Pathology of the Ovaries

Dominant follicles measure ___ cm at ovulation

2.0-2.5

What may occasionally be detected as an eccentrically located, cyst-like, 1 mm internal mural protrusion in the ovary?

cumulus oophorus

What does visualization of cumulus oophorus indicate?

imminent ovulation

Most ovarian cysts measure less than ___ in diameter and regress during next menstrual cycle

5 cm

What can be used to treat ovarian cysts when necessary?

birth control pills or cystectomy

What are types of functional ovarian cysts?

- follicular

- corpus luteum

- hemorrhagic

- theca lutein cysts

What is the most common cause of normal ovarian enlargement?

functional cysts

A follicular cyst develops when the ___ ___ fails to ___ or ___

mature follicle; ovulate; involute post ovulation

Follicular ovarian cysts are usually less than ___, but can grow up to ___

2 cm; 20 cm

Corpus luteum cysts result from failure of ___ or excess ___ into the corpus luteum

resorption; bleeding

Corpus luteum cysts are usually less than ___

4 cm

Corpus luteum cysts are prone to ___ and ___

hemorrhage; rupture

Corpus luteum cysts usually appear as ___ masses with central ___ ___ and ___

complex; blood clot; septations

Corpus luteum cysts are seen up to __ weeks of pregnancy

16

Corpus luteum cysts have a similar appearance to ___

ectopics

What is most commonly seen in corpus luteal cysts?

hemorrhagic cysts

An acute hemorrhagic cyst is usually ___ with ___

hyperechoic; enhancement

A chronic hemorrhagic cyst appears ___ with ___ clotted blood and a ___ level

complex; echogenic; fluid

What is the largest functional cyst?

theca-lutein cyst

Theca-lutein cysts are ___ (bilateral/unilateral)

bilateral

Theca-lutein cysts appear as ___, cystic masses

multiloculated

Theca-lutein cysts are associated with high levels of ___

hCG

30% of theca-lutein cysts occur alongside ___

gestational trophoblastic disease

Patients with theca-lutein cysts may experience ___ ___ and ___

pelvic fullness; nausea/vomiting

What is a frequent iatrogenic complication of ovulation induction?

ovarian hyperstimulation syndrome (OHSS)

What are symptoms of mild OHSS?

- pelvic discomfort

- no weight gain

- ovaries less than 5 cm

What are symptoms of severe OHSS?

- severe pelvic pain

- abdominal distention

- ovaries greater than 10 cm

OHSS can be associated with ___ and ___

ascites; pleural effusions

What was polycystic ovarian syndrome (PCOS) previously called?

Stein-Leventhal syndrome

PCOS is an increased number of ___ with ___

follicles; anovulation

PCOS occurs in late ___ through ___

teens; twenties

What are 4 symptoms of PCOS?

- infertility

- oligomenorrhea

- obesity

- hirsutism

What are sonographic findings of PCOS?

- normal or enlarged ovaries

- string of pearls

What presents as a cystic mass after bilateral oophorectomy?

ovarian remnant syndrome

Ovarian remnant syndrome results from ___ ___ ___ after a difficult surgery

residual ovarian tissue

The residual ovarian tissue can become ___

functional

Peritoneal inclusion cysts are ___ ___ ___

benign cystic mesothelioma

Peritoneal inclusion cysts are formed when ___ trap ___ ___ around the ovaries

adhesions; peritoneal fluid

Peritoneal inclusion cysts occur in the ___ and cause ___

adnexa; pain

Peritoneal inclusion cysts are ___, cystic masses

multiloculated

Peritoneal inclusion cysts predominantly occur in ___ women with a history of ___, ___, ___, and ___

premenopausal; abdominal surgery; trauma; PID; endometriosis

Peritoneal inclusion cysts reoccur up to __% of the time

50

Paraovarian cysts arise from the ___ ___ or ___ ___

fallopian tubes; broad ligament

Paraovarian cysts are ___ from the ovary and ___ change size with cycle

separate; do not

Benign cysts in fetuses and adolescents are stimulated by ___ hormones and may cause ___

maternal; precocious puberty

Simple cysts in postmenopausal women are normal if less than ___

5 cm

Focal endometriosis consists of a mass called ___ or ___

endometrioma; chocolate cyst

Chocolate cysts are "___" and ___ to the uterus, cul de sac, or rectosigmoid

sticky; adhere

Ovarian torsion is caused by ___ or ___ rotation of the ovarian pedicle on its axis

partial; complete

Ovarian torsion usually occurs in ___ or ___

childhood; adolescence

Once torsion has occurred, there is a __% increased risk of torsion in the contralateral ovary

10%

What are sonographic findings of ovarian torsion?

