Questions and Answers
What is the evaluation method recommended for assessing ovarian issues?
Transvaginal ultrasound (TVUS) or pelvic ultrasound (PUS); TV/US is best
Which characteristics categorize ovarian cysts as high risk for cancer? (Select all that apply)
Functional ovarian cysts typically follow a menstrual cycle.
True
In cases of ovarian torsion, there is complete or partial rotation of the ovary on its ligaments and ________ supply.
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Match the benign tumors with their corresponding cell types:
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Study Notes
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
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Description
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.