DMS 212 Chapter 10 Workbook

Oral and intravenous contrast is given

A CT examination can demonstrate pelvic sidewall masses, lymph node enlargement in the retroperitoneum, liver metastases, and calcifications, especially when:

Ovary

A Krunkenberg tumor is a cancerous tumor of the:

The gastrointestinal tract

A Krunkenberg tumor usually metastasizes from:

Form cystic masses with multiple septa

A characteristic of most epithelial cancers is the tendency to:

Vaginal bleeding

A large number of patients with ovarian malignancy present with or develop:

Meigs syndrome - A combination of ascites, pleural effusion, and an ovarian neoplasm

A patient with known ovarian cancer complained of abdominal pressure and submitted to an abdominal ultrasound. View the four images. A and B demonstrate the right upper quadrant in transverse and longitudinal view. C displays the inferior abdomen/superior pelvis. D shows pleural space superior to the liver. Name a likely disgnosis.

Teratoma/Teratocarcinoma

A rare malignant form of a common germ cell tumor found in young adults containing fat, bone, hair, skin, and/or teeth

Alpha fetaprotein

AFP

Pseudomyxoma Peritonei

Accumulation of mucinous material in the peritoneal cavity

Pelvic cul-de-sac, and paracolic gutters, mostly on the right side

Ascites associated with ovarian malignancy collects in the:

Ovarian cancer

Benign processes, such as endometriosis, fibroids, and even pancreatitis, result in and increased CA 125, as does:

Carcinoembryonic antigen

CEA

Krunkenberg Tumor

Carcinoma of the ovary, usually metastatic from gastrointestinal cancer, marked by areas of mucoid degeneration and by the presence of signet-ring cells

Disorganized vascular patterns

Color Doppler of malignant lesions frequently demonstrates:

"Hands-on" maneuver

Compressibility of a mass while scanning can assist in differentiating from malignancy and is performed by:

Mucinous Cystadenoma

Cystic mass filled the thick gelatinous cystic fluid

Pre-predominatley solid mass with heterogeneous internal echotexture complete with spetations

Describe the appearance of this case of ovarian cancer

Epthelium covering the ovaries

Eighty percent of ovarian malignancies originate from the:

Lactate Dehydrogenase (LDH)

Enzyme involved in production of energy of the cells. Elevated levels in the blood indicate tissue damage, cancers, or other diseases

Solid papillary growths

Epithelial ovarian cancers typically form cystic masses and:

High risk

Extended ovulatory activity, over 40 years, places women in what risk category for developing ovarian cancer?

Struma Ovarii

Extremely rare neoplasm of the ovary containing thyroid tissue

Ovarian malignancies

Fallopian tube neoplasms are rare and frequently malignant and often confused with:

Pelvic pressure and bloating

Frequently, the only symptom of ovarian cancer is:

HER2/neu

Gene that produces a protein, which regulates normal cell growth found in breast and ovarian cancer cells. The identification of this protein enables determination of treatment options

BRCA1/BRCA2

Inherited gene mutation associated with a significant increase of breast and ovarian cancer risk

Lactate dehydrogenase

LDH

11. Liver edge ascites 12. Right lobe of liver 13. Left lobe of liver 14. Stomach 15. Transverse colon 16. Left paracolic gutter 17. Small bowel 18. Cul-de-sac 19. Rectum 20. Right paracolic gutter

Label this image:

1. Diaphragm 2. Liver 3. Serosal bowel implants 4. Colon 5. Nodes 6. Ovaries 7. Pleura 8. Omentum 9. Stomach 10. Pelvic peritoneal implant

Label this image::

Mucinous Cystadenocarcinoma

Large cystic ovarian mass with thick-walled septations; may have internal debris layering components

Serous Cystadenocarcinoma

Large multilocular ovarian neoplasm with papillary projections

Poor prognosis

Late stage diagnosis of ovarian malignancy leads to a:

10 cm^3 ; 20 cm^3

Malignancy suspicion increases with the amount of solid tissue in a complex mass and if the volume exceeds ____________ in postmenopausal woman and _____________ in premenopausal women

Dysgerminoma

Malignant tumor of the ovary arising from undifferentiated germ cells of the embryonic gonad. the tumor is historically identical to seminoma found in the testicle

Normal-sized ovaries

Menopausal females utilizing hormone replacement therapy (HRT) will demonstrate:

Common

Metastasis to the ovary is:

3-D multiplanar with surface rendering Image A demonstrated internal architecture of a simple cyst with smooth regular walls Image B shows internal wall projections into an ovarian cyst

Name the imaging technique used in these images. Describe image A and compare it to image B.

