OVARIES

_____ phase many follicles develop and increase in size (one becomes dominant)

proliferative (day 6-14)

what are the most common solid serious ovarian tumours

cystadenoma and cystadenocarcinoma

doppler of ovary

• cut off for PI is 1.0

• cut off for RI is 0.4

endometriosis

functioning endometrial tissue is present outside the uterus

• negative sliding sign

  • organs done move, stuck together (frozen pelvis)

  • obliterated PCDS

• kissing ovaries

  • endometrioma

endometrioma sono

• well-defined unilocular or multilocular

• predominantly cystic mass

• diffuse homogenous, low-level internal echoes

polycystic ovarian syndrome

• includes Stein-Leventhal syndrome

• bilaterally enlarged polycystic ovaries

clinic of polycystic ovarian syndrome

• amenorrhea

• obesity

• infertility

• hirsutism

sono of polycystic ovarian syndrome

• multiple tiny cysts around periphery of ovary

• ovary may be normal size or enlarged

ovarian torsion symptoms

• severe pain

• nausea/vomit

• fever

• palpable mass

(similar to appendicitis)

ovarian torsion sono

• enlargement of ovary

• decreased or absent blood flow

• twisted coiled vessels within vascular pedicle (whirlpool sign)

what is the m/c cause of ovarian enlargement in young women

functional ovarian cysts

functional ovarian cysts include

• follicular

• corpus luteum

• hemorrhagic

• theca-lutein cysts

follicular cysts

• usually unilateral

• thin walled, translucent, watery fluid

• simple cyst

corpus luteum cysts

result from hemorrhage within persistently mature corpus luteum

• filled with blood and cystic fluid

• may accompany IUP

• > 4cm

corpus luteum sono

• small, < 4cm

• hypoechoic

• cyst with low level internal echoes

• thicker wall

• ring of fire

• involutes before menstruation

hemorrhagic cysts

• internal hemorrhage in cyst

• acute onset of pelvic pain

acute: hyperechoic, smooth posterior walls, enhancement

internal pattern becomes more complex

theca-lutein cysts

• large, bilateral multiloculated cysts

• high level of hCG

• nausea and vomit

ovarian hyperstimulation syndrome

complication of ovulation induction

• mild

  • pelvic discomfort, ovaries enlarged, < 5cm in diameter

• severe

  • severe pelvic pain, abdominal distention, ovaries > 10cm diameter

ovarian remnant syndrome

pt undergone bilateral oophorectomy

• cystic mass may develop

• residual tissue left behind

peritoneal inclusion cysts

• lined with mesothelial cells

• when adhesions trap peritoneal fluid around ovaries

paraovarian cysts

located in broad ligament

• simple cyst adjacent to ovary

ovarian carcinoma

• masses > 10cm more likely to be malignant

• increasing pt age correlates with increased incidence of malignancy

• strongest risk factor is family hx of ovarian/breast cancer

ovarian carcinoma clinical

• vague abdominal pain

• swelling

• indigestion

• frequent urination

• constipation

• weight change (ascites)

most common type of ovarian malignancy

epithelial tumours

• SEROUS (m/c)

• mucinous

mucinous cystadenoma sono

• can be very large

• usually unilateral

• simple or septate thin walled multilocular cysts

• contains internal echoes with compartments differing in echogenicity

mucinous cystadenocarcinoma sono

• can be very large

• bilateral

• thick, irregular walls and septations

• papillary projections and echogenic material

• ascites

what is m/c benign tumour of ovary

dermoid cyst

serous cystadenoma sono

second m/c benign tumour of ovary

• unilateral

• unilocular or multiocular with thin septations

• smaller than mucinous

• borders irregular with loss of capsular definition

• small amount of solid tissue

serous cystadenocarcinoma sono

• bilateral

• loss of capsular definition, tumour fixation calcifications

• septations / papillary projections

• internal and external papillomas

m/c germ cell tumours

benign cystic teratomas (dermoid)

germ cell tumours are associated with elevated

AFP and hCG

germ cell tumours include

• teratomas

• dysgerminoma

• embryonal cell carcinoma

• choriocarcinoma

• transdermal sinus tumour

teratoma/dermoid tumours

fatty, sebaceous material, hair, cartilage, bone, teeth

sono for dermoid/teratoma

1. completely cystic

2. echogenic nodule along mural wall, dermoid plug “tip of the iceburg”

3. fat-fluid level

4. high amplitude echoes with shadowing

5. complex mass with internal septations

what are the two m/c ovarian neoplasms seen in pregnancy

dysgerminoma, serous cystadenoma

endodermal sinus tumour

• yolk sac tumour

• < 20ys

• unilateraal

• increase AFP

• poor prognosis

sex cord stromal tumour include

• granulosa cell tumour

• thecoma

• fibroma

• sertoli leydig cell tumours

thecomas

• abundance of thecal cells

• usually unilateral

• postmenopausal women

• shows signs of estrogen production

fibroma

• rarely associated with estrogen production

• postmenopausal women

• associated with ascites and pleural effusion

  • MEIGS SYNDROME

sono of fibroma

thecoma appears similar

• unilateral

• variable sono appearance

• hypoechoic with post enhancement

• larger are prone to torsion

meigs syndrome

presence of

• ascites

• pleural effusion

• benign, ovarian mass

most common hormone-active estrogenic tumour of ovary

granulosa

clinical of granulosa

• precocious puberty

• vaginal bleeding

• full breasts

sono of granulosa

• variable

• similar to endometrioma/cystadenoma

Krukenberg tumours

• “drop” metastases to ovaries from GI tract

sono of metastatic disease

• bilateral

• ascites

• completely solid or solid with “moth-eaten” cystic pattern

benign sono

• well defined anechoic lesions

• thin septations

• more peripheral flow

• higher resistive flow

malignant sono

• irregular walls

• thick septations

• mural nodules

• solid echogenic elements

• centralized flow

• lower PI

• lower RI

• higher diastolic flow