Ovarian Mass DDX
Teens | Reproductive Age |
Germ Cell Tumors -Choriocarcinoma -Dysgerminoma -Endodermal Sinus Tumors -Embryonal Cell Tumors -Teratoma | -Simple/Hemorrhagic Physiologic Cysts -Mature teratoma -Endometrioma -Benign, borderline, or malignant neoplasms -Metastatic carcinoma -Theca lutein cysts |
Adnexa
Cysts
Corpus Luteum Cysts
- -occur when corpus luteum fails to involute (filled with blood – hemorrhagic)
- -gross: yellow
- -ultrasound: complex