chapter 44: pathology of the ovaries

describe the shape of the ovaries.

almond, oval shaped

the ovaries are on the ____ side of the uterus.

lateral

the ovulatory cycle is dependent on the production of…

LH and FSH

LH and FSH are both produced by the ____.

pituitary gland

what creates the dominant follicle?

FSH

follicular (ovulatory) cycle determines _____.

endometrial thickening

how do normal ovaries appear on ultrasound?

homogeneous, small anechoic/cystic follicles in the cortex

the dominant follicle produced during the ovulatory cycle usually measures ___.

2.0-2.5 cm

functioning part of the ovary

follicle

the anechoic follicles typically seen on the ovary usually measure…

less than 1 cm (10 mm)

following a hysterectomy, where do the ovaries tend to be located?

more medially and directly superior to the vaginal cuff

the corpus luteum produces ___ to maintain a pregnancy.

progesterone

describe the sonographic appearance of a corpus luteum cyst.

anechoic center, echogenic border, ring of fire appearance

what is the ovary’s function?

to mature oocytes until ovulation

the ovary synthesizes ____ and converts them to ___.

androgens, estrogens

the ovary produces progesterone to sustain early pregnancy until the placenta can do so at ____.

10-12 weeks of gestation

what causes a follicular cyst to develop?

if the fluid in the nondominant follicle is not reabsorbed

____ commonly occurs after ovulation and peaks in the early luteal phase.

fluid in the CDS

simple cystic masses are a result of..

imbalance of LH and FSH

ovarian cysts measure ___.

greater than 2.5 cm

how do simple cystic masses appear on ultrasound?

smooth, thinned walls, anechoic center, posterior enhancement

when is surgical intervention considered for simple cystic ovarian masses?

if cyst is greater than 6 cm and persists more than 8 weeks

the ovary has ____ flow.

low resistance

ovarian dopplers can correspond to ___.

cyclic changes

uterine artery dopplers have ____ flow.

high resistance

presents with a power doppler discrepancy

ovarian torsion

postmenopausal cysts measuring ___ usually go to surgery.

greater than 5 cm

any simple cyst that hemorrhages as it involutes may appear as…

complex mass

in patients of reproductive age, what are the classic differential considerations of complex adnexal masses?

ectopic pregnancy, endometriosis, PID, dermoids

mix of hypoechoic and hyperechoic, demarcated area that is separate from normal tissue

complex ovarian cystc

complex ovarian cysts are usually ___.

hemorrhagic cysts

the more sonographically complex the tumor is, the more likely to be ____.

malignant

the more sonographically complex the tumor is, the more likely to be malignant, especially if associated with ___.

ascites

mixed solid to cystic ovarian masses are typical of all the ___ ovarian tumors.

epithelial

what are the most common types of cystic epithelial ovarian masses?

cystadenoma and cystadenocarcinoma

the epithelium of serous tumors is…

tubal in type and may be one or multiple

__ of solid-serous ovarian tumors are bilateral.

1/4

solid-serous ovarian masses mostly occur in women ____ and are large and often fill the pelvic cavity.

over 40

abnormal waveforms can be seen in…

inflammatory masses, metabolically active masses, and corpus luteum cysts

RI is/is not a sensitive indicator of malignancy.

is not

PI and RI values may vary considerably in the….

fertile patient during menstrual cycle

in the first 7 days of the menstrual cycle, flow to the ovaries has the ____ resistance with the ___ diastolic flow, and the indices are at their ____.

greatest; lowest; highest

later in each menstrual cycle, diastolic flow ____, particularly to dominant ovary.

increases

later in each menstrual cycle, diastolic flow increases, particularly to dominant ovary and may ___ indices sufficently to falsely suggest malignant process.

lower

what are the common functional cysts of the ovary?

follicular cysts, corpus luteum, hemorrhagic cysts, theca lutein cyst

functional cysts are part of the _____.

ovarian cycle

functional follicular cysts should go away within…

1-2 cycles

determining between corpus luteum and hemorrhagic cysts depends on…

where the pt is in their cycle

a _____ forms when a mature follicle fails to ovulate or involute post-ovulation.

follicular cyst

follicular cysts are usually unilateral/bilateral.

unilateral

____ cysts result from failure of resorption or excess bleeding in the corpus luteum and correspond to the corpus luteum phase.

corpus luteum

corpus luteum cysts usually measure ___ in diameter.

less than 4 cm

what are the clinical findings of follicular cysts?

asymptomatic to dull, adnexal pressure and pain, abnornal ovarian function

what are the sonographic findings of a follicular cyst?

