The Ovaries

What shape are the ovaries?

almond shape

What do the ovaries secrete?

hormones such as estrogen and progesterone.

How will prepubertal ovaries appear?

smaller with follicles measuring up to 1 cm

How will pre-menarche ovaries look?

they will be multi-cystic in appearance

How will post-menarche ovaries look?

they will be ovoid in shape 

What connects the ovaries to the uterus

the ovarian ligaments

what connects the ovaries to the fallopian tubes?

The infundibulopelvic ligament

What is another name for the infundibulopelvic ligament?

the suspensory ligament

What ligament connects the uterus to the pelvis?

the broad ligament

What ligaments support the ovaries?

the ovarian ligaments, the infundibulopelvic ligament, the mesovarium, and the broad ligament

Simple Cyst

A benign cyst in the ovary often found in women throughout their reproductive years that are <3cm and resolves spontaneously

Functional cyst

benign completely anechoic cyst that can be classified as ovarian follicles, follicular cysts, corpus luteum cysts and theca luteum cysts

Ovarian follicles

they will be anechoic and measure at least 5mm

Follicular cyst

results from a dominant follicle that didn’t rupture

Clinical indicators of follicular cysts

it is usually asymptomatic with mild to severe pelvic pain when the cyst becomes hemorrhagic, torsed, or ruptures.

Sonographic appearance of follicular cyst

typically anechoic with smooth, thin walls and no internal echoes. if it is hemorrhagic it will appear complex

Corpus luteum cyst

A functional cyst that develops from the graafian follicle after ovulation, often resolving on its own. It can cause pelvic pain and may appear hemorrhagic.

Symptoms of a corpus luteum cyst

pain, nausea, vomiting, enlarged tender ovary

Corpus luteum cyst on color doppler

will have ring of fire around the cyst, indicating increased vascularity.

Theca lutein cyst

A type of ovarian cyst associated with excessive levels of human chorionic gonadotropin (hCG), often seen in molar pregnancies or multiple gestations. These cysts are typically bilateral and can appear enlarged.

Treatment for theca lutein cysts

involves monitoring, reducing hCG levels, or surgical intervention if complications arise.

Sonographic appearance of theca lutein cysts

bilateral large thin-walled multilocular cyst

Hemorrhagic cyst

when there is more than minimal bleeding into the corpus luteum

Sonographic appearance of hemorrhagic cyst

fresh bleed will be anechoic as it clots, it will become echogenic will have posterior enhancement with a smooth posterior wall 

hemorrhagic cyst on color doppler

will have no blood flow inside the cyst but will appear like an ectopic

Normal measurement of a corpus luteum cyst

up to 8cm

normal measurement of theca lutein cyst

range from 3-20cm

What is molar pregnancy associated with

the presence of theca lutein cysts due to elevated levels of hCG.

What is associated with stein leventhal syndrome?

PCOS

The black pearl necklace is associated with what?

the appearance of multiple ovarian follicles in polycystic ovarian syndrome.

Polycystic ovarian syndrome

When the ovaries are enlarged bilaterally and contain multiple cysts as a result of a hormone imbalance

Benign cystic teratoma is also known as

dermoid cyst.

Dermoid cyst

a type of benign tumor that originates from germ cells and can contain various tissues such as hair, skin, and teeth.

Sonographic appearance of dermoid cyst

typically shows a "tip of the iceberg" sign with echogenic components and may include shadowing. The appearance may be varied with a fat fluid level

When will dermoid cyst become concerning

when it measures >7cm

Endometrioma

endometriosis cyst filled with blood

Endometrioma is also known as a

chocolate cyst due to its appearance.

Brenner tumors

benign ovarian tumors that are typically solid and may contain a mixture of epithelial cells. They are often asymptomatic and found incidentally; they occur in women ages 50-60

How will brenner tumors appear on ultrasound?

they will appear as a shadowing hypoechoic mass with punctate echogenic foci

How will malignant ovarian tumors appear on ultrasound?

as a complex or solid mass with thick irregular contours septations and increased vascularity.

Symptoms of malignant ovarian tumors

vague pelvic pressure, abdominal distention, GI symptoms, backache and vaginal bleeding

What is serous cystadenoma associated with?

ascites

Serous cystadenoma

unilocular with possible septations or papillary projection

What is the malignant form of serous cystadenoma

serous cystadenocarcinoma

What is the most common malignancy of the ovary

serous cystadenocarcinoma

Mucinous cystenoma

A type of ovarian tumor that is typically multilocular and filled with mucinous fluid, often benign.

What is mucinous cystadenoma associated with?

pseudomyxomatous peritonei

What is the malignant form of mucinous cystadenoma

mucinous cystadenocarcinoma

Fibroma

a hypoechoic, large, attenuating, solid benign mass

What meigs syndrome associated with?

a fibroma, ascites, and right pleural effusion.

Dysgerminoma

rare usually unilateral malignant tumor found in patients under 30

What are symptoms of dysgerminoma

localized pain, pressure

Thecoma

estrogen-producing, hyperechoic solid with areas of focal necrosis or hemorrhage

Sex cord stromal tumors include all of the following except

dysgerminomas and germ cell tumors

Sex cord stromal tumor

solid tumor most common in post menopausal women

Granulosa cell tumor

unilateral solid structure with varying degrees of hemorrhage

What is a granulosa cell tumor associated with?

endometrial hyperplasia and endometrial carcinoma.

What is another name for sertoli-leydig cell tumors?

androblastoma

Sertoli-leydig cell tumors

small unilateral echogenic solid masses

Krukenberg tumors

metastatic tumors of the ovary that usually arise from gastrointestinal tract cancers, particularly gastric cancer.

Predunculated fibroid

a type of uterine fibroid that is attached to the uterine wall by a stalk, allowing it to hang into the uterine cavity.

Paraovarian cyst

a fluid-filled sac located near the ovaries that is often benign and asymptomatic.

What can paraovarian cysts be a remnant of

the mullerian tubes or wolffian ducts

Paraovarian cysts are also known as

paratubal cysts or hydatidcysts of morgagni

Ovarian torsion

a condition where an ovary twists around the ligaments that support it, potentially compromising blood flow and causing severe pain.

What are symptoms of ovarian torsion

lower abdominal pain, loss of appetite, nausea, vomiting. the pain is acute sharp and radiates torward the groin or flank

Lymphocele

is a fluid-filled cyst that occurs in lymphatic tissue, often following surgical procedures or trauma.

Sonographic appearance of lymphocele

anechoic well defined septated mass

Doppler of ovary before the formation of the dominant follicle

high resistance diastolic flow with low velocity

Doppler of ovary after the corpus luteum is formed

low resistance diastolic flow