Ob-Chap 47: Ovarian And Adnexal Disease

Front 1

the first part will be all ...

Back 1

dr. trankle's lecture, then i will also be adding from the book for my own benefit, as i learn better this way! enjoy.

Front 2

__ includes all structures between the lateral pelvic wall and the cornual region of teh uterus. Includes the ovaries, fallopian tubes and the connective tissue surrounding them...this is the ???

Back 2

adnexal area

Front 3

what are the most common urologic disorders?

-upper uti
-lower uti
-both
-neither

Back 3

both upper an lower uti's

Front 4

in the premenarchal age group the ovaries are....?

-palpable 1/2 the time
-easily palpable
-not palpable

Back 4

not palpable

Front 5

in the reproductive age group the ovaries are......?

-palpable all the time
-palpable 1/2 the time
-not palpable

Back 5

palpable 1/2 the time

Front 6

why is ovarian CA usually caught late in the disease process?

-have a palpable mass
-usually no symptoms at all
-severe cmt

Back 6

usually no symptoms until it is very late in the disease

Front 7

if a woman is having intermittent abnormal vaginal bleeding, does that indicate adnexal disease?

-usually
-not usually

Back 7

not usually adnexal

Front 8

what is the 1st test to do when evaluating someone for ovarian or adnexal disease?

Back 8

pregnancy test

Front 9

what is pain with periods, and that pain does not go away with OCP's, ???

-endometritis
-endometriosis
-PID

Back 9

endometriosis

Front 10

what are the typical causes of PID?

Back 10

GC or chlmydia

Front 11

what are 5 non-neoplastic causes of adnexal disease?

Back 11

ectopic pregnancy
PID
endometriosis
urinary problems
GI problems

Front 12

what are urinary dx/dx of ovarian/adnexal disease?

Back 12

uti
lithiasis
pelvic kidney

Front 13

What should be included in your GI dx/dx for ovarian/adnexal disease?

Back 13

appy
IBS
IBD
diverticulitis
constipation
colon CA

Front 14

do OCP's shrink ovarian cysts?

Back 14

no they don't, but prevents new cysts from forming. and they can shrink the ovaries themselves

Front 15

when do ovarian cysts tend to rupture?

-3-5 days prior to ovulation
-at or right after ovulation
-right before menses

Back 15

at or right after ovulation

Front 16

which is the best diagnostic test to evaluate the ovaries?

-CT
-ultrasound
-MRI
-laparoscopy

Back 16

ultrasound

Front 17

do OCP's "shrink" the ovaries?

Back 17

yep

Front 18

how often are ovaries palpable in the reproductive age woman?

-not palpable
-always palpable
-palpable 1/2 of the time

Back 18

1/2 of the time

Front 19

during a pelvic exam you should describe what specifically about the ovaries?

Back 19

-size (as a fruit)
-consistency
-mobility

Front 20

are malignancies usually fixed or mobile?

Back 20

fixed usually

Front 21

t/f

hormonal contraceptives make ovaries senescent, therefore they may not be palpable.

Back 21

true

Front 22

what % of postmenopausal ovarian masses are malignant?

-10%
-25%
-40%
-50%

Back 22

25% are malignant

Front 23

if a postmenopausal woman has a <5 cm ovarian cyst on u/s, how should you treat it.?

-refer to ob/gyn for removal
-get a CT
-watch with serial u/s

Back 23

watch with serial u/s

Front 24

what % of reproductive age ovarian masses are malignant?

-2%
-5%
-10%
-15%

Back 24

10% are malignant in the reproductive age woman

Front 25

what is a theta lutein cyst?

Back 25

a corpus luteum cyst that can occur after ovulation and persist during pregnancy

Front 26

what is a potential complication of a theta luteum cyst?

Back 26

can bleed into itself causing a hemorrhagic cyst

Front 27

what is the most common type of ovarian cyst?

-malignant
-senescent
-functional ovarian cyst
-non functional ovarian cyst

Back 27

functional ovarian cyst

Front 28

functional ovarian cysts arise from __ ovarian function.

