Term
| What percentage of ovarian masses are functional in the child bearing years? |
|
Definition
|
|
Term
| Name and breifly describe congenital abnormalities leading to benign conditions of the ovary and tubules |
|
Definition
- congenital duplication or absence of an ovary
- Turner's (XO)
- Klinefelter's (XXY)
- Testicular feminization (XY gonadal dysgenesis)
|
|
|
Term
| Name the types of functional cysts. What is a functional cyst anyway? |
|
Definition
- Follicular
- Theca-lutein
- Haemorrhagic
- Luteomas of pregnancy
- PCOS (polycystic ovarian syndrome)
- If a follicle forms and then persists and is >3cm, it is defined as a funcitonal cyst
|
|
|
Term
| Describe the "RMI" for ovarian and tubular anomalies. What are some worrysome signs that a cyst may be malignant? |
|
Definition
- RMI is the risk of malignancy index, it takes into account: age, menopause, cyst characteristics, Ca125.
- Bad signs are if septums are present, if there are solid areas, if ascites is involved or if there are other masses
|
|
|
Term
| How would you diagnose a functional cyst? |
|
Definition
- pelvic exam: may be palpable in non-obese patients if they are bigger than 5-6 cm or so. Functional cysts will be mobile, unilateral and not associated with ascites
- Pelvic U/S can help differentiate between functional and neoplastic
|
|
|
Term
| How would you manage a functional cyst? |
|
Definition
- If they are reproductive age with <6cm cyst, wait and re-examine in 3 mo
- if > 6cm, feels solid or is fixed, perform U/S
- if painful, multilocular or paritally solid, surgical exploration with laparoscopy/laparotomy is indicated.
|
|
|
Term
- Describe a follicular cyst
|
|
Definition
- Most common ovarian cyst
- when the follicle fails to rupture
- Produces ESTROGEN (may cause sexual precocity, menstrual abnormalities or endometrial hyperplasia)
- lined by granulosa cells, theca cells or both
- rarely exceed 8 cm except in pregnancy
|
|
|
Term
|
Definition
- persistant corpus luteum
- secretes PROGESTERONE (may delay menses)
- associated with high hCG (causes unpleasant symptoms)
|
|
|
Term
| List the types of neoplastic (ovarian) tumors. How might you diagnose them? |
|
Definition
- Epithelial (serous, mucinous, endometroid, Brenner)
- Sex-cord stromal (granulosa-theca cell, fibromas)
- Germ cell
- Most asymptomatic unless torsion or rupture occurs
- bimanual exam, pelvic U/S, tumor makers (ex; Ca125 and hcG), laparoscopy
|
|
|
Term
| How would you treat a neoplastic ovarian tumor? |
|
Definition
- Take tube and ovary (USO - unilateral salpingo-oophorectomy)
- ovarian cystectomy (just take the tumor and leave the rest of the ovary)
- ascitic fluid must be sent to biopsy
|
|
|
Term
| Describe epithelial ovarian neoplasms |
|
Definition
- derived from mesothelium lining the peritoneal cavity
- develop into different types of tissue from the Mullerian tract:
- Serous: warrants removal cause they should be treated as precancerous! 70% benign, 20-25% malignant
- Mucinous: CAN GET MASSIVE. 85% benign, always take appendix so you don't get it there next
- Endometroid
- Brenner: rare and benign, cells look like transitional cells of the bladder
|
|
|
Term
| Describe sex-cord stromal tumors |
|
Definition
- Granulosa-theca cells tumors: feminizing (cause they can produce estrogen, causes mennorhagia, endometrial hyperplasia and precocious puberty in children) OR virilizing (those are the Sertoli-Leydig cell tumors that produce testosterone)
- Fibromas: solid smooth muscle tumor make of interlacing fibrocyte bundles. Benign but can cause ascites.
|
|
|
Term
| Describe germ-cell ovarian neoplasms |
|
Definition
- 60% of ovarian neoplams in kids
- benign cystic teratoma most common: ectodermal tissue that turns into sweat and sebaceous gands, hair follicles, teeth. All that tissue is benign. Some endodermal and mesodermal elements are present in rare forms.
|
|
|
Term
| How would you manage tubular anomalies? |
|
Definition
- pyosalpinc: aggressively treat with Abs.
- surgical excision may be needed
- hydrosalpinx may be managed conservatively if asymptomatic and salpingectomy is symptomatic
- benign growths excised via laparascopy
- MAKE SURE IT'S NOT AN ECTOPIC PREGNANCY!
|
|
|