simple cyst features

what are the clinical findings of a corpus luteum cyst?

irregular menstrual cycle, pain, mimic ectopic pregnancy, rupture

what are the sonographic findings of a corpus luteum cyst?

cystic type of lesion, echogenic rim, may have internal echoes secondary to hemorrhage, increased color (ring of fire)

what are the sonographic findings of a hemorrhagic cyst?

variable depending on the amount of hemorrhage, clot formation, and time passed since hemorrhage

the largest of the functional cysts that appear as very large, bilateral, multiloculated cystic masses

theca-lutein cysts

theca-lutein cysts are associated with ____.

high levels of hCG

theca lutein cysts correspond with…

high hCG, gestational trophoblastic disease, multiple gestations, infertility drugs

what is stein-leventhal syndrome?

infertility, oligomenorrhea, hirsutism, and obesity

endocrine disorder associated with chronic anovulation, includes stein-leventhal syndrome

polycystic ovarian syndrome (PCOS)

an imbalance of ___ results in abnormal estrogen and androgen production.

LH and FSH

how do ovaries appear in cases of PCOS?

rounded, usually 2-5x the normal size, increased number of follicles

what are the clinical findings of PCOS?

amenorrhea, obesity, infertility, hirsutism

what are the sonographic findings of PCOS?

echogenic center with multiple tiny cysts around the periphery of the ovary, ovary may be normal size or enlarged

what is commonly seen in patients with PCOS due to the large cysts causing a the weight of the ovary to become heavier?

kissing ovaries

results due to a small amount of residual ovarian tissue becoming functional and producing cysts with a thin rim of ovarian tissue in the wall; patient has had oopherectomy and may be experiencing pelvic pain

ovarian remnant syndrome

lined with mesothelial cells and are formed when adhesions trap peritoneal fluid around the ovaries, resulting in a large adnexal mass

peritoneal inclusion cyst

what are the clinical signs of peritoneal inclusion cysts?

pelvic pain or pelvic mass

what are the sonographic findings of a peritoneal inclusion cyst?

multiloculated adnexal mass, possible echoes

what could peritoneal inclusion cysts be confused with?

hydrosalpinx

paraovarian cysts will/will not change with the hormonal cycle.

will not

paraovarian cysts arise from…

the broad ligament

what are the clinical findings of paraovarian cysts?

asymptomatic

what are the sonographic findings of paraovarian cysts?

simple cyst (possible septations) adjacent to ovary

___ can create cystic structures of odd shapes throughout the abdomen.

fluid collections in adhesions

____ cysts tend to be higher in the abdomen.

omental

____ cysts are midline in the anterior abdominal wall peritoneum above the bladder.

urachal

small simple cysts usually occur in fetuses and newborn because of…

stimulation by maternal hormones

in premenarchal girls, small follicles measuring ___ are common.

less than 9 mm

most ovarian malignancies are ___ in origin and most are cystic.

epithelial

cysts seen in postmenopausal women used to be assumed abnormal, but it has been shown that cysts less than ___ in diameter are likely not malignant.

5 cm

common condition in which functioning endometrial tissue is present outside of the uterus

endometriosis

what are the 2 forms of endometriosis?

diffuse and localized

localized endometriosis =

endometrioma

which form of endometriosis is more common and consists of endometrial plantings within the peritoneum and is rarely diagnosed with ultrasound?

diffuse

what is an endometrioma also known as?

chocolate cyst

patients with an endometrioma are usually ____.

asymptomatic

what are the sonographic findings of endometriosis?

unilateral or bilateral, ovaries are typically adherent to the posterior surface of uterus or stuck in the CDS

how does an endometrioma appear on ultrasound?

well-defined unilocular or multilocular, predominately cystic mass containing diffuse homogeneous, low-level internal echoes

positive sliding test means…

the uterus moves separately from the bowel

a negative sliding test means…

uterus and bowel move together

what is torsion of the ovary caused by?

partial or complete rotation of the ovarian pedicle on its axis

ovarian torsion produces an enlarged, edematous ovary, usually measuring ____ in diameter.

greater than 4 cm

how does ovarian torsion appear on ultrasound?

usually associated with a mass, appears hypoechoic, enlarged ovary, with or without peripheral follicles, absent blood flow on doppler, free fluid in CDS

what are the clinical signs of ovarian torsion?

severe unilateral pain, N/V, fever, palpable mass

in cases of ovarian torsion, the ___ ovary is 3x more likely to torse than the other.

right

if the volume of the ovary is doubled, think ____.

torsion

ovarian cancer is a ____.

silent cancer