Uterus and Ovaries- Exam 1 2/2

ovaries are _____ glands located _____ to the uterus

endocrine, lateral

ovaries will _____ in size after menopause, unless on _____

decrease, HRT

normal ovarian volume

9.8- 22 cm³

normal ovarian volume after menopause

5.8 (avg.), 8 cm³ >

ovarian _____ of _____ times the other side is abnormal

volume, two

Graafian Follicle average size at time of ovulation

2.0-2.5 cm

Graafian Follicle size (considered normal)

1.5-3.0 cm

cumulus oophorus

small cyst (~1mm) attached to dominant follicle wall indicating maturity & imminent ovulation

ovarian cortex

consists of follicles and contains most of the ovarian tissue

ovarian medulla

composed of CT contains nerves, blood, & lymph vessels. can sometimes be more echogenic

ovarian blood supply

uterine and ovarian arteries

_____ branch off the _____ iliac

uterine arteries , intemal

_____ branch off the _____ below the _____ arteries

ovarian arteries, aorta

in postmenopausal women, cysts measuring _____ are seen _____ of the time

<3 cm, 15%

Functional ovarian cysts

result from normal function of the ovary and are the most commoncause for ovarian enlargement in young women

Functional ovarian cyst types

Follicular, corpus luteum, hemorrhagic theca-lutein cysts

most ______ ovarian cysts measure <5cm and _____ during the next menstrual cycle

functional, regress

If ____ functional cyst persists, surgical intervention or _____ is considered

>5 cm, aspiration

Follicular cysts

Occurs when dominant follicle does not succeed in ovulating and is not reabsorbed

follicular cyst can be

In ovary or exophytic

Exophytic

Growing outward or raised from a surface

Follicular cysts are _____ while corpus liteum cysts are _____

Simple, complex

“_____” can be seen on Doppler in a _____ cyst and can be difficult to distinguish from ectopic pregnancy

Ring of fire, corpus luteum

A Coria lutea cyst Can be difficult to differentiate between a _____

Ectopic pregnancy

internal hemorrhage can occur in any cyst but is most commonly seen in _____ and _____

Follicular, corpus outrun

Theca-Lutein Cyst

Largest functional cyst, bilateral, multiloculated, and associated with high levels of Bach

_____ is present in 30% of _____ cases and causes extremely high levels of hCG

Gestational trophoblastic disease, theca-lutein cyst

_____ are located next to ovary, in _____

Paraovarian, broad ligament

Paraovarian cysts account for 10% of all ______ and is a remnant of the _____

Adnexal masses, wolffian ducts

Ovarian hyper stimulation syndrome

Occurs in women taking fertility drugs that induce ovulation and there is a higher risk of these drugs are injected

Ovarian hyperstimulation syndrome AKA

OHS AKA

_____ is associated with _____ and _____. In severe cases, it can be fatal.

OHS, ascites, pleural effusion

OHS severe symptoms

pelvic pain, weight gain, blood clots, enlarged ovaries, and abdominal distention

Numerous large and thin-walled cysts can be found in the _____ of ovary in _____

Periphery, OHS

Ovarian torsion

Caused by partial or complete rotation of the ovarian pedicle on its axis

_____ is 3x more likely to torse

Right ovary

Ovarian torsion risk factors

young females with mobile adnexa, pre-existing ovarian cyst or mass, pregnancy

“Whirlpool” sign

Is rarely seen in ovary showing a twisted vascular pedicle, between the uterus and ovary

In over 80% of _____ cases fluid in the _____ can be seen

Ovarian torsion, cul-de-sac

Polycystic ovarian syndrome AKA

Stein-Leventhal syndrome AKA

PCOS

Disorder characterized by an elevated level of male hormones (androgens) and low or absent ovulation

PCOS clinical findings

Amenorrhea, obesity, infertility, hirsutism

Birth control or ovulation inducing drugs

can be used to manage PCOS

in PCOS there is ____ LH and _____ FSH

Increased, decreased

_____ LH leads to increased _____

increased, androgen production

decreased ____ impairs _____

FSH, follicle maturation/ ovulation

“String of pearls”

