Chapter 18 - Ovaries & F-tubes

Ovaries form in the ___ in utero

abdomen

Ovaries are oval shaped and __peritoneal

intra

ovary's blood supply is from the..

ovarian artery and branch of uterine artery

Right ov vein dumps into __

Left ov vein dumps into ___

rt: ivc

lt: left renal vein

Ovaries are ___crine glands responsible for releasing (2)

endocrine

estrogen + progesterone

Ovaries are located in the __ pelvis

true

Ov fossa is __ to ureter and internal iliac artery

___ to external iliac artery

posterior

superior

Does the ovary have a peritoneal covering?

no, it's covered by epithelium

What is the protective layer of the ovary?

tunica albuginea

Ovary's cortex is the mass of the ovary and site for..

oogenesis

Ovary's medulla contains.. (2)

ovarian vasculature and lymphatics

Ovaries are stimulated by ___ which is released by the __

follicle stimulating hormone (FSH)

anterior pituitary gland

FSH develops multiple ___ during the ___ phase

follicles, follicular

Cells surrounding the follicles produce __ for....

estrogen

endo to thicken

1 follicle will become the dominant follicle, also called ___, and the rest will atrophy

Graafian

Follicles are less than __cm

3

___ is contained within the cumulus oophorus of the dominant follicle

ovum

Approx day 14, ovulation occurs when the dominant follicle ___

ruptures

When the dominant follicle ruptures, it releases (2)

a mature ovum

& some follicular fluid

Most follicular fluid released during the rupture settles in the...

posterior CDS

__ describes middle pain during ovulation, usually on the side of the dominant follicle

Mittelschmerz

After the dominant follicle ruptures, what is that structure called?

corpus luteum

During the luteal phase, the corpus luteum produces __ and some __

progesterone

some estrogen

If fertilization does NOT occur, the corpus luteum becomes...

corpus albicans

Multiple follicles may be noted in what ages? 3

- neonates

- prepubertal

- during menstrual cycle

__ resistance during early follicular + late luteal phase

high

__ resistance during late follicular + early luteal phase

low

Formula to calculate ov volume

what's the unit?

l x w x h x 0.523

cm3 or mL

Average premenopausal volume

9.8 cm3

Average postmenopausal volume

5.8 cm3

3 Conditions can increase ovarian volume

torsion

PCOS

Ov hyperstimulation syndrome

Define: when the dominant follicle fails to ovulate and continues to enlarge

follicular cyst

Follicular cyst sono appearance (3)

- anechoic

- thin walled

- unilocular

Follicular cysts typically resolve within __ weeks

6

What is the surgical removal of a cyst called?

ovarian cystectomy

Follicular cyst that contains blood is called...

hemorrhagic cyst

Hemorrhagic cyst sono appearance (3)

- complex

- fluid-debris level

- fishnet appearance

define: most common pelvic mass in the 1st trimester

corpus luteum cyst

corpus luteum cysts usually resolve by __ weeks gestation

16

corpus luteum cyst's color doppler sign

ring of fire

corpus luteum cysts might appear similar to ___ due to ring of fire appearance

ectopic

define: largest and least common functional cyst

theca lutein cyst

theca lutein cysts are found in the presence of high __ levels

so.. what 3 conditions increase the risk?

- HCG

- gestational trophoblastic disease (molar)

- ov hyperstimulation syndrome

- multiple gestations

Due to the high HCG with theca lutein cysts, patients may have (2)

hyperemesis

pelvic fullness

Sono appearance of theca lutein cysts (3)

- bilateral

- multiloculated

- can reach up to 15cm

Define: small cysts adjacent to the ovary, arises from F tube or broad ligaments

paraovarian cyst

Paraovarian cyst may contain..

small amounts of hemorrhage & septations

Define: most common benign ovarian tumor

Cystic Teratoma/dermoid

Cystic teratoma results from the retention of an ___ ____ that has __ germ cell layers

unfertilized ovum

3

What are the 3 germ cell layers?

ectoderm, mesoderm, endoderm

What age group are dermoids most common in?

reproductive age

(can happen postmeno but less common)

If a cystic teratoma ruptures it can lead to..

peritonitis

Sono appearance of cystic teratoma

complex with one or more echogenic structures

Cystic teratoma sonographic sign

tip of iceburg - anterior element is seen but the rest is shadowed out

What is dermoid mesh?

dermoid mesh describes hair within the mass (linear strands)

define: benign ovarian sex cord stromal tumor composed of ovarian thecal cells

thecoma

thecomas are most often seen in what age group? what is a common symptom?

postmeno

postmeno bleeding

Thecoma is associated with ___ syndrome which is....

