Obgyn Ovarian And Adnexal Dz

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4 types of functional ovarian cysts

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1. follicular cyst0 when ovarian follicle fails to rupture during ovulation thus no ovulation
2. corpus luteum cyst- corpus luteum that exceeds 3 cm -- prolonged luteal phase leads to missed period complaint with neg preg test
3. luteal-phase cyst/corpus hemorrhagicum- may rupture late in the luteal phase
4. theca lutein cyst- least common- associated with pregnancy and usually bilateral

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serous cystademona

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most common epithelial cell ovarian neoplasm - 70% benign

20% are frankly malignant so all of these tumors should be removed with varying degrees of aggressiveness depending on pt age

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mucinous cystademona

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second most common epithelial cell tumor of the ovary
- 15% are malignant
- cystic, they can become quite large and sometimes fill the entire pelvic cavity and go into the abdomen

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most common tumor found in women of all ages

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benign cystic teratoma aka dermoid cyst or dermoid
- 80% occur during reproductive years
- may contain differentiated tissue from all three cell lines including hair, sebum, cns tissue, cartilage, bone, teeth, intestines
- one variant (struma ovarii)- contains thyroid tissue

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sx and tx of dermoid cyst

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sx- unilateral cystic adnexal mass that is mobile and tender-- often asx and high fat content
tx- must be surgically removed because 1% are malignant and there is 15% of resulting ovarian torsion--> surgical emergency. 10-20% are bilateral-- check both sides!

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functioning ovarian tumors

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benign stromal cell neoplasms-- 1. granulosa theca cell tumor (female cell type)- produce estrogen, 2. sertoli-leydig cell tumor (male type)- produce testosterone

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meigs syndrome

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combination of ovarian fibroma, ascites, and right pleural effusion

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most common symptoms of ovarian cancer

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abdominal fullness/distention > abdominal or back pain > decreased energy or lethargy > urinary frequency

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early warning signs of ovarian cancer

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- increase in abdominal size
- abdominal bloating
- fatigue
- abdominal pain
- indigestion
- inability to eat normally
- urinary frequency
- constipation
- back pain
- recent onset urinary incontinence
- unexplained weight loss

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risk factors for development of ovarian cancer

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1. age
2. nulliparity
3. primary infertility
4. endometriosis
5. BRCA1 or 2
6. HNPCC/Lynch syndrome- 13 x higher risk

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what may be protective against ovarian cancer

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long-term suppression of ovulation (OCPs)

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proper use of CA-125 marker

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- should not be used for routine screening for ovarian ca but rather as an indication of response to tx
- can be elevated in other conditions
- may be helpful in raising the index of suspicion for cancer in a postmenopausal woman with a pelvic mass but not in a symptomatic premenopausal woman

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conditions with elevated CA-125

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uterine leiomyomata, PID, endometriosis, adenomysosis, pregnancy, and even mestruation
(also ovarian cancer)

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chance of developing breast and ovarian cancer if BRCA-1 positive

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breast- 85-90% lifetime risk
ovarian 50% risk

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HNPCC

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familial disorder involving increased risk for colon, breast, ovarian and endometrial cancer
- 3 x inc risk of cancer

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most common ovarian carcinoma of women younger than 20

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germ cell tumors-- most common are dygerminomas and immature teratomas

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management of ovarian and fallopian tube cancers

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1. surgical debulking in attempt to get all tumors to < 1 cm in size
2. sample ascites fluid or pelvic washings
3. sample periaortic and pelvic nodes
4. partial omenectomy
5. insepct entire abdomen, palpate along surfaces
6. biopsies from various anatomical locations (anterior and posterior culde sacs etc)
7. adjunctive chemotherapy with paclitaxel combined with carboplatin
8. F/U with tumor marker (CA-125) and imaging
- radiation not very helpful

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When should ovaries be palpable?

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1/2 of the time in women of reproductive age (less often if on OCPs)
- NOT in premenarchal girls