-normal
-abnormal

Back 28

normal

Front 29

t/f

functional ovarian cysts are suppressed with OCP's

Back 29

true

Front 30

what type of OCP's work better in the suppression of functional ovarian cysts?

-monophasic
-biphasic
-triphasic

Back 30

monophasic

Front 31

if a woman is pregnant and has symptomatic ovarian cysts when could you address them?

-immediately
-6 weeks gestation
-12 weeks gestation
-20 weeks gestation

Back 31

12 weeks gestation

Front 32

__ that do not rupture due to lack of ovulation can enlarge and throw periods off.

-ovarian
-follicular
-non-follicular

Back 32

follicular

Front 33

__ cyst is lined with granulosa cells and clear straw colored fluid which is rich in estrogen and can grow as large as 5 cm.

-ovarian
-follicular
-estrogenic

Back 33

follicular

Front 34

if a pt. is found to have a functional ovarian cyst what is the workup at this point?

Back 34

pelvic u/s and recheck in 6 weeks for resolution

Front 35

rupture of an ovarian cyst can cause acute pain and free fluid in the __ on u/s

-cervix
-adnexa
-posterior forchette
-cul de sac

Back 35

cul de sac

Front 36

what are the 4 types of functional ovarian cysts?

Back 36

follicular
corpus luteum
theca lutein
hemorrhagic

Front 37

what does the u/s tell you about an ovarian cyst?

Back 37

simple or complex

a hemorrhagic may have debris or internal echoes

a funcitonal cyst dose not have papillary projections (into the cyst cavity)

Front 38

papillary projections from an ovarian/adnexal lesion are suspiscious for what process?

-std
-hiv
-malignancy
-hpv

Back 38

malignancy

Front 39

funcitonal ovarian cysts are typically what size?

1-2 cm
3-5 cm
> 5 cm

Back 39

3-5 cm

Front 40

t/f

benign ovarian neoplasms will usually resolve on their own.

Back 40

false; they are not going away

Front 41

what are the 3 sub types of BON? all but 1.

-germ cell
-stromal cell
-endothelial cell
-epithelial cell

Back 41

endothelial cell is not one, and

epithelial cell are the most common

Front 42

__ are more common in all age groups than malignant tumors.

Back 42

BON

Front 43

a ballon filled with H2O, that is probably straw colored is what type of cyst?

-complex
-simple

Back 43

simple

Front 44

a cyst that may have debris or internal echoes are also called?

-simple
-complex
-hemorrhagic

Back 44

hemorrhagic

Front 45

a cyst with walls that is divided with possible debris is a ?

-simple cyst
-hemorrhagic cyst
-complex cyst

Back 45

complex cyst

Front 46

papillary projections in a cyst are suspicious for ??

-infection
-complexity
-malignancy

Back 46

malignancy

Front 47

what are the 4 types of benign epithelial neoplasms?

Back 47

serous cystadenoma-looks like a simple cyst that keeps getting bigger
mucinous cystadenoma-filled with mucoid material
endometrioid (endometrioma)-lined w/ well differentitated endometrial glandular tissue (endometrial cells in pelvis)
brenner cell tumor-rare, solid and small, more common inolder women, rarely malignant

Front 48

if an endometrioma is filled with icky colored old blood, how is it getting there?

Back 48

menses bleed into the cyst which makes it icky looking

Front 49

does endometriosis cause an elevated CA 125?

yes or no

Back 49

yes

Front 50

a Dermoid is what type of tumor?

-epithelial cell
-germ cell
-stromal cell

Back 50

benign germ cell neoplasm

Front 51

a benign cystic teratoma in which 80% are seen during the reproductive age, that is filled with well differentiated tissue from all embryonic germ cell layers that may contain teeth hair and the like are known as what ?

-dermoid (benign germ cell neoplasm)
-benign stromal cell neoplasm
-malignant ovarian neoplasm

Back 51

benign germ cell stroma-dermoid

Front 52

which type of solid mass is composed of sex cord stroma of the developing gonad?