In PCOS, 19 or more cysts per ovary can be seen. All under 1 cm

Due to dual blood supply, _____ goes first in ovarian torsion

Venous flow

_____ kills more women in America than all other _____

Ovarian carcinoma, GYN malignancies

_____ carcinoma is the ____ leading cause of cancer death and is not usually detected until advanced

Ovarian, 4th

Stage 1 OV cancer

Limited to ovary

Stage 2 OV cancer

Limited to pelvis- uterus/fallopian tubes

Stage 3 OV cancer

Limited to abdomen

Stage 4 OV cancer

Spread beyond abdomen

CA 125

Blood work that is helpful in some patients to detect ovarian carcinoma

Ovarian carcinoma risk factors

Over 50, having more periods, family hx of ovarian/breast cancer

Ovarian carcinoma clinical findings

Abdominal pain, swelling, indigestion, frequent urination, constipation, and weight change

Papillary projections, also known as _____, are a sign of _____

Mural nodules, malignancy

SLAM acronyms

Side, Lab/hormone, Age, Malignancy

Epithelial tumors types

Serous and mucinous

epithelial tumors

80-90% of all ovarian malignancies and arise from the surface lining

Adenoma form

Benign or low malignancy

Adenocarcinoma form

Malignant

Most common epithelial tumors

Mucinous cystadenoma, mucinous cystadenocarcinoma, serous cystadenoma, and serous cystadenocarcinoma

Mucinous cystadenoma SLAM

Unilateral(95%), large simple cyst, 13-35 yrs old, benign

Mucinous cystadenocarcinoma SLAM

Bilateral (20%), large, 40-70 yrs, malignant

______ is more likely to rupture and is associated with _____ (loculated ascites)

Mucinous cystadenocarcinoma, pseudomyxoma peritoneum

Serous cystadenoma SLAM

Unilateral, smaller than mucinous, 40-70 yrs, benign

2nd most common benign ovarian tumor

Serous cystadenoma

Serous cystadenocarcinoma SLAM

Bilateral (50%+), smaller than mucinous, older women, malignant

In _____, ascites is common, and it is the _____ of all ovarian carcinomas

Serous cystadenocarcinoma, most common

Germ cell tumors

15-20% of all ovarian tumors, with 95% being benign cystic teratomas

Teratoma AKA

Dermoid AKA

Germ cell tumor types

Teratomas, dysgerminoma, and endo dermal sinus tumor

______ are the most common germ cell tumor, ______, and the most common cause for _____

Dermoids, benign ovarian tumor, ovarian torsion

Dermoid SLAM

unilateral, AFP, any age, benign in adults and malignant in children

dermoids

Contain fat, hair, bone, teeth, etc

_____ dermoids affect kids aged _____

Malignant, 10-20 yrs

_____ labs are _____ in 50% of patients with dermoids

AFP, elevated

“Dermoid plug”

Echogenic nodule along mural wall

to confirm fluid-fluid ratio

roll the patient

"Tip of the iceberg”

Echogenic area with shadowing, representing bone or teeth

"Dermoia mesh”

Multiple echogenic linear interfaces, representing hair fibers

Dysgerminoma

Entirely solid ovarian mass in women over 30 yrs with a similar appearance to testicular seminoma

most common malignant germ cell tumor

Dysgerminoma

Endodermal sinus tumor AKA

Yolk Sac tumor AKA

Endodermal sinus tumor

malignant with poor prognosis and similar appearance to dysgerminoma

Endodermal sinus tumor SLAM

Unilateral, increased AFP, <20 yrs, and malignant

stromal tumors are _____ and there are _____ types

rare, 4

Stromal cell tumors

Granules a celltumor, thecoma, fibroma, Sertoli-Leydig tumor

Granulosa cell tumor

estrogen producing tumor

thecoma

estrogen producing tumor that attenuates sound like a fibroma

Sertoli-Leydig tumor

testosterone producing tumor that can cause hirsutism and mostly affects young adults

Sertoli-Leydig tumor AKA

Androblastoma AKA

Fibroma SLAM

unilateral, ascites in 50 % of pts with mass >5 cm in diameter, postmenopausal women, benign

Meig's syndrome

Fibroma + ascites + pleural effusion

the most common stromal cell tumors

Fibroma and thecoma

the _____ are more involved with _____ than any other pelvic organ

ovaries, metastatic disease

Krukenberg tumor

mets to the ovary from a primary cancer on the Gl tract

ovary is a common site for mets from

Gl tract, breast, lung, and endo