Pathology: Ovaries

What are the dermoid germ cell layers?

1. Ectoderm 2. Mesoderm 3. Endoderm

Theca lutein cysts typically measure up to?

15 cm

A corpus luteum cyst often regress by?

16 weeks of gestation, by then the cyst should be down to at least 3 cm or less.

What's the typical size of a follicular cyst?

3-8 cm +

Hemorrhagic cyst

A follicular cyst that contains blood.

What is the result of an enlarged graafian follicle that failed to ovulate?

A follicular cyst.

Ovarian hyperstimulation syndrome

A syndrome resulting from hyperstimulation of the ovaries by fertility drugs; resulting in the development of multiple, enlarged follicular cysts.

Reproductive ages and postmenopausal women that present with granulosa cell tumors will have what clinical symptom?

Abnormal vaginal bleeding.

Patients with an endodermal sinus tumor present with elevation of what serum?

Alpha-fetaprotein (AFP)

A complex or thick walled corpus luteum cyst may resemble?

An ectopic pregnancy.

Virilization

Changes within the female that are caused by androgens

What is considered the most common pelvic mass seen during a first trimester sonographic exam?

Corpus luteum cyst

What ovarian pathology has the the "tip of the iceberg" sign?

Dermoid

What pathology frequently consist of fully formed or rudimentary teeth?

Dermoid

What is the most common benign ovarian tumor?

Dermoid (cystic teratoma)

What is the most common malignant germ cell tumor of the ovary?

Dysgerminoma

(T/F) Mucinous cystadenomas are often bilateral.

False -Serous cystadenomas are often bilateral.

(T/F) 50%-70% of serous adenomas are malignant.

False -benign.

(T/F) Color Doppler & flow analysis of the torsed ovaries is effective.

False because the ovaries have a dual blood supply & one vessel may show flow while the other may not.

(T/F) The abnormal vessels created with malignancy often lack smooth muscle & thus produce a higher resistive wave form.

False, lower.

(T/F) Multiple gestations decrease the likelyhood of theca lutein cysts.

False.

(T/F) Dermoids are most commonly seen in postmenstrual patients.

False. They can be found in post menstrual patients but they are most often seen with the reproductive age group.

(T/F) As a result of consistent estrogen stimulation, postmenstrual patients with the thecoma have about 10-15% chance of developing endometrial carcinoma.

False. This is true with granulosa cell tumors which have malignant potential.

Which cysts are usually unilocular?

Follicular cysts

Where does a krukenberg tumor metastasize from?

GI tract, most frequently from the stomach.

What is considered to be the most common estrogenic tumor?

Granulosa cell tumor

The Doppler analysis of malignant ovarian masses often reveal high or low diastolic flow velocities?

High

With the presence of what hormone is the corpus luteum maintained during an early pregnancy?

Human chorionic gonadotropin (hCG)

Patients with such high levels of hCG may suffer from what?

Hyperemesis Pelvic fullness

What is the result of the dermoid containing the germ cell layers?

It may contain any number of tissues (glandular thyroid components, bone, hair, sebum, fat, cartilage, & digestive elements)

What is a supportive sonographic distinguishing factor between a mucinous & serous cystadenoma?

Mucinous cystadenomas present with internal debris secondary to solid components of the material contained within it.

Why does multiple gestations increase the likelyhood of theca lutein cysts?

Multiple gestations = higher levels of hCG = theca lutein cysts

Ovarian hyperstimulation syndrome often result in the development of what?

Multiple, enlarged follicular cysts.

What is the sonographic appearance of dermoid mesh?

Numerous linear interfaces within the cystic area of a dermoid.

What are common concurrent conditions of theca lutein cysts?

Ovarian hyperstimulation syndrome & gestational trophoblastic disease.

Which cyst is adjacent but not attached to the ovary?

Paraovarian cysts

Dermoid plug

Part of a Dermoid tumor that contains various tissues & will be a source of posterior shadowing.

What may an ovarian fibroma mimic?

Pedunculated uterine leiomyoma

Children with ovarian dysgerminomas present what clinical symptoms?

Precocious puberty Elevated hCG levels

Adolescent patients with granulosa cell tumors with present what clinical finding?

Pseudoprecocious puberty

Ovarian cystectomy

Removal of an ovarian cyst

Dysgerminomas are found in patients of what age?

Reproductive age, younger than 30.

What does a dermoid result from?

Retention of an unfertilized ovum that differentiates into three germ cell layers.

What is the tumor marker for dysgerminomas?

Serum lactate dehydrogenase

Mesoderm

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

Endoderm

The germ cell layer of the embryo that develops into the gastrointestinal respiratory tracts.

Ectoderm

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

"Tip of the iceberg" sign

The sonographic appearance of the mass when only the anterior element is seen, while the greater part is obscured due to complete attenuation of the sound beam by dense tissue components.

Which cysts are usually bilateral & multiloculated?

Theca lutein cysts

Which of the functional cysts is the largest & least common?

Theca luteum cysts

Which ovarian mass are most often unilateral and appear similar to a pedunculated uterine fibroid?

Thecoma

If a cyst is large, what can it lead to?

Torsion

(T/F) An ovarian fibroma are not associated with hormone (estrogen) production.

True

(T/F) Torsion of the ovaries are three times more likely to occur on the left.

True

(T/F) Ovarian hyperstimulation syndrome is recognized as a predisposing circumstance that can result in ovarian torsion.

True because it's cystic enlargements.

(T/F) Cystic teratomas have the capability of malignant degeneration (develop into cancer).

True but this is rare.

(T/F) Granulosa cell tumors can reach up to sized up to 40 cm.

True.

(T/F) Mucinous cystadenomas are often larger than serous cystadenomas.

True.

What may lead to deepening of the voice and hirsutism?

Virilization

Dermoid mesh

Visualization of hair within a cystic teratoma.

What is the second most common malignant germ cell tumor?

Yolk sac tumor (endodermal sinus tumor)

Yolk sac tumors occur in females of what age?

Younger than 20

Theca luteum cysts are found with elevation of what hormone?

hCG, about 100,000 mIU/mL