ARRT - Chapter 18 - ovaries and Fallopian tubes

Virilization

(Female) changes within the female that are typically associated with males Caused by increased androgens and may lead to deepening of the voice and hirsutism

Yolk sac tumor

(ovary) Highly malignant germ cell tumor of the ovary Characterized by RAPID GROWTH Occurs in females younger than 20 Carries poor prognosis

Fibroma

-An ovarian sex-cord stromal tumor -benign Most commonly found in middle aged women

Theca lutein cysts

-Functional ovarian cysts that are found in the presence of elevated levels of human chorionic gonadotropin; -also referred to as a theca luteal cyst

Hemorrhagic cyst

A cyst that contains blood

Gestational Trophoblastic Disease (GTD). (Molar pregnancy)

A disease associated with abnormal proliferation of the trophoblastic cells during pregnancy Aka molar pregnancy

Follicular stimulating hormone

A hormone of the anterior pituitary gland that causes the development of multiple follicles o the ovaries

Dermoid plug

A part of a Dermoid tumor that contains various tissues and may produce posterior shadowing during u/s exam *small arrows

Septations

A partition separating two or more cavities

CA -125

A protein that may be increased in the blood of women with ovarian cancer and other abnormalities

Hysterosalpingography

A radiographic procedure that uses a dye instilled into the endometrial cavity and Fallopian tubes to evaluate for internal abnormalities

Papillary projections

A small protrusion of tissu

Germ cell tumor

A type of neoplasm derived from germ cells of the gonads May also be found outside the reproductive tract

Endometrioid tumor

A typically malignant ovarian tumor often associated with a history of endometrial cancer, endometriosis, and endometrial hyperplasia Often seen in 50-60's

Clinical findings follicular cysts

ASX Pain associated w/ hemorrhage and enlargement of cyst

Clinical findings of corpus luteum cysts/ of pregnancy

ASX Pain associated with hemorrahge and enlargement of cyst Corpus luteum of pregnancy accompanies a pregnancy

Ovarian arteries are branches of what?

Abdominal aorta

A complex or thick walled corpus luteum cyst may resemble what? And why should we take careful consideration of the entire clinical picture?

An ectopic pregnancy Should establish the presence of an IUP

"Whirlpool sign""

An indicator of the torso ovarian pedicure adjacent to the ovary , appearing as a round mass with concentric hypoechoic and hyperechoic rings that demonstrates a swirling color Doppler signature

The ovary consists of what:

An outer cortex and inner medulla

"Chocolate cysts"

Another name for endometriomas

Anterior cul-de-sac (vesicouterine pouch)

Area between the uterus and pubic bone

Meigs syndrome

Ascites and PE in the presence of benign ovarian tumor

How is the corpus luteum cyst maintained during pregnancy?

B/c production of hCG by trophoblastic cells preserve it

Cystic teratoma (Dermoid cyst)

Benign ovarian mass that is composed of three germ cell layers

Thecoma

Benign ovarian sex cord-stromatolites tumor that produces estrogen in older woman

Medulla of ovary:

Contains ovarian vasculature & lymphatics

After the Graafian follicle has ruptured , its structure is converted into what?

Corpus luteum

What are the most common pelvic masses seen during a 1st trimester u/s?

Corpus luteum of pregnancy

"Tip of the iceburg sign"

Denotes the sonographic appearance of a cystic teratoma (Dermoid) when only the anterior element of the mass is seen , while the greater part of the mass is obscured by shadowing

Lysis

Destruction or breaking down

Malignant degeneration

Developing into cancer

Ovarian arterial flow throughout the menstrual cycle:

Early follicular phase — high resistance w/ absent or low end-diastolic RI=1.0 Late follicular phase — low resistance w/ increased end diastolic RI= 0.5 Early luteal phase — Low resistance w/ increased end diastolic RI=0.5 Latel luteal phase — high resistance w/ absent r low end diastolic RI =0.1

Ovaries are what kind of glands?

Endocrine Responsible for releasing estrogen and progesterone

What is the most common cancer to originate within an endometrioma???

Endometrioid tumor (endometrioid carcinoma)

What stimulates the ovaries?

Follicle- stimulating hormones - released by anterior pituitary gland

Ovaries

Form in upper abdomen in utero , and descend to pelvis Paired, oval shaped Intraperitoneal organs Endocrine glands

Endometrioisis

Functional ectopic endometrial tissue located outside the uterus

Cilia

Hair like projections within the fallopian tube

Unilocular

Having only one internal vanity

Typical ovarian flow is said to be ...

High resistant during : early follicular phase and late luteal phase Low resistant during : late follicular phase and early luteal phase

U/s of ovary

Homogenous w/ medium to low-level echoes Multiple follicles Size of ovary depends on physiologic state and age of patient

human chorionic gonadotropin (hCG)

Hormone produced by the trophoblastic cells of the early placenta May also be.a tumor marker for nongravid pts and males

Fluid from a ruptured follicle will most often settle where?

