Ovaries – Flashcard
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Primordial gern cells originate in yolk sac and migrate to induce?
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Gonadal Formation
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Primitive sex cords differentiate into either ovaries or testes at what week?
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7th
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What is the adult length of the ovary?
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3 cm L
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How do we calculate the volume of the ovary?
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L X W X H X 0.523
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Prepubertal volume of the Ovary is?
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3 cm^3
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Menstrual volume of the ovary is?
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9.8 cm^3
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Post menopausal volume of the ovary is?
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5.8 cm^3
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Attaches the inferior margin of the ovary to uterine cornu?
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Ovarian ligament
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Suspends superior ovary from the posterior/lateral wall?
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Infundibulopelvic ligament
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Double layer of the peritoneum extending from posterior surface of broad ligament?
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Mesovarium
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What are the four ovarian layers?
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Germinal epithelium Fibrous capsule (tunica albuginea) Ovarian parenchyma Central Medulla
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Which layer is the thin layer that surrounds the tunica albuginea?
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Germinal epithelium
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What layer of ovary is the dense connective tissue that covers the cortex?
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Fibrous capsule (tunica albuginea)
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Which layer is the cortex of the ovary?
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Ovarian parenchyma- cortex
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Which layer of ovary holds all the follicles?
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Ovarian parenchyma (cortex)
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What follicles grow each month?
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Graafin
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How many follicles becomes the dominant follicle?
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One
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The dominant follicle can get to what measurement before before it ruptures?
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1.8-2.4 cm
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What is pain associated with ovulation called?
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Mittelschmerz
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With pregnancy what happens to the corpus luteum and what is it then called?
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Enlarges and becomes corpus luteum cyst of pregnancy
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Without pregnancy what happens to the corpus luteum and what is it then called?
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Shrinks(involutes) and becomes corpus albicans
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What pelvis are ovaries located? True pelvis or false pelvis?
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True
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What fossa do ovaries sit in?
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Waldeyer's Fossa
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What two arteries supply ovaries?
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Adnexal branch of UT artery Ovarian artery
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Left ovary vein blood supply drains into?
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Left renal vein then IVC
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Right ovary vein blood supply drains into?
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directly to IVC
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Normal doppler waveform will include what resistance?
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High resistance- multiphasic
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What happens to the flow of the dominant follicle for ovarian doppler?
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Increased diastolic flow
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The abnormal resistive index (RI) for ovaries should be?
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less than or equal to 0.4
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The abnormal Pulsatility index (PI) for the ovaries should be?
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less than or equal to 1
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Is ovarian doppler a sensitive indicator of malignancy?
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No
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Cancer of the ovary would show what waveform?
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Low resistant- constantly wants blood
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Neovascularity of ovarian cancer lacks what?
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Muscle make-up of normal vessels
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What are the types of ovarian functional cysts? (4)
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Follicular Corpus luteum Hemorrhagic Theca lutein
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The ovarian cyst usually regresses if its what measurement?
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;5cm
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Mature follicle that fails to ovulate or fails to shrink postovulation is what kind of cysts?
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Follicular cysts
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What size are the follicular cysts?
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2-20 cm (variable)
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If the follicular cyst regresses or spontaneously pop what should you expect to see?
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Cul de sac fluid
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No involution of corpus luteum would result in what kind of cyst?
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Corpus luteum cyst
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Corpus luteum cysts are usually what measurement?
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;4 cm
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Corpus luteum cysts are unilateral or bilateral?
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Unilateral (only comes from side that just ovulated)
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What are corpus luteum cysts prone to?
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Hemorrhage/Rupture
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The corpus luteum cyst will create what kind of doppler image?
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Ring of fire (complex echo pattern)
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Corpus luteum cysts that happen in pregnancy produce what?
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Progesterone
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The corpus luteum cyst will resolve when?
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Week 16 of pregnancy
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What type of cyst occurs with: Variable echogenicity Debris Septa (weblike) (PROBABLY MOST IMPORTANT) Enhancement (from fluid) Cul de sac fluid (as result of ovulation or cyst popped)
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Hemorrhagic Cyst
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What cysts is associated with high levels of hCG?
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Theca lutein cysts
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Molar pregnancy can become?
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Cancerous
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What is the largest of the functional cysts?
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Theca lutein
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Are theca lutein cysts unilateral or bilateral?
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Bilateral
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GTD is aka?
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Molar pregnancy (Gonadal trophoblastic disease)
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Abnormal pregnancy tissue takes over uterus?
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Molar pregnancy (GTD)
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Theca lutein cyst had what kind of walls?
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Thin walls
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What syndrome is a complication of ovulation induction?
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Ovarian Hyperstimulation Syndrome (OHSS/ OHS)
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What are the size of the ovaries and cysts associated with OHSS?
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large ovaries/ large cysts
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Which syndrome is an endocrine disorder and does not ovulate?
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Polycystic ovary syndrome (PCOS)
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What are the size of ovaries and cysts associated with PCOS?
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large ovaries/ small cysts (string of pearl)
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What would there be a deffisciency of in PCOS? (2)
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FSH LH (because you do not ovulate with this syndrome)
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Those with Stein leventhal syndrome typically experience what symptoms? (Name the two most important)
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Infertility (cyst fail to become dominant follicle) Hiruitism (abnormal facial growth)
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PCOS will happen unilaterally or bilaterally?
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Bilaterally
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Ovarian remnant syndrome usually occurs with what surgery?
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Salpingoophrectomy
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What syndrome has residual tissue that produces functional cysts?
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Ovarian remnant syndrome
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Most common gonadal dysgenesis?
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Turners syndrome (A chromosomal disorder in which a female is born with only one X chromosome)
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Turners syndrome will effect what chromosome?
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45, XO
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People who have turners syndrome may have complete or partial absence of?
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Ovary
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If you find ovaries on a patient with turners syndrome, what may you not find?
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Follicles
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Women who have turners syndrome will have menorrhea or amenorrhea?
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Amenorrhea (no periods)
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What syndrome will you see streak gonads, no follicles or ovaries, and women who have amenorrhea?
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Turners syndrome
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Cysts that are caused by surgery and adhesions trap peritoneal fluid around the ovaries?
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Peritoneal inclusions cysts
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Are peritoneal inclusion cysts ovarian in nature?
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No
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A cyst with: Multioculated (multiple pockets) Cystic adnexal mass Presence of intact ovary within margin of cyst (PROBABLY MOST IMPORTANT)
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Peritoneal Inclusion Cysts
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Cysts that happen from embryonic remnant?
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Paraovarian cyst
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Why do paraovarian cysts not undergo cyclic changes?
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Not ovarian in nature - separate from ovary
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Paraovarian cysts typically occur in what aged women?
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30-40 yrs old
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What is a chocolate cyst?
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Endometrioma
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Localized endometriosis is called?
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Endometrioma
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Who usually gets endometriomas?
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Those who suffer from endometriosis
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Ovaries typically have what kind of resistance?
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High
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PID stands for?
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Pelvic inflammatory disease
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Ovary rotates on its pedicle?
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Ovarian torsion
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What time of life does torsion normally occur? (2)
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Childhood Adolescent
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Ovarian torsion is associated with what kind of masses?
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Adnexal
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What side does ovarian torsion normally occur?
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Right side
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Cystic teratoma is AKA?
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Dermoid cysts
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What is the most common germ cell tumor?
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Cystic teratoma (Dermoid cysts)
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What is the most common ovarian tumor?
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Cystic teratoma (Dermoid cysts)
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Do cystic teratomas usually turn malignant?
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No
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A cyst that: Fat fluid level Anechoic mass w/ echogenic foci (teeth?) Calcification May mimic bowel gas Tip of iceberg sign (PROB most important)
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Cystic Teratoma
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What is the more common epithelial tumor? (serous cystadenoma or mucosal cystadenoma)
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Serous cystadenoma
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What is the second most common benign tumor?
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Serous cystadenoma
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The key for serous cystadenomas is?
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Thin septations
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What is the less common cystadenoma?
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Mucinous cystadenoma
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Whats larger, serous cystadenoma or mucinous cyst adenomas?
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Mucinous cystadenoma
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If we saw a thin walled septated cyst and it was multilocular, what would we guess it is?
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Serous cystadenoma (because it is more common)
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Benign epithelial tumor that is uncommon that occur in 1.5-2.5% of ovarian neoplasms that are usually unilateral is?
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Brenner tumor
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The key about Brenners tumor is that its associated with?
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Ipsilateral neoplasm (something else thats happening on that same ovary ex: Dermoid and Brenners on same ovary)
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Benign stromal tumors? (2)
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Fibroma Thecomas
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Meigs syndrome will usually occur when the patient has either? (3)
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Fibroma, Brenners tumor Massive Ascites Pleural effusion
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How often do meigs syndrome occur?
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Rare
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Is meigs syndrome malignant?
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No
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What kind of tumor is a thecoma?
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Stromal
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Thecomas produce what hormone?
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Estrogen- more feminizing features
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What symptoms do women get in thecomas?
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Abnormal uterine bleeding
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What are Sertoli leydig cells called?
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Androblastomas
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A rare type of ovarian tumor in which the tumor cells secrete a male sex hormone. This may cause virilization (the appearance of male physical characteristics in females)?
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Androblastoma aka Sertoli leydig cell
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Whats important to know about androblastomas?
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Malignant potential!
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Cell tumor that sends out estrogen into body and more common in postmenopausal women?
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Granulosa cell tumor
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Granulosa cell tumor cause what symptoms? (3)
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Early onset of puberty Bleeding Full breasts
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If granulosa cell tumors get to large they can torse and cause what syndrome?
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Meigs
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What does arrhenoblastoma send out into body?
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Testosterone
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About out of how many women develop ovarian cancer?
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1 in 70
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Leading cause for GYN malignancy?
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Ovarian cancer
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Ovarian cancer is usually called?
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Silent cancer
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Ovarian cancer is most common in?
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Postmenopausal
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Any ovarian cancer are what in nature?
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90% Epithelial tumors
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What is a key to differnitiate ovarian cancer?
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Thick walls
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What stage of cancer is confined to just ovary?
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Stage 1
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What stage of cancer has a lesion to one or both ovaries with extending into pelvis?
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Stage 2
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What stage of cancer effects both ovaries with intraperitoneal mets, nodes, mental/small bowel involvment?
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Stage 3
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What stage of cancer effects one or both ovaries with distant mets, include liver, pleural effusion?
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Stage 4
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What are the risk factors for ovarian cancer? (6)
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55-59 Hx of breast cancer Family hx of ov cancer hx of colon Ca Nulliparous Increased years of ovarian activity (OHSS)
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What can protect you from ovarian cancer? (5)
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Pregnancy Lactation Birth control (OCP's) Short reproductive span (period later than life) Early menopause
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What is one lab they can do on women on ovarian cancer?
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CA125
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Is CA125 a good indicator to determine ovarian cancer?
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No, but still good to do it
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What is the treatment options for ovarian cancer? (3)
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Surgery Radiation therapy Chemotherapy
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What is the 5 year survival rate of ovarian cancer?
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20-30%
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What is the survival rate for stage 4 ovarian cancer?
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5%
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Most common epithelial cancer?
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Serous cystadenocarcinoma
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What is a key for muctinous cystadenocarinoma?
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Septations that are thick
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How do they determine if its serous cystadenocarcinoma or mucinous?
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Surgery
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Least common epithelial tumor is?
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Endometroid tumor
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Endometroids are associate with? (2)
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Endometriosis Endometrial cancer
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Endometriod tumor have what kind of walls?
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Thick
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Can teratomas become malignant?
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Yes but rare
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Teratomas are comprised of all?
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Germ cell layers
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Teratoma labs are? (3)
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HCG AFP (alphafetalprotein) LDH (lactate dehydrognase)
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Most common pediatric ovarian mass?
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Dysgerminoma
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Young women mass known as?
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Dysgerinoma
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Dysgerminoma grow slow or rapid?
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Rapid
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Mets is unilateral or bilat?
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Bilat
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Mets mimics what?
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Stage I and II Ovarian cancer
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Specific type of ovarian met that contains signet ring cells and is usually from a gastric primary cancer?
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Krunkenberg tumor
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Krunkenberg tumors may be what shaped?
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Kidney shaped ovary
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Krunkenberg tumors are small or big?
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Big (huge)
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For ovarian doppler, what is recommended/used? (2)
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PI RI
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How do we want to get doppler, TA or TV?
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TV preferred because better resolution
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Normal ovarian impedance is low or high?
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High
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Ovarian malignancy would show on doppler what kind of impedance?
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Decreased (low resistance)
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What are other reasons the PI may be low other than ovarian malignancy? (4)
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Inflame process Germ cell tumors Corpus luteum cysts Endometriomas
