OB Ovaries – Flashcards
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An ovary is generally considered abnormal if its volume is _____ the size of the contralateral ovary.
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twice
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In PCOS, the ovaries have a/an _____ shape.
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rounded
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Paraovarian cysts arise from the:
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broad ligament
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The most common benign tumor of the ovary is a/an:
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dermoid
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A benign adenoma containing multiple cysts is a/an:
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cystadenoma
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What statement about Meige's syndrome is false?
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It includes pleural effusions. 2. It is associated with fibroma. 3. It includes massive ascites. 4. It is associated with theca lutein cysts.
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Which of the following is a localized tumor of endometriosis most frequently found in the ovary, cul-de-sac, retrovaginal septum, and peritoneal surface of the posterior wall of the uterus?
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endometrioma
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When you are concerned about the possibility of pelvic cancer, what additional two things would you look for to help rule out or in that diagnosis?
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lymphadenopathy and ascites
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The patient complains of bloating and constipation and generalized malaise.The patient is 54 years of age and her GYN examine was inconclusive, but her doctor said something about a frozen pelvis. What is the most likely diagnosis after looking at the sonogram
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Serous Cystoadenocarcinoma
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Hyperstimulation of the ovaries will likely result in
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theca lutein cysts
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Metastatic lesions in the adnexa are more commonly associated with a primary
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gastrointestinal tract
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An adolescent patient presents with a history of severe acute right lower quadrant pain. Her last menstrual period was 2 to 3 weeks prior. A hypoechoic ovarian mass is identified on ultrasound. On the basis of this clinical history, the sonographic findings are most suspicious
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hemorrhagic cyst
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Large pelvic masses, whether benign or malignant, may cause____; therfore the _______ should be evaluated also:
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Urinary obstruction, kidneys
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Physiologic ovarian cysts are the most common cystic mass in women of child-bearing
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True
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The postmenopausal ovaries are usually enlarged
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false
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Krukenberg's tumor is
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a secondary carcinoma of the ovaries with promary in the gastrointestinal tract
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A large cyst of about 15-18 cm is situated in the broad ligament between the fallopian tube and ovaries with remnants of the wolffian body. This is most likely.
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paraovarian cyst
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The appearance of solid echo patterns (papillary projections) within a cystic pelvic mass suggests malignancy.
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True
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A mucinous cystadenoma is all of the following except:
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Thick with irregular walls and septations b. Large cystic mass with multilocular cystic spaces c. Most common cystic tumor d. Unilateral
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Which one of the following endocrine disorders is associated with
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Polycystic ovarian syndrome
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there is risk of torsion of the ovary if it greater than
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5 cm
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Normal ovarian volume
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mean9.8+/- 5.8 cc up to 22cc
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Precocious puberty can be caused by a tumor on where
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adrenal glands or ovary
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Tip of the iceberg is referring to
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solid tumors
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Best time to doppler the ovaries
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first ten days of cycle to avoid changes in blood flow during luteal phase
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Pulsatility index
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PSV - EDV / mean velocity
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Resistive Index
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PSV - EDV / PSV
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Normal values for doppler
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PI is 1.0 and RI .4
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Malignancy on doppler would be
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below normal value
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Benign disease on doppler would be
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above the normal value
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Follicular Cysts
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1. usually unilateral 2. thin-walled, translucent, have watery fluid, may porject above or within the surface 3. may grow 1-8 cm
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Corpus Luteum cysts
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1. filled with blood and cystic fluid 2. grow 1- 10 cm 3. may follow IUP/ ectopic
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Hemorrhagic cyst
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can happen in follicular but more common in corpus luteal cysts
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Appearance of hemorrhagic cysts on sono
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could look cystic as first(anechoic) then solid (light grey) , then cystic again depends when you view it. it could have blood in it then it could be resolving itself
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Theca- Lutein cysts appearane
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1. Large, bilateral , multiloculated
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Theca- Lutein cysts are associated with
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high levels of Hcg and 30% PATIENTS with trophoblastic disease
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Ovarian hyperstimulation syndrome
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complication of ovarian induction; fertility treatments
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Appearance of OHS
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1.large ovaries up to 10cm 2. ascites 3. pleural effusions 4. numerous thin walled cysts throughout periphery of ovary (theca-lutein cysts)
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Polycystic ovarian syndrome
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includes Stein-Leventhal syndrome (moon face) bilateral enlarges polycystic ovaries occurs in teens-20's endocrine inbalance Completely afertile
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PCOS looks like on sono
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string of pearls, same size follicles along periphery
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Peritoneal Inclusion cysts
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Lined with mesothelial cells Form when adhesions trap peritoneal fluid around ovaries (large ADNEXAL MASS
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Paraovarian cysts
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Simple can bleed or torse WOLFFIAN duct remnants
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Location of paraovarian cysts
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broad ligament
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Endometriosis
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functioning endometrial tissue is outside the uterus
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Where can this ectopic endometrial tissue be found?
