OB exam 3 ovary benign

can ultrasound alone determine benign from malignant masses?

NO

what is a sonographic feature that indicates a more benign disease process?

fluid filled cysts

what are two sonographic feature that indicates a more malignant disease process?

thick irregular septa, papillary projections

__ sonographic findings:

* anechoic
* thin walled
* round/oval
* sharp margins
* increased through transmission (acoustic enhancement

simple cyst US

__ - benign, results from the normal function of the ovary

functional cyst

functional cysts are __ active cysts

hormonally

functional cysts result from stimulation of released pituitary __

pituitary gonadotropins

what are the most common cause of ovarian enlargement in young women?

functional cysts development

__ types:

* follicular
* corpus luteum
* theca-lutein

functional cyst types

__ cm or greater to be considered a cyst

3

__ cm are followed up for cysts

* best time to re-evaluate is __ later, immediately after __

3-5 cm, 6 weeks, menses

__ cm or greater should be evaluated for septations or solid components

5

__ cm or greater, they have a greater potential to be malignant or invasive and are usually removed

10

cysts of any size found in __ women should be further investigated

postmenopausal

__ - normal anechoic structures in the ovaries

ovarian follicles

normal ovarian follicles are as small as __

5 mm

normal ovarian follicles are seen typically _ before ovulation

10 days

normal ovarian follicles has a single follicle become __, measuring __ to __

dominant, 1.0 to 2.5 cm

during the mid portion of the menstrual cycle, a release of __ leads to ovulation

luteinizing hormone

luteinizing hormone leads to ovulation with follicular rupture and conversion into __

corpus luteum

__ - a dominant follicle that fails to release the ovum or fails to regress following ovulation

follicular cyst

follicular cysts are usually __

unilateral

follicular cysts usually disappear spontaneously by __

resorption/rupture

measurements of follicles

__ - normal follicle

measurements of follicles:

__ - dominant follicle

1 cm to

measurement of follicles:

__ - follicular cyst

>3cm

__ symptoms:

* asymptomatic
* dull adnexal pain/pressure
* large cyst can result in torsion/severe pain

follicular cyst s/s

__ sonographic findings:

* simple cyst
* anechoic
* thin walled
* ETT
* may see fluid in cul-de-sac with cyst rupture

follicular cyst US

__ - a result of failure of the corpus luteum to reabsorb or excess bleeding into the corpus luteum

corpus luteum cyst

corpus luteum cysts are prone to __

hemorrhage/rupture

corpus luteum cysts usually measure __

with corpus luteum cysts, if no pregnancy their presence usually __, within __ days

involutes, 14

with corpus luteum cysts, if pregnant the corpus luteum will persist through the __ trimester, and can reach up to __

first, 10

with corpus luteum cysts, if pregnant the corpus luteum will usually resolve by __

16 weeks gestation

__ symptoms:

* pain
* irregular menstrual cycle

corpus luteum cyst s/s

__ sonographic findings:

* cystic type of lesion
* may have internal debris due to hemorrhage
* may appear complex due to hemorrhage (echogenic clotting/septations)
* may demonstrate ETT
* increased peripheral color doppler “ring of fire”

corpus luteum cyst US

__ - largest of the functional cysts, may range from 3 to 20 cm

theca lutein cyst

theca lutein cysts are caused by increased levels of __ which hyperstimulates ovarian follicles, causing them to enlarge

HCG

theca lutein cysts are associated with __ disease (invasive pregnancy)

gestational trophoblastic

theca lutein cysts may be seen in patients using __ therapy

infertility drug

__ cysts:

* multilocular
* bilateral
* enlarged ovaires with multiloculated cysts

theca lutein

__ effects:

* hemorrhage
* torsion
* rupture
* pain

theca lutein cyst effects

theca lutein cysts __ when the source of __ is removed but can persist

involute, HCG

__ symptoms:

* abnormally high levels of HCG
* 30% associated with trophoblastic disease
* nausea/vomiting

theca lutein cyst s/s

__ sonographic findings:

* multilocular cysts bilateral

theca lutein cyst US

all cysts can __ which can change the sonographic appearance of the cyst

hemorrhage

__ hemorrhage:

* hyperechoic can mimic a solid mass
* ETT

acute

__ hemorrhage:

* debris
* complex

resolving

__ - iatrogenic complication of ovulation induction associated with women taking hormone medications to induce ovulation

ovarian hyperstimulation syndrome

ovarian hyperstimulation syndrome is caused by hormone medication to __

induce ovulation

__ signs and symptoms:

* pain
* abdominal distension
* may have ascites, pleural effusions
* bilateral

ovarian hyperstimulation syndrome s/s

__ sonographic findings:

* enlarged ovaries up to 10 cm in diameter
* thin walled cysts throughout periphery of the ovary

ovarian hyperstimulation syndrome US

hyperstimulated ovaries in a patient after gonadotropin therapy for __

infertility

polycystic ovary disease (PCOS) is also known as the __ syndrome

stein-leventhal

polycystic ovary disease is an __ disorder - hormonal imbalance

endocrine

polycystic ovary disease is an endocrine disorder - __

hormone imbalance

__ symptoms:

* obesity
* amenorrhea
* chronic anovulation
* hirsutism
* infertility

polycystic ovarian syndrome s/s

in PCOS, the imbalance of __ causes the abnormal production of estrogen and androgen resulting in anovulation

