Ovarian Diseases

Ovarian Mass DDX

Adnexa

• -region adjoining uterus (contain ovary, fallopian tube, assoc vessels/ligaments/CT)

Cysts

Corpus Luteum Cysts

• -occur when corpus luteum fails to involute (filled with blood – hemorrhagic)
  
• -gross: yellow
  
• -ultrasound: complex

Follicular Cyst

• -normal smooth, thin-wall unilocular cyst (usu <2.5cm)
  
• -spontaneously resolve (wks)

Theca Lutein Cysts

• -Luteinized follicle cysts which form as a result of overstimulation from high hCG levels or a hypersensitivity to hCG
• -Often seen in gestational trophoblastic disease or ovarian hyperstimulation

Endometrioma

• -growth of ectopic endometrial tissue on surface of ovary
  
• -present: pelvic pain, dysmenorrhea, dyspareunia (painful sex)
  
• -“chocolate cysts”

Polycystic ovarian syndrome (PCOS)

• -ovary has multiple 2-9mm follicles along periphery
  
• -increase ovarian volume
  
• -obese women, hirutism, anovulatory

Tumor

Mature Teratoma

• -benign germ cell tumor
  
• -most common ovarian tumor (20s-30s)
  
• -derive from 3 germ cell layers (teeth, hair sebum)
  
• -malignant: immature teratoma (neural)

Benign Ovarian Neoplasms

• –Serous cystadenoma (thin wall, unilocular)
  
• –Mucinous cystadenoma (multiloculated, larger, bilateral)
  
• -mature cystic teratoma

Malignant Ovarian Neoplasms

• -Epithelial cells origin
  
• -Germ cell origin
  
• -Sex cord-stromal origin
  
• -Mixed cell types
  
• -Metastatic disease:
  
  • Krukenberg tumor (arise from GI tract or breast)

Ovarian Cancer

• Majority of primary ovarian tumors derive from:
  • Epithelilal cells
    
    • -Serous (Fallopian tube)
      
    • -Endometrioid (Endometrium)
      
    • -Mucinous (Cervix)
      
    • -Clear cell (Vagina)
• Path:
  • Incessant ovulation
    • -repeated trauma/repair (genetic mutation/cellular neoplasia)
  • excess gonadotropin secretion (high estrogen = epithelial proliferate)
• Protective factors:
  • -oral contraceptive pills
    
  • -Multiparity
    
  • -Tubal ligation
    
  • -Breast feeding
    
  • -Progesterone
• Risk factors:
  • -Infertility
    
  • -Early age at menarche or late age at menopause
    
  • -Postmenopausal estrogen replacement therapy
    
  • -Endometriosis
    
  • -Genetic mutations