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Author:
rbeacr
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120427
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ob
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2011-12-03 15:07:50
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pathology of ovaries
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  1. Ovaries
    Homogenous texture, change with cycle LH&FSH, volume 8cc or less after menopause, Abnormal size if volume more than doubled, shrinks after menopause, normal volume up to 22 cc, mature oocytes til ovulation, synthesize androgens and convert to estrogen, produce progesterone after ovulation until 12wks preg, 3-5x2x2
  2. Follicular cyst
    • Most common ovarian cyst,fluid in non dominant follicle is not reabsorbed
    • unilateral, asympt, usually <2cm- may grow 1-8cm, regress sponateneously
  3. Simple Cysts
    • follicle enlarges to 24mm... ovulation... corpus luteum (1-10cm)- functional cyst.
    • Surgery for post menopausal cysts >5cm or sepations/solid nodules
  4. Common cystic or homogenous masses
    • follicular cyst
    • corpus lutem of pregnancy
    • cystic teratoma
    • para ovarian cyst
    • hydrosalpinx
    • endometrioma
    • hemorrhgic cyst
  5. Common complex cysts
    • Cystadenoma
    • dermoid cyst
    • tubo ovarian abcess
    • ectopic pregnancy
    • granulosa cell tumor
  6. Common solid masses
    • solid teraroma
    • adenocarcinoma
    • arrhenoblastoma
    • fibroma
    • dysgerminoma
    • torsion
  7. serous and muscionous- more common benign? malignant?
    • muscionous more common benign
    • serous cyst adenocarcinoma more commone malignant
  8. malignant tumors
    more sonographically complex with ascites,papillae, thick sepations, solid echogenic,irreg walls, solid nodules, usually 5cm or > to be surgically removed
  9. Pulsatility Index (PI)
    PS-ED/mean velocity
  10. Resistive Index (RI)
    PS-ED/PS
  11. Functional cysts
    • normal function of ovary
    • follicular, corp lut, hemorrhagic, theca lut
    • less than 5 cm
  12. Corpus Luteum cysts
    hemorrhage in mature corpus luteum, usually <4cm, 1-10cm, maintain IUP til 12 wks, pain- mimic ectopic
  13. Hemorrhagic cyst
    in follicular or more common corp lut, may mimic solid lesion, mimic rupture ectopic
  14. Theca-Lutein cysts
    largest functional cyst, bilateral, multi loculated, high hCG, associated w/ gestational trophobastic disease, nausea vomiting
  15. Ovarian Hyperstimulation syndrome (OHS)
    • Mild- pelvic discomfort, Enlarge ovaries but less than 5cm
    • Severe- severe pelvic pain, enlarged ovaries <10cm
    • Many large thin walled cysts inperiphery of ovary
  16. Polycystic Ovarian Syndrome (PCOS)
    • Stein Leventhal syndrome
    • infertile, oligomenorrhea, hirsutism, anovulation, imbalence of low FSH high LH, round ovaries with increased #follicles bilateral, string of pearls,
  17. Ovarian Remnant syndrome
    history of bilateral oopherectomy, residual ovarian tissue left behind and become functional and produces cysts
  18. Peritoneal Inclusion cysts
    adhesions trap peritoneal fluid around ovaries, multiloculated, usually in women:premenopausal women with abd surgery, trauma, PID, endometriosis
  19. Paraovarian cysts
    Arise from broad ligament mesothelial or paramesothelial in origin, 30-40s, anywhere in adnexa, size does not change with horomonal cycle
  20. benign cysts in fetuses and adolescents
    small simple cysts in fetus from maternal horomones, premenarchal- small follicles, rarely sign of precocious puberty
  21. simple cysts in post menopausal women
    ok if <5cm, ovaries should not be palpable, only normal size with HRT
  22. endometriosis
    • functioning endometrial tissue outside uterus
    • diffuse- within peritoneum
    • localized- (endometrioma)
    • bilat or unilat, may see fluid level
  23. ovarian torsion
    partial or complete roatationof ovary, usually childhood adolescence, produces enlarged edematous ovary >4cm, absent blood flow
  24. Ovarian Carcinoma
    Kills more than uterine and cervix combined, 4th leading cause of cancer death, 1 in 70 women get oc, 60% 40-60 yrs, Peri & post men, usu. detected stage II or III (50%), ascites & lymphadenopathy, predominantly cystic, vascular, incresed w/ breast or colon cancer, strong fact is fam hist or breast cancer,no children/infertile, late menopause
  25. Cancer Stages
    • I- limited to ovaries
    • II- limited to pelvis
    • III- limited to abdomen
    • IV- liver- beyond abdomen
  26. Surface epithelial-stromal tumors
    • gyn tumors that arise from surface epithelium and cover ovary and underlying stroma
    • 65-75% neoplasms
    • 80-90% ovarian malignancies
    • Most common serous and muscinous
  27. Mucinous Cystadenoma
    • Most common cystic tumor, benign
    • Epithelial tumor (benign more common than serous)
    • can be very large and fill pelvis and abdomen
    • usually benign and unilateral
    • multilocular
    • benign more common than malignant
  28. Mucinous Cystadenocarcinoma
    • bilateral, lose sup border
    • large,likely to rupture, mucoid ascites
    • thick irregular walls, papillary projections and sepations
    • if ruptures assoc with pseudomyxoma peritoneum (mass ascites)
  29. Serous Cystadenoma
    • Second most common benign tumor after dermoid
    • usually unilateral
    • thin sepations, multilocular
    • smaller than mucinous
    • frozen pelvis
  30. Serous Cystadenocarcinoma
    • More common than muscinous cystcarcinoma, lose sup. border
    • 60-80% all ovarian carcinomas
    • smaller than muscinous
    • irregular borders, papillary projections, calcifications, septations, ascites, mets to liver, lymphnodes, lungs
  31. Other epithelial tumors
    • 1. Endometroid
    • 2. Clear Cell (mullerian duct origin)
    • 3.Brenner (transitional cell) uncommon
  32. Germ Cell Tumors
    • Derived from primative germs cells of embryonic gonad
    • 95% are benign cystic teratomas
    • rare, usually adolescents
    • mixed tumors
    • associated with elevated AFP and high hCG
    • unilateral
  33. Teratoma
    Dermoid Tumors
    • germ cell
    • Most common ovarian neoplasm
    • benign with malignant potential
    • unilateral round/oval mass
    • 80% child bearing age
    • 3 germ layers: ectoderm, mesoderm, endoderm
    • teeth, bones, fat, cartilege
    • tip of iceberg shadowing/conf. w/ bowel
  34. Immature teratomas
    • germ cell
    • uncommon
    • young girls 10-20 yrs
    • rapidly growing, solid malignant
    • AFP elevated
    • unilateral
  35. Dysgerminoma
    • Rare malignant germ cell
    • solid mass in women less than 30 yrs
    • along with serous cystadenoma-most common neoplasms in pregnancy
    • hyperechoic solid with hemorrage and necrosis, speckled calcification
  36. Endodermal sinus tumors
    • germ cell
    • rare rapidly growing also called yolk sac
    • women under 20 yrs
    • unilateral
    • increased AFP
    • 2nd most common malignant germ cell neoplasm after dysgerminoma
  37. Stromal tumors
    • sex cord stromal tumors are solid adnexa mass from embryonic gonadal or ovarian stroma2% ovarian malignancies
    • Thecoma and fibroma most common
    • hypoechoic
  38. Fibroma and Thecoma
    • mostly theca cells - thecoma
    • benign,unilateral,postmenopausal, estrogen production

