Flashcards in Ovarian Cysts Deck (66)
1
What groups can ovarian tumours be divided into?
- Functional
- Bengin
- Malignant
2
What % of ovarian cysts are benign?
70%
3
What are the types of benign ovarian tumours?
- Benign epithelial neoplastic cysts
- Benign cystic teratomas
- Benign neoplastic solid tumours
4
What % of benign ovarian tumours are benign epithelial neoplastic cysts?
60%
5
What are the types of benign epithelial neoplastic cysts?
- Serous cystadenoma
- Mucinous cystadenoma
6
Who are serous cystadenomas most common in?
Women 40-50 years
7
What might happen to the size of mucinous cystadenoma?
They may become enormous
8
What are mucinous cystadenomas filled with?
Mucinous material
9
What can happen if mucinous cystademomas rupture?
Can cause pseudomyxoma peritonei
10
Who are mucinous cystadenomas most common in?
20-40 age group
11
What cells do benign cystic teratomas arise from?
Primitive germ cells
12
What is a benign mature teratoma also known as?
Dermoid cyst
13
What might a dermoid cyst contain?
Well-differentiated tissue, e.g. hair, teeth
14
Who are dermoid cysts most common in?
Young women
15
What are the types of benign neoplastic solid tumours?
- Fibromas
- Thecomas
- Adenofibromas
- Brenner's tumoru
16
What is a fibroma?
A small, solid, benign fibrous tissue tumour
17
What are ovarian fibromas associated with?
- Meigs syndrome
- Ascites
18
What are Brenner's tumours?
Rare ovarian tumours displaying benign, borderline/proliferative, and malignant variants
19
What other ovarian tumours might Brenner's tumours be associated with?
- Mucinous cystadenoma
- Cystic teratoma
20
What % of women do benign ovarian cysts occur in?
30% with regular menses
50% with irregular menses
21
Which age group do ovarian cysts occur in?
Premenopausal women (uncommon in post-menopausal and pre-menarchal women)
22
What are the most common type of ovarian cysts in young women?
Benign neoplastic cysts of germ cell origin
23
What are the risk factors for ovarian cysts?
- Obesity
- Tamoxifen therapy
- Early menarche
- Infertility
24
What type of ovarian cysts might run in families?
Dermoid
25
How might ovarian cysts present?
- Incidental finding (asymptomatic)
- Pain
- Dysparuenia
- Swollen abdomen
- Pressure effects
- Symptoms of complications
- Endocrine symptoms
26
Describe the pain in ovarian cysts?
Dull ache or pain in lower abdomen, low back pain
27
Describe the swollen abdomen in ovarian cysts?
Palpable mass arising out of pelvis, which is dull to percussion and does not disappear if bladder is emptied
28
What might ovarian cysts put pressure on causing symptoms?
- Bladder
- Venous return
29
What symptoms might be caused by ovarian cysts putting pressure in the bladder?
Urinary frequency
30
What symptoms might be caused by ovarian cysts putting pressure on venous return?
- Varicose veins
- Leg oedema
31
How might asymptomatic ovarian cysts be found?
Chance finding on bimanual examination or ultrasound
32
When might ovarian cysts cause endocrine symptoms?
If they secrete hormones
33
What endocrine symptoms might be caused by ovarian cysts secreting hormones?
- Virilisation
- Menstrual irregularities
- Post-menopausal bleeding
34
Is it common for ovarian cysts to cause endocrine synmptoms?
No, uncommon
35
What are the differential diagnoses of ovarian cysts?
- Non-neoplastic functional cysts
- Any other cause of pelvic pain
- Polycystic ovary syndrome
- Endometrioma
- Ovarian malignant tumour
- Bowel causes
- Other gynae causes
- Pelvic malignancies
36
What non-neoplastic functional growths are differentials for ovarian cysts?
- Follicle cyst
- Corpus luteum cyst
- Theca lutein cyst
37
What are the bowel differentials for ovarian cysts?
- Colonic tumour
- Appendicitis/appendix mass
- Diverticulitis
38
What are the other gynaecological differentials for ovarian cysts?
- Pelvic inflammatory disease
- Tubo-ovarian abscess
- Uterine tumour, e.g. fibroid
- Para-ovarian cyst
- Ectopic pregnancy
39
What pelvic malignancies are differentials for ovarian cysts?
- Retroperitoneal tumours
- Small intestine tumours
- Mesothelial tumours
40
What cysts is it important that a correct diagnosis is made?
Some adnexal cysts, including;
- Endometrioma
- Mature cystic teratoma
- Paraovarian cysts
41
Why is important that some adnexal cysts are diagnosed correctly?
As they may affect patients' fertility, and may be associated with significant pelvic disease or put the patient at risk of ovarian torsion
42
What investigations may be done in ovarian cysts?
- Pregnancy test
- FBC
- Urinalysis
- Ultrasound
- CT or MRI scan
- Diagnostic laparoscopy
- Fine needle aspiration and cytology
- CA125
43
What might be indicated on FBC in suspected ovarian cyst?
- Infection
- Haemorrhage
44
When should urinalysis be done in suspected ovarian cyst?
If there are urinary symptoms
45
When should urinalysis be done in suspected ovarian cyst?
If there are urinary symptoms
46
What is the role of ultrasound in ovarian cysts?
A pelvic ultrasound is the single most effective way of evaluating an ovarian mass
47
What type of ultrasound is preferable in ovarian cysts?
Transvaginal
48
What is the role of biopsy in ovarian cysts?
May be used to confirm the impression that a cyst is benign
49
When does CA125 not need to be done in ovarian cysts?
In premenopausal women who have had an ultrasound diagnosis of simple ovarian cyst
50
Why should CA125 not be done in pre-menopausal women with an ultrasound diagnosis of ovarian cysts?
Unreliable in differentiating benign from malignant masses in premenopausal women due to increased rate of false positives and reduced specificity
51
What other conditions can result in raised CA125 levels?
- Diverticulitis
- Endometriosis
- Liver cirrhosis
- Uterine fibroids
- Menstruation
- Pregnancy
- Benign ovarian neoplasms
- Other malignancies
52
What other malignancies is CA125 raised in?
- Pancreatic
- Bladder
- Breast
- Liver
- Lung
53
What is the main of use of CA125?
Assessing response over time to treatment for malignancy
54
What are the management options for ovarian cysts?
- Expectant management
- Surgery
55
When do women with ovarian cysts not require follow up?
Small (less than 50mm diameter) simple ovarian cysts
56
Why do women with small simple ovarian cysts not require follow up?
As these cysts are very likely to be physiological and almost always resolve within 3 menstrual cycles
57
What follow up should be given to women with simple ovarian cysts of 50-70mm diameter?
Yearly ultrasound follow-up
58
What should be done in women with simple ovarian cysts of over 70mm diameter?
Consider for either further imaging (MRI) or surgical intervention
59
When are ovarian cysts unlikely to be functional, and may need surgical management?
Those that persist or increase in size
60
Is the oral contraceptive recommended for use in ovarian cysts?
No
61
When is surgery used for ovarian cyst?
If conservative measures fail or criteria for surgery are met
62
What is good about surgery for ovarian cysts?
It is generally very effective and provides cure with minimal effect on reproductive capacity
63
What are the options for surgical management of ovarian cysts?
- Cystectomy
- Oophrectomy
64
When might cystectomy be preferred to oophorectomy?
In children and younger women wishing to preserve maximum fertility
65
What are the complications of ovarian cysts?
- Torsion
- Haemorrhage
- Rupture
- Infertility
66