- enlarged ovary greater than 4 cm

- solid adnexal mass

- free fluid

- no flow

What is usually the cause of ovarian torsion?

solid mass

The ___ ovary is 3 times more likely to torse than the ___

right; left

Only __% of ovarian cysts less than ___ are malignant

3; 5 cm

It is recommended that a cyst greater than ___ be surgically removed

5 cm

Any change in ovarian ___ or volume of more than ___ should be considered suspicious

echogenicity; 20 mL

Abnormal ovaries suggestive of malignancy are defined as ___, ___ ovaries

enlarged, echogenic

What is the leading cause of death from gynecologic malignancy (25%) in the US?

ovarian carcinoma

Ovarian carcinoma is ___ in early stages

asymptomatic

50% of ovarian cancer is diagnosed at stage ___

3

Ovarian cancer can present as either a ___, ___, or ___ mass

complex; cystic; solid

Masses greater than ___ are more likely to be malignant

10 cm

Ovarian cancer incidence increases with history of ___ or ___ cancer

breast; colon

Ovarian cancer risk factors include increasing ___, ___, ___, ___, and late ___

age; nulliparity; infertility; uninterrupted ovulation; menopause

What are symptoms of ovarian cancer?

- abdominal pain

- swelling

- indigestion

- frequent urination

- constipation

- weight change with ascites

Stage I ovarian cancer is limited to ___

ovary

Stage II ovarian cancer is limited to ___

pelvis (ovaries, uterus, tubes)

Stage III ovarian cancer includes pelvis, ___, and ___

abdomen; small bowel

Stage IV ovarian cancer includes pelvis, abdomen, small bowel, ___, and ___

liver; beyond

All stages of ovarian cancer have ___

ascites

___ is a marker for ovarian cancer, but is also elevated with endometriosis, PID, fibroids, pregnancy, and other cancers

CA-125

Epithelial tumors account for __% of all ovarian malignancies

90%

Two types of epithelial tumors are serous and mucinous tumors. Which is the most common?

serous

What is the most common cystic ovarian tumor?

mucinous cystadenoma

Mucinous cystadenoma is a type of epithelial tumor that is lined by the mucinous elements of the ___ and ___

endocervix; bowel

Mucinous cystadenomas are found in ___ women

younger (13 to 45)

Mucinous cystadenomas measure ___ in diameter and are filled with ___-like material

15 to 30 cm; gelatin

Mucinous cystadenocarcinoma is found in ___ women

older (40-70)

Which is more likely to rupture; mucinous cystadenomas or cystadenocarcinoma?

mucinous cystadenocarcinoma

When mucinous cystadenocarcinoma ruptures, it causes ___ ___

pseudomyxoma peritoneum (collection of mucinous material in peritoneal cavity)

Mucinous cystadenocarcinoma appears as ___ ___ with mass effect

loculated ascites

Mucinous cystadenocarcinoma is ___ (bilateral/unilateral)

bilateral

What is the second most common benign tumor of the ovary (after the dermoid cyst)?

serous cystadenoma

Serous cystadenomas are commonly seen in ___

pregnancy

Serous cystadenomas are ___ than mucinous cysts, measuring up to ___

smaller; 20 cm

Serous cystadenocarcinoma is usually ___ (bilateral/unilateral)

bilateral

Serous cystadenocarcinoma can contain ___

calcifications

What is the second most common epithelial malignancy?

endometrioid tumors

Germ cell tumors originate from germ cells or ___

oocytes

Germ cell tumors are rare, except for ___

teratomas (dermoid)

Germ cell tumors are associated with elevated ___ and ___

AFP; hCG

Germ cell tumors are found in adolescents ages ___

4-27

What is the most common ovarian tumor?

teratoma / dermoid

Teratomas consist of ___, ___, and ___

ectoderm; endoderm; mesoderm

Teratomas can mimic ___

bowel

What is it called when teratomas contain thyroid tissue?

stroma ovarii

What is sonographic appearance of teratomas?

- cystic

- complex

- solid

- shadowing

The expression "___" refers to a mixture of matted hair and sebum with shadowing

tip of the iceberg

Immature teratomas are rapidly growing ___ tumors

malignant