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pelvis, ovary, fallopian tube, broad ligament, external surface of the uterus, scattered over the peritoneum, cul-de-sac- and even bladder
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Localized form of endometriosis consistinf of a mass
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endometrioma
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Endometrioma looks on sono
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well defined, unilocular or multilocular predominantly cysticmass diffuse homogenous, low level internal echoes
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Torsion of ovary happens more often in who
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children and younger females with mobile adnexa
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Which ovary is more likely to torse?
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right
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Sono signs of torse ovary?
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avascular hypoechoic enlarged ovary free fluid in cul-de-sac
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4ht leading cause of cancer death
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ovarian carcinoma
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60% of ovarian malignancies happen in what years
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40-60
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sono appearance of ovarian CA
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complex, cystic, or solid mass more likely cystic 20% bilateral
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Masses less than 5 cm
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benign usually
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Masses greater than 10 cm
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MALIGNANT
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Women who have had what have a greater risk of ovarian cancer?
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breast CA
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Risk factors for ovarian Ca
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increasing age, nulliparity, infertility, uninterrupted ovulation, and late menopause
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Ovarian cancer usually arises from what tumors?
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epithelial serous cystadenocarcinoma
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Clinical signs of ovarian CA
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vague ab pain, swelling, indigestion, frequent urination, constipation, and weight change
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Stage 1 cancer
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limited to ovary a. 1 ovary b. 2 ovaries c. ascites
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Stage 2 cancer
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limited to pelvis a. uterus/fallopian tubes b. other pelvic tissues c. ascites
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Stage 3
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limited to abdomen
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Stage 4
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beyond abdomen
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Two types of Epithelial Tumors
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serous ( most common) mucinous
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Benign tumor
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adenoma
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Malignant tumor
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adenocarcinoma
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When it is labeled fibroma
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50% is fibrous
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mucinous cystadenoma
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most common cystic tumor lined by mucinous elements of endocrevix and bowel
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when and what do they look like (mucinous cystednoma)
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ages 13-45 large 15-30 cm and up to 100 lbs
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sono findings of mucinous cystedoma
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mucinous gelatin-like septates no greater than 2mm thin walls multilocular unilateral
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mucinous cystadenocarcinoma
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bilateral pseudomyxoma peritoneum- fluid inside septation thick >2mm irregular thickwalls papillary projections
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sign of malignancy
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can not define borders especially superior bordet
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second most common benign tumor of ovary
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serous cystadenoma
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serous cystadenoma
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usually unilocular thin septations irregular borders occupies space given to them clear fluid (no echoes) smaller than mucinous
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Serous cystadenocarcinoma
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`loss of capsular definition frozen pelvis cystic structure with papillary projections vascularity
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Germ Cell tumors
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derived from primative germ cells of embryonic gonad
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the largest kind of germ cell tumor
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benign cystic teratomas
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95% of germ cell tumors are
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benign
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germ cell tumors are associated with what hormones
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elevated AFP and HcG
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germ cell tumors present themselves as
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mixed tumor with elements of two or three varieties of germ cell tumors
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Germ cell tumor appear
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unilateral 40% will calcify homogeneously solid, predominantly solid, predominantly cystic
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Dermoid tumor/ Teratoma
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small-40 cm unilateral contains fatty, sebaceous material, hair, cartilage, bone, teeth
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symptoms of teratoma
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irregular menses pelvic pressure
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Dermoid tumors appear
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1.completely cystic mass 2. cystic mass with very echogenic nodule along mural wall representing "dermoid plug" 3. fat-filled level 4. high-amplitude echoes with shadowing (teeth, bone) 5. complex mass with internal septations
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Iceberg sign
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sound can't penetrate through in dermoid tumors
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immature teratomas
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occur between 10-20 yrs old rapid growing solid malignant tumors with many tiny cysts AFP elevated in 50% of patients unilateral
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What tumor are most common in pregnant women?
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dysgerminoma serous cystadenoma
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Stromal tumor
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solid adnexal massses that arise from sex cords of embryonic gonadal and/or ovarian stroma
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Fibroma and Thecoma
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arise from ovarian stroma
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Thecoma
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usually benign unilateral shows signs of estrogen production
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Fibroma
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not associated with estrogen production found in postmenopausal women
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Meig's syndrome (fibroma)
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triad: ovarian tumor ascites pleural effusion
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sono appearance of fibroma
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unilateral hypoechoic mass with posterior attentuation
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Granulosa
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feminizing neoplasm composed of cells that resemble graafian follicle
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Granulosa happens to who?
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postmenopausal women most common 50% reproductive 45%
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most common hormone active tumor of the ovary?
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granulosa
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Least common of GYN malignancies
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carcinoma of the fallopian tube