In the rectouterine pouch (pouch of Douglas) , the most dependent portion of the peritoneal cavity

Pelvic inflammatory disease (PID)

Infection of the female genital tract that may involve the ovaries, uterus, and/or fallopian tubes

Salpingitis

Inflammation of the Fallopian tube

Pseudomyxoma peritonnei

Intraperitoneal extension of mucin-secreting cells that result from rupture of. Malignant mucinous ovarian tumor or possibly a malignant tumor for the appendix

Location of ovaries :

Intreaperitoneal organs Anywhere in true pelvis (exception of anterior cul de sac) Ovarian fossa—. Posterior to urethra and internal iliac artery , superior to external iliac artery

Cortex of the ovary:

Involves the mass of the ovary Site of oogensis

If fertilization occurs what happens to the corpus luteum?

It is maintained and becomes the corpus luteum of pregnancy

If fertilization does not occur what happens to the corpus luteum?

It regresses and becomes the corpus albicans

Ampulla

Longest & most tortuous segment of Fallopian tube Significant portion of tube because this is where fertilization takes place Also where ectopic pregnancies often embed

Sertoli-Leydig cell tumor

Malignant sex cord-stromatolites ovarian neoplasm that is associated with virilization More often found in women younger than 30

Dermoid mesh

Mass of hair within a cystic teratoma

Follicular cyst

Ovarian cyst that forms as a results of the failure of the Graafian follicle to ovulate

A large ovarian has a high risk of what?

Ovarian torsion

On day 14 of the menstrual cycle what occurs?

Ovulation The dominant follicle ruptures, releasing the mature ovum , and a small amount of follicular fluid into the peritoneal cavity (Mittelschmerz)

Mittelschmerz

Pelvic pain at the time of ovulation

During the second half of the menstural cycle (luteal phase) what does the corpus luteum produce?

Progesterone And small amounts of estrogen

The right ovarian vein drains into what? Left ovarian vein?

Right— IVC Left — left renal vein

Psuedoprecocious puberty

Secondary sexual development induced by sex steroids or fro mother sources like ovarian tumors adrenal tumors, or steroid use

Androblastoma

Settling-Leydig cell tumor Malignant sex cord-stromatolites ovarian neoplasm that is associated w/ virilization

U/s follicular cysts

Simple cyst— anechoic, thin walled, unilocular , round, posterior enhancement Hemorrhagic cyst— variable appearances, including complex components or entirely echogenic depending on the amount of blood and stage of lysis , May have a web like or lacy appearance as well

Brenner tumors

Small benign ovarian tumors

Cumulus oophorus

Structure that contains the developing oocyte

corpus luteum

Temporary endocrine gland that results on the rupture of the Graafian follicle after ovulation

Adnexa

The area located posterior to thee broad ligament and adjacent to the uterus, which contains the ovaries and Fallopian tubes

Corpus luteum of pregnancy

The corpus luteum that is MAINTAINED during an early pregnancy for the purpose of producing estrogen and primarily progesterone

Oogenesis

The creation of the ovum

infundibulum

The distal segment of the Fallopian tube

Fimbria

The finger like extension of the Fallopian tube located on the infundibulum.

Endoderm

The germ cell layer of the embryo that develops into the GI and respiratory tracts

Mesoderm

The germ cell layer of the embryo that develops into the circulatory system, muscles, reproductive system and other structures

Ectoderm

The outer germ cell layer of the embryo that develops into : hair, skin. Nails, and other structures

Pyosalpinx

The presence of pus within the Fallopian tube

Ovulation

The release of the mature egg from the ovary

Interstitial

The segment of the Fallopian tube that lies within the uterine horn (Cornu)

Ovarian cystectomy

The surgical removal of an ovarian cyst

Isthmus

Tube: the segment of the Fallopian tube that is located between the interstitial and ampulla Uterus: area of the uterus between the corpus and cervic

Serum lactate dehydrogenase

Tumor marker that is elevated in the presenc of an ovarian dysgerminoma and other abdominal abnormalities

The sonographic manifestation of a hemorrhagic cyst may be described as :

Weblike or lacy appearanc

Where is the ovum contained?

Within the cumulus oophorus of the dominant follicle

Corpus luteum cyst

a physiologic cyst that develops within the ovary after ovulation secretes progesterone, maintains the endometrium and prevents menses if fertilization occurs in preparation for implantation

Daughter cyst

a small cyst within a large cyst

Ovarian hyperstimulation syndrome

a syndrome resulting from hyperstimulation of the ovaries by fertility drugs; results in the development of multiple, enlarged follicular ovarian cysts

Menorrhagia

abnormally heavy and prolonged menstruation

Ovarian torsion

an abnormality that results from the ovary twisting on its mesenteric connection, consequently cutting off the blood supply to the ovary

Sebum

an oily substance secreted by sebaceous glands

Endometrioma

benign, blood containing tumor that forms forms from the implantation of ectopic endometrial tissue, tumor associated with endometriosis.

Hematosalpinx

blood within the fallopian tube

Peristalsis

contractions of smooth muscles that provide the force that moves food through the esophagus toward the stomach

Ascites

excessive fluid in the peritoneal cavity

Hirsutism

excessive hair growth in women in areas where hair growth is normally negligible

hyperemesis

excessive vomiting

Multiloculated

having more than one internal cavity

Krukenberg tumor

malignant ovarian tumor that metastasizes from the gastrointestinal tract, like stomach cancer Presence of "signet-ring cells" key to histoligic diagnosis

Dyspareunia

painful sexual intercourse

Hydrosalpinx

the abnormal accumulation of fluid within the fallopian tube

Graafian follicle

the name for the dominant follicle prior to ovulation

Corpus albicans

the remaining structure of the corpus luteum after its deterioration