Meig's

Benign tumor with ascites and pleural effusion

Thecoma sonographic appearance (3)

Hypoechoic

Solid mass with post. shadowing

mostly unilateral

Thecomas may appear similar to..

a pedunculated fibroid

Define: most common estrogenic tumor

granulosa cell tumor

aka granulose theca cell tumor

Granulosa cell tumor mostly in what age group?

what will happen if this happens post meno vs adolesence?

postmeno

- postmeno bleeding

- adolesence: pseudoprecocious puberty

Due to estrogen production, the risk for ____ is raised with granulosa cell tumor

endometrial cell carcinoma

Granulosa cell tumor sono findings (3)

- unilateral

- unpredictable appearance

- can reach up to 40cm

define: a sex cord stromal tumor that does not produce estrogen

fibroma

fibroma age group

middle aged women

fibromas are benign and may be associated with ___ and appear similar to ___

meigs syndrome

pedunculated fibroid

fibroma sono appearance (3)

hypoechoic, solid, posterior shadowing

transitional cell tumor is also known as...

brenner tumor

brenner tumor sono findings (4)

- small

- solid

- hypoechoic

- calcs possible

brenner tumor appears similar to (3)

fibroid, thecoma, fibroma

Brenner tumors are usually benign or malignant?

benign

Brenner tumor is usually asymptomatic but can have what 3 symptoms?

- palp mass

- pain

- meigs

define: blood containing tumor due to ectopic endometrium tissue on the ovary

endometrioma / chocolate cyst

Endometriomas can be anywhere in the ___ but most commonly on the ___

pelvis, ovary

Is there usually multiple or just one endometrioma?

multiple

Endometriomas are more common in what age group?

reproductive ages

5 symptoms of endometrioma

- pelvic pain

- menorrhagia

- dyspareunia

- dyschezia

- possible infertility

2 possible causes/theories of endometriomas

- endo tissue might pass thru F tubes during menstruation

- scarring from surgery

Endometriomas can also be found in the ___ scar as a palpable mass

C-section

Sono appearance of endometriomas (4)

- predominantly cystic mass

- low level echoes

- similar to hemorrhagic cyst

- fluid-fluid level

Serous Cystadenomas

- what age group

- more common during...

- small or large

- unilateral or bilateral

- 40s - 50s

- more common during pregnancy

- large

- bilateral

Serous Cystadenomas sono appearance (3)

- anechoic

- septations

- papillary projections

Mucinous Cystadenomas

- size compared to serous ones

- unilateral or bilateral

- larger than serous

- unilateral

Sono appearance of mucinous cystadenomas (3)

- septations

- papillary projections

- internal debris

Mucinous cystadenoma symptoms (5)

- pelvic pressure

- swelling due to large size

- abnormal ute bleeding

- GI issues

- acute pain if rupture/torsion

Ovarian malignancies are silent killers with a strong ___ link

familial

Pts are at very high risk for ovarian cancer if they have these 3 gene mutations:

- BRCA1

- BRCA2

- HER 2/neu

6 risk factors for ovarian cancer

- age 50+

- nulliparity

- delayed child bearing

- early menses

- late menopause

- estrogen HRT after menopause

Most ovarian cancer is ___ origin

epithelium

define: most common ovarian malignancy

serous cystadenocarcinoma

Serous cystadenoma looks similar to the benign version but with more prominent..

papillary projections and septations

5 symptoms of serous cystadenocarcinoma

- weight loss

- pelvic pressure

- swelling

- abnormal vag bleed

- GI issues

Serous cystadenocarcinoma possibly has what lab elevated?

CA 125

Mucinous cystadenocarinoma is usually __lateral

uni

Mucinous cystadenocarcinoma may have pseudomyxoma peritonei which is..

intraperitoneal extension of mucin secreting cells that result from the rupture of the mucinous tumor, resembles complex ascites

define: malignant ov tumor that metastasized from GI tract, usually the stomach

Kruckenberg Tumor

Kruckenberg tumor will have __ cells

Signetring

Kruckenberg tumor is often __lateral with ___

bilateral, ascites

Kruckenberg tumor will have a ____ appearance (solid mass with lots of cystic areas)

moth eaten