LH/FSH

in PCOS, the imbalance of LH/FSH causes the abnormal production of __ and __ resulting in anovulation

estrogen, androgen

in PCOS, the imbalance of LH/FSH causes the abnormal production of estrogen and androgen resulting in __

anovulation

in PCOS, instead of the follicles growing and ovulation occurring, the follicles stall and secrete a __ hormone into the blood

male

__ sonographic findings:

* bilateral, large ovaries with multiple, tiny cysts usually peripherally located
* ranging from 5 to 8 mm
* ‘string of pearls’ multiple tiny cysts on periphery of ovary

polycystic ovarian syndrome US

__ - adnexal mass as a result of fluid accumulation in adhesions

peritoneal inclusion cyst

peritoneal. inclusion cyst is a __ cyst in adnexa seen in women with hx of __

multiloculated, surgery

__ - cyst in broad ligament that is separate from the ovary

paraovarian cyst

paraovarian cyst is a __ adjacent to the ovary

simple cyst

__ - partial or complete rotation of the ovary, resulting in occlusion of arterial and venous blood flow

torsion

torsion is most common in __ and __, but can occur at any age

children, adolescence

with torsion there is a higher incidence of the __ side occurrence

right

torsion requires prompt __

medical intervention

__ sonographic appearance:

* enlarged edematous ovary > 4 cm
* hypoechoic-may demonstrate peripheral follicles
* absent blood flow

acute torsion US

__ sonographic appearance:

* heterogenous small ovary
* absent blood flow

chronic torsion US

sonographers must document arterial and venous blood flow with __ to rule out torsion

doppler

__ symptoms:

* acute unilateral adnexal pain and tenderness
* intermittent pain may precede the acute pain by weeks
* 50% will feel a palpable adnexal mass

torsion s/s

__ - can become very large and usually seen in postmenopausal women but can occur in child-bearing years

cystadenomas

cystadenomas are __ tumors

epithelial

type of cystadenomas:

__ - contain serous fluid; some with thin septations and or papillary projections

* multilocular

serous

types of cystadenomas:

__ - contain thicker mucin; can grow extremely large, 15 to 30 cm, with prominent septations and debris

* multilocular often containing internal echoes

mucinous

what is the most common cystic tumor

mucinous cystadenomas

__ - rare solid ovarian tumors from the undersurface of the epithelium

* rare
* range from microscopic to 8 cm in diameter

transitional cell

__ sonographic appearance:

* hypoechoic, solid masses that may contain calcifications
* sonographically similar appearance to thecoma and fibroma

transitional cell/brenner tumor US

__ - composed of derivatives of all three germ laters (endoderm, mesoderm, and extoderm)

teratomas

teratomas can also be called __ or __

cystic teratomas, dermoid

what is the most common benign ovarian tumor

teratomas

teratomas occur in 80% of women in __ age

childbearing

__ symptoms:

* pain
* palpable mass
* twisting can occur causing torsion

teratoma s/s

teratomas can be __

bilateral

__ sonographic appearance:

* very depending on elements
* cystic mass
* complex mass
* fluid/fluid level
* ‘plug’ - echogenic mass within a cyst (caused by hair, teeth, or fat)
* ‘tip of the iceberg’ - very echogenic anterior component and a posterior shadow (due to the high attenuation of the calcified materials within)
* ‘mesh’ - small hyperechoic lines/dots within a cyst (caused by small hairs within the cystic fluid)

teratoma US

__ - echogenic mass within a cyst (caused by hair, teeth, or fat)

dermoid plug

__ - a very echogenic anterior component and a posterior shadow (due to the high attenuation of the calcified materials within)

tip of the iceberg

__ - small hyperechoic lines/dots within a cyst (caused by hairs within the cystic fluid)

dermoid mesh

__ - found in women in the 5th and 6th decades of life; ranging in size from 5 to 16 cm

fibromas

__ sonographic findings:

* solid
* hypoechoic with attenuation
* > 5 cm
* 50% will have ascites

fibromas US

__ - triad of benign pelvic mass, hydrothorax, ascites

meigs syndrome

__ - estrogen-producing ovarian mass

thecomas

thecomas are __ and can measure up to __ cm in diameter

unilateral, 30

thecomas occur 70% in __ women

postmenopausal

in thecomas, estrogen stimulates __, pt may complain of postmenopausal bleeding

endometrium

in thecomas, estrogen stimulates estrogen, pt may complain of __

postmenopausal bleeding

__ sonographic appearance:

* hypoechoic
* solid mass with attenuation

thecomas US