Ovarian Disorders and Functional Ovarian Cysts

Ovarian Disorders

• Adnexa refers to the area between the lateral pelvic wall or the top of the uterus.
• Evaluate ovarian disorders using TVUS/PUS, with TV/US being the best method.
• Ovarian issues in menopause should be considered cancerous until proven otherwise.

Functional Ovarian Cysts

• Functional ovarian cysts are asymmetrical or symmetrical and follow the menstrual cycle.
• Categorize ovarian cysts as high or low risk for cancer based on characteristics:
  • Low risk: anechoic, unilocular, fluid-filled
  • High risk: solid, nodular, thick septations
• Biomarkers for cancer suspicion: CA125, alpha-fetoprotein, beta HCG

Management of Ovarian Cysts

• For large cysts (> 8-10 cm), perform surgical removal (Sx).
• For recurrent cysts, prescribe oral contraceptives (OCP).
• For ruptured cysts:
  • Uncomplicated: observe, pain meds, rest
  • Stable with hemoperitoneum: hospitalize, fluids
  • Hemodynamically unstable with ongoing hemorrhaging: laparoscopy, cystectomy (preserve tissue)

Types of Ovarian Cysts

Follicular Cyst

• Cause: failed growth or rupture
• Characteristics: unilocular, smooth, thin-walled
• Symptoms: unilateral pain, asymptomatic or symptomatic if large
• Diagnosis: TVUS/PUS
• Treatment: repeat TVUS in 1-2 cycles, < 8 cm supportive, > 8 cm laparoscopy or laparotomy

Corpus Luteum Cyst

• Cause: failed degeneration
• Characteristics: slightly larger cyst with progesterone release > 14 days
• Symptoms: dull pain, secondary amenorrhea
• Diagnosis: TVUS/PUS
• Treatment: repeat TVUS in 1-2 cycles, < 8 cm supportive, > 8 cm laparoscopy or laparotomy

Corpus Hemorrhagium

• Cause: failed degeneration
• Characteristics: rapidly increasing cyst with hemorrhage
• Symptoms: acute pain in luteal phase, potential hypovolemia
• Diagnosis: TVUS/PUS, CT scan
• Treatment: repeat TVUS in 1-2 cycles, < 8 cm supportive, > 8 cm laparoscopy or laparotomy

Theca Lutin Cyst

• Cause: pregnancy, trophoblastic disease, induced ovulation with clomiphene and gonadotrophin
• Characteristics: bilateral pain
• Symptoms: bilateral pain
• Diagnosis: TVUS/PUS
• Treatment: repeat TVUS in 1-2 cycles, < 8 cm supportive, > 8 cm laparoscopy or laparotomy

Ovarian Torsion

• Definition: complete or partial rotation of the ovary on its ligaments and vascular supply, an emergency situation
• Risk factors: mobile ovarian mass > 5cm, history of torsion
• Symptoms: abrupt severe pelvic pain, radiating, diffuse or unilateral, N/V/fever, +/- palpable mass, +/- hemorrhaging
• Work-up: pelvic US with doppler, beta hCG, CBC
• Diagnosis: direct visualization of torsion
• Treatment: laparoscopy with detorsion, salpingo-oophorectomy if cannot detorsion or concern for cancer
• Prevention: OCP to suppress cysts, oophoropexy

Polycystic Ovary Syndrome (PCOS)

• Definition: endocrine disorder with unknown etiology, altered LH and FSH ratio
• Symptoms: acne, hirsutism, oligomenorrhea or amenorrhea, infertility, trunk obesity, DM2, anxiety, depression, insomnia
• Physical exam: bilateral large smooth mobile mass, acanthosis nigrans
• Work-up: CBC, CMP, TSH, A1C, lipid, prolactin, LH/FSH, testosterone, TVUS/PUS (string of pearls)
• Diagnosis: need 2 of the following - irregular menses, biochemical or clinical evidence of hyperandrogenism, polycystic (12+ cysts on each ovary, sizing 2-9 mm, enlarged ovarian volume)
• Treatment: weight loss, OCP, statins, metformin, letrozole or clomiphene +/- metformin
• Goals: symptom relief, prevent endometrial cancer, decrease DM, decrease CV, induce ovulation if wanted pregnancy
• Complications: increased risk of metabolic syndrome, DM, CVD, dyslipidemia, endometrial hyperplasia, endometrial cancer, pregnancy complications

Hyperthecosis

• Definition: severe form of PCOS with extreme levels of testosterone causing virilization
• Symptoms: balding, clit enlargement, deep voice, remodeling of limb and shoulder girdle
• Treatment: BSO, gnRH agonist

Benign Tumors

• Definition: most common type of ovarian tumor
• Types: Epithelial, Germ, Stromal
• Benign Epithelial Cell:
  • Serous: high rate of cancer
  • Mucinous
  • Endometrioid
• Benign Germ Cell:
  • Most common type: cystic teratoma, mature teratoma, dermoid cyst, dermoid
  • Occurs in: reproductive years
  • Characteristics: bone, hair, teeth, sebaceous glands
  • Struma ovarii: functioning thyroid tissue
  • Symptom: asymptomatic, unilateral adnexal mass, mobile, nontender
  • Tx: Sx and serial US
• Benign Stromal Cell:
  • Solid tumor from sex cord of gonad
  • Types:
    • Sertoli-Leydig: androgen
    • Granulosa theca: estrogen

This quiz covers the evaluation and categorization of ovarian disorders, including functional ovarian cysts, and their characteristics. Learn about the importance of TVUS/PUS in diagnosis and cancer risk assessment.