Ovarian & Adnexal Pathology

What disease is the most common cause of infertility?

PCOS

What syndrome is PCOS related to clinically?

Stein-Leventhal syndrome

What is the sonographic appearance of PCOS?

• bilaterally enlarged ovaries with multiple small follicles around the periphery

• string of pearls

• secondary endometrial hyperplasia

What condition describes ectopic endometrial tissue outside the uterus into the adnexa that dorms blood-filled cysts?

endometriosis

What is another name for endometriomas?

chocolate cysts

What is the most common location of endometriomas?

ovaries

What clinical signs of endometriosis differentiate it from adenomyosis?

infertility and nulliparity

What is the sonographic appearance of an endometrioma?

• cystic mass with low-level echoes, anechoic, or complex with posterior enhancement

• may demonstrate fluid/fluid level

What is a functional infertility cause?

• hormone related cause

• ex. PCOS

What is a physical infertility cause?

• damage or blockages

• endometriosis, polyps, chronic PID

What is the most common adnexal mass?

follicular cyst

What is a Graafian follicle that fails to rupture and continues to enlarge >3 cm but typically remains as a simple cyst?

follicular cyst

What is the most common adnexal mass in pregnancy?

corpus luteal cyst

What is the sonographic appearance of a corpus luteal cyst?

typically hemorrhagic “lacy” appearance

What is a cyst that is located adjacent to or next to the ovary, typically <2cm and asymptomatic?

paraovarian cyst

What is a mass that is found only with elevated hCG levels and may coincide with gestational trophoblasic disease (molar pregnancy) or multiple gestations?

theca lutein cyst

What is it called when a non-pregnant person develops theca lutein cysts due to hCG from fertility treatments?

ovarian hyperstimulation syndrome (OHSS)

What is the sonographic appearance of theca lutein cysts?

• bilaterally enlarged multiloculated ovarian cysts

• grape clusters

• no normal ovarian parenchyma

What is the most common benign ovarian tumor?

cystic teratoma (dermoid)

What is a germ cell tumor most often seen in reproductive age that is retained unfertilized ovum that is composed of 3 layers and can have bone, hair, fat, and teeth?

cystic teratoma (dermoid)

What is the most common complication of a cystic teratoma (dermoid)?

ovarian torsion

What is the sonographic appearance of a cystic teratoma (dermoid)?

• complex, cystic, solid mass

• tip of iceberg, posterior shadowing

• dermoid plug (poor thru transmission) or dermoid mesh (linear echoes caused by hair)

What is the most common solid benign tumor?

fibroma

What syndrome is a fibroma associated with?

Meigs syndrome

What is Meigs syndrome?

ascites and pleural effusion in the presence of a benign ovarian tumor

What is a Brenner tumor?

a nonfictional transitional cell tumor that is small, solid, and unilateral with calcifications

What is the most common estrogenic tumor?

granulosa cell tumor

What populations is the granulosa cell tumor seen in?

postmenopausal women with bleeding and pediatrics with precocious puberty

What population is a thecoma usually seen in?

postmenopausal women with bleeding

What are the clinical symptoms of a cystadenoma?

• can be asymptomatic

• pelvic pressure and swelling due to large size

What is a serous cystadenoma?

• large and typically bilateral

• thin septations, anechoic

What is a mucinous cystadenoma?

• larger than serous and usually unilateral

• septations and presence of internal debris

What is the most common ovarian malignancy?

serous cystadenocarcinoma

How does serous cystadenocarcinoma compare sonographically to the benign version?

• more prominent papillary projections (mural wall nodules/irregularities)

• thicker septations

How does mucinous cystadenocarcinoma appear sonographically?

• web like extensions of mucin-secreting cells

• appears similar to complex ascites—pseudomyxoma peritonei

What is a clinical marker for cysadenonocarcinoma?

elevated CA-125

What is a tumor that results from metastasis from the GI tract and presents as bilateral ovarian masses and ascites?

Krukenburg tumor

What is a sex-cord stromal tumor associated with virilization (development of masculine characteristics) that is usually malignant?

Sertoli-Leydig cell tumor (androblastoma)

What population is the Sertoli-Leydig cell tumor (androblastoma) usually seen in?

women <30

What population are dysgerminomas found in?

women <30

What is the most common malignant germ cell tumor?

dysgerminoma

What are the lab markers for dysgerminoma?

elevated hCG in a non pregnant patient

What is the second most common malignant germ cell tumor?

yolk sac tumor (endodermal sinus tumor)

What population are yolk sac tumors usually found in?

women <20

What is the lab marker for yolk sac tumors?

elevated AFP in non-pregnant woman

What side does ovarian torsion usually occur on?

right

What is the most common cause of ovarian torsion?

ovarian mass or cyst