    • mostly fibrous cells- fibroma
    • Meigs syndrome- PE, ascites, solid tumor, unilateral, calcified
    • 30yrs old
  39. Granulosa
    • Feminizing neoplasm
    • cells resembling graffian follicle
    • most common horomone active estrogenic tumor
    • more common after menopause
    • precocious puberty
    • may torsion
    • malignant transformation rare
  40. Sertoli-Leydig Cell Tumor
    • Androblastomas- rare
    • women under 30 yrs
    • unilateral
    • malignant in 10%
  41. Arrhenoblastoma
    • Masculizing horomone
    • peak incidence in 25-45 yrs
    • Amenorhea and infertility
    • malignant transformation in 22%
    • unilateral 2-30 cm
  42. metastatic disease
    • ovaries more involved in mets than any other pelvic organ
    • arise from breast, GI, pelvic organs (lymphatic spread)
    • bilateral, ascites, "moth eatten" cystic pattern (necrotic)
  43. Krukenberg's tumor
    • mets to ovary from bowel,GI tract, GB, biliary, pancreas
    • solid
  44. Carcinoma of fallopian tubes
    • lease common of gyn malignacies
    • postmenopausal women
    • usually the distal end
    • Rare
    • sausage shape complex mass
  45. Other pelvic masses
    • pelvic kidney
    • omental cyst
    • impacted feces
    • distended bladder
    • hydroureters
    • colon cancer/masses
    • ectopic pregnancy

    identify uterine connection and search for ovary

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