-benign germ cell neoplasm
-benign stromal cel neoplasm
-benign epithelial neoplasm

Back 52

benign stromal cell neoplasm

Front 53

if there is a presence of female gonadal tumors these are called?

-sertoli-leydig cell tumors
-granulosa theca cell tumors

Back 53

granulosa theca cel tumors

Front 54

if there is a male type gonadal tumor, it is called?

-sertoli-leydig cell tumor
-granulosa epithelia neoplasm

Back 54

sertoli-leydig cell tumor

Front 55

sertoli-leydig cell tumors have the potential to change the mom in what ways?

Back 55

cause virilizing changes as clitoromegaly, hirstuism, acne, voice changes, male pattern baldness

Front 56

do benign stromal cell neoplasms have the potential to become malignant?

Back 56

yep, they both do. also both have a gradual onset of the course of months

Front 57

what is the epidemiology of stromal cell neoplasms?

Back 57

both produce hormones (estrogen and testosterone)
occur in all age groups
both have malignant potential

Front 58

which type of tumor is seen usually in older women, is small, solid, does not produce hormones, is an ovarian fibroma, and can cause ascites and right hydrothorax?

Back 58

meigs syndrome

Front 59

is there a screeening test for malignant ovarian neoplasms? and what is it?

Back 59

no, there is not

Front 60

which of the following: is the 3rd most common gyn malignancy, the 5th most common CA in women, has the highest mortality rate among gyn CA's, most commonly occurs in the 5-6th decades, has no good method of screening, is somewhat familial in which may improve survival, PCOS increases risk of epithelial tumors, and OCP decreases risk of epithelial tumors......wow, what is it?

-benign epithlial neoplasm
-malignant ovarian neoplasm
-stromal cell neoplasm

Back 60

malignant ovarian neoplasms

Front 61

how is ovarian CA spread?

Back 61

primarily by direct extension in the peritoneal cavity, then lymphatic and hematogenous (epithelial tumors)

Front 62

which method of spread is the most destructive?

-direct extension in the peritoneal cavity
-lymphatic spread
-hematognous spread

Back 62

direct extension in the peritoneal cavity

Front 63

why do most women have advanced disease at presentation and diagnosis?

Back 63

there is no screening test
many women have no symptoms until advanced disease state is present

Front 64

what is the one tumor marker for serous epithelial tumors, but is not a good screening tool, not cost effective and is not elevated in early disease?

Back 64

CA 125

Front 65

does malignant ovarian CA cause bulk disease?

Back 65

no, but it "seeds" all over the place

Front 66

how are ovarian tumors classified?

-location
-histologically
-via spread

Back 66

histologically

Front 67

what are the 3 cellular origins of ovarian tumors?

Back 67

epithelial (most common)
germ cell
stromal cell

Front 68

t/f

most malignancies have benign counterparts

Back 68

true

Front 69

most low malignant potenial tumors are found in what stage?

-1
-2
-3
-4

Back 69

stage 1

Front 70

malignant tumores occur mostly in __ age range, and risk decreases after age 70.

-pre menopausal
-menopausal
-post menopausal

Back 70

menopausal

Front 71

what is the FIGO staging for primary CA or the ovary?

Back 71

1-limited to ovaries
2-growth involving one or both ovaries with pelvic extension
3-tumor involving one or both ovaries with periotneal implants outside the pelvis and/or postive inguinal nodes.
4-growth involving one or both ovaries with distant mets

Front 72

what type of malignancy is the most common ovarian malignancy?

-epithelial cell
-germ cell

Back 72

epithelial cell ovariann malignancies account for 90% of all ovarian malignancies

Front 73

where do epithelial cell ovarian CA's come from?

Back 73

emanate from ovarian capsule, can be peritoneal

metaplasia occurs in the capsule over the area of a follicle, therefore repeated folicular growth can stimulate a dysplastic process....changes from making cysts

Front 74

what are the hereditary considerations for epithelial cell ovarian CA's? all but one.

-BRCA 1
-BRCA 2
-Lynch II syndrome

Back 74

not BRCA 2

Front 75

what is Lynch II syndrome?

Back 75

breast, ovarian, endometrial, and colon cancer

Front 76

what is the benign counterpart to the malignant serous cystadenocarcinom?

Back 76

benign serous cystadenoma

Front 77

what are the 4 types of malignant epithelial cell ovarian CA's?

Back 77

serous cystadneocarcinoma (most common)
mucinous cystadenocarcinoma
endometroid tumors
clear cell carcinomas

Front 78

what is the most common ovarian malignancy in girls under 20?

-epithelial cell
-germ cell
-endometrial cell

Back 78

germ cell

Front 79

what are the tumor markers for germ cell tumors? all but 1.

-AFP
-CEA 125
-HCG

Back 79

not cea 125

Front 80

what are the 2 types of germ cell tumors?

Back 80

dysgerminoma
immature teratoma

accounts for less than 5%

Front 81

which is the most common germ cell tumor?

-dysgerminoma
-immature teratoma

Back 81

dysgerinoma is most common, radiosensitive, more apt for lymph node spread

immature teratoma is 2nd is fast growing, mostly unilateral, seen usually in girls under age 25, with cure rate over 80%.

Front 82

endodermal sinus tumor and embryonal cell carcinomas are what type of tumors?

Back 82

rare germ cell tumors

Front 83

a tumor that occurs in children and adolescents in which the tumor marker is AFP, that is treatable with resection and chemotherapy is....

-endodermal sinus tumor
-embryonal cell carcinoma

Back 83

endoderma sinus tumor

Front 84

which type of tumor occurs in children and adolescents, is treatable with resection and chemotherapy, and the tumor markers are AFP and beta HCG,,,,is what?

-endodermal sinus tumor
-embryonal cell carcinoma

Back 84

embryonal cell carcinoma

Front 85

what are the 4 types of gonadal stromal cell tumors?

Back 85

granulosa cell tumor
sertoli-leydig
fibrosarcomas
malignant thecomas

Front 86

of the 4 gonadal stromal cell tumors (granulosa cell tumor, sertoli leydig, fibrosarcoma, and malignant thecomas) which is the most common?

Back 86

granulosa cell tumor-occur in all ages, produces estrogen, can cause post menopausal bleeding....

Front 87

which type of gonadal stromal cell tumor is found in older women, is testosterone secreting, and is also called arrhenoblastoma, and are rare?

Back 87

sertoli-leydig

Front 88

what is the name of a cancer from another origin, with mets to the ovary?

-sertoli-leydig tumor
-krukenberg tumor
-fibrosarcoma

Back 88

krukenberg tumor which comes from the GI tract, breast, or endometrium

Front 89

where do krukenberg tumors come from?

Back 89

gi tract
breast
endometrium

Front 90

what type of metastatic ca to the ovary are:

mucinous
signet ring
invasive
bilateral
may produce hormones
and can benefit from bilateral
oophorectomy (usually)

Back 90

krukenberg tumors

Front 91

t/f

you should put your pt's who have had an oophorectomy due to krukenberg tumor on oral hormone replacement therapy to treat there surgical menopausal symptoms.

Back 91

false! this is why you took out the ovaries in the first place

Front 92

which type of ovarian cancer, accounts for 25% of all neoplasms in the reproductive age, 90% of these are benign, most are asymptomatic, and the 3 subgroups are epithelial germ, stromal?

-benign ovarian neoplasms
-benign epithelial neoplasms
-benign stromal cell neoplams

Back 92

benign ovarian neoplasms

Front 93

what is the treatment of benign germ cell neoplasms?

-watchful waiting
-chemo
-surgical resection

Back 93

surgical resection

Front 94

what is the name of a rare benign germ cell neoplasm which is composed of functional thyroid tissue?

Back 94

struma ovarii