Image A - Ovary with mulitseptated cyst displaying internal projections (open arrows) Image B - Flow in the thick separating membrane (long arrows) The complex fluid and cystic septations suggest ovarian malignancy C8-4V transducer

Name the structure visualized in images A and B. Identify the struture the open arow is pointing to on image A and B. Describe what the long arrows are pointing to in image B. What transducer was used to obtain these images?

Transbadominal, transverse pelvis Small open arrow - Right ovary with simple cyst Thin arrow - Left adnexal dermoid Thick arrow - Uterus Large open arrow - Distended urinary bladder

Name the view and organs imaged. Describe what the small open arrow, thin arrow, thick arrow, and large open arrow are depicting.

Clear-cell adenocarcinoma

Neoplasm involving the surface epithelium of the female reproductive organs (ovary), which involves cells with a clear appearance on microscopic examination

Epithelial Ovarian Cancer

Neoplasm involving the surface epithelium of the ovary

Yolk cell tumor/endodermal sinus tumor

Neoplasm originating in the germ cells (ovum)

Menstruating

Nonneoplastic cystic foci of the ovary are commonly seen in ___________________ females and are difficult to differentiate from malignant lesions, so should be considered when determining the diagnosis.

Late stages of the condition

One of the most lethal forms of cancer is ovarian because it is frequently diagnosed in:

Perimenopausal and postmenopausal women

Ovarian cancer is mostly a disease of:

Dependent portion of the peritoneal cavity

Ovarian malignancy is often associated with ascites, which first accumulates in the:

Right side

Ovarian metastatic masses are usually bilateral and more common on the:

CA 125

Protein found in tumor cells that results in an elevation of blood levels

The accumulation of gelatinous material in the peritoneal cavity

Pseudomyxoma peritonei is defined as:

Sertoli-Leydig Cell Tumors/Androblastoma

Related to the sex-cord (cord-like masses of gonasal epithelial tissue) stromal tumors seen in ovaries, mostly in young adults

Sex Cord Stromal Tumors

Solid ovarian mass originating from the embryonic gonadal ridges and Sertoli cells

Laparotomy

Surgical incision in the abdomen usually performed to evaluate the organs

Salpingo-Oophorectomy

Surgical removal of the ovary and fallopian tube

False

T/F - Studies show that women who used oral contraceptives are at the greatest risk for developing ovarian cancer

Ovarian epithelium

The effect of ovulation is known to cause increased inflammation and wound healing because of repeated trauma to the:

Pelvic ultrasound, physical examination, and the tumor marker CA 125

The effective method to investigate for ovarian cancer includes:

Meigs Syndrome

The finding of pleural effusion, ascites, and an ovarian mass

HER2/neu

The gene that is related to errors in the replication process resulting in over expression:

MRI

The imaging modality providing the most accurate tissue characterization regarding adnexal masses is:

25%

The stage I ovarian cancer detection rate is:

CA 125, AFP, hCG, CEA

To increase specificity in diagnosing ovarian malignancy, laboratory values such as what are tested?

Carcinoembryonic Antigen (CEA)

Tumor marker for colon, stomach, breast, lung, some thyroid, and ovarian cancers

Endomertroid Tumor

Tumor of the ovary containing containing epithelial or stromal elements resembling endometrial tissue. typically arises form endometriosis, and a large percentage are malignant

BRCA1 and BRCA2

Two inherited gene mutations related to an increase of breast and ovarian cancer are:

Serous Carcinoma

Type of epithelial ovarian cancer, which presents as a partially cystic mass with solid components

Alpha Fetoprotein (AFP)

Used as a tumor marker for carcinomas of embryonic origin

Plain film radiography

What imaging method provides diagnostic value by presenting calcification, sometimes in a curvilinear fashion, soft tissue masses, and patterns suggesting abdominal distention?

Living in a developing country

What is the most unlikely risk factor for developing ovarian cancer?

Peristalsis

What must be identified to determine pelvic mass from possible bowel?

Endocrine studies

What technique is not directed at improving detection and outcome of ovarian cancer?

Human chorionic gonadotropin

hCG

Antegrade spread

If positive vaginal cytology is noted in association with ovarian cancer, it is most likely due to:

90%

If there is early detection of Stage I ovarian cancer, the cure rate is:

Peritoneal malignancy

In women, ovarian cancer is the most common tumor responsible for: