystadenocarcinoma

40-70 years old, usually unilateral

What is the sonographic appearance of mucinous cystadenoma

Huge cystic mass, 15-30 cm, Up to 100 pounds, Can fill abdominal and pelvic cavities, Multiple thin septae, Low-level echoes, Mucoid material (gelatin-like

What is the sonographic appearance of mucinous cystadenocarcinoma

large multiloculated cystic mass, papillary projections, septations are thicker and nodular, echogenic material

what pathology penetration of the tumor capsule or rupture leading to intraperitoneal spread of mucin-secreting cells that fill the peritoneal cavity with a gelatinous material

pseudomyxoma peritonei

What is the ultrasound appearance of pseudomyxoma peritonei

similar to ascites or may have septations that fill the abdomen, associated with mucinous tumors, ruptured appendix, and colon cancer

What tumor is malignant (80%)

endometroid tumor

What are the clinical symptoms of endometroid tumor

better prognosis than serous or mucinous, commonly unilateral, 50-60 year olds

What is the sonographic appearance of endometroid tumor

smaller than serous or mucinous, predominately cystic mass, papillary projections, may contain areas of hemorrhage and necrosis, associated with endometrial abnormality

What tumor originates from mullerian duct

clear cell tumor

Are clear cell tumors benign or malignant

almost always malignant

What are the clinical appearance of clear cell tumor

almost always malignant, 50-70 year olds, associated with endometriosis

What is the sonographic appearance of clear cell tumor

nonspecific, complex, predominately cystic mass

What is another name for transitional cell tumor

brenner tumor

What tumor is rare and almost always benign

transitional cell tumor

What is the sonographic appearance of a transitional cell tumor

small, hypoechoic solid masses, calcification in outer wall

What are type 2 germ cell tumors derived from

primitive germ cells

What are the 3 layers of cystic teratoma (dermoid)

ectoderm, mesoderm, endoderm

What is the most common ovarian neoplasm

cystic teratoma

What population does cystic teratoma affect

reproductive women

What are the clinical symptoms of cystic teratoma

palpable mass or abdominal swelling, abdominal pain, abnormal bleeding

What are some complications of cystic teratoma

torsion or ruputre

what does a cystic teratoma look like sonographically

Variable, Depends on the elements present, May see teeth, bones, fat, hair, etc., Completely anechoic to completely hyperechoic, Specific features, Predominantly cystic mass w/ echogenic mural nodule (“dermoid plug”), Posterior acoustic shadow

How does “tip of the iceberg” appear

matted har and sebum=ill defined acoustic shadow obscuring the posterior wall of the lesion, hair, fat fluid or hair fluid

what is a rare, rapidly growing, malignant, solid tumor

immature teratoma

How does an immature teratoma appear clinically

serum alpha-fetoprotein is elevated in 50% of patients, may cause torsion, 10-20 year olds

How does an immature teratoma appear sonographically

solid mass; may seen numerous tiny cysts, calcifications

T/F: Dysgerminoma is a rare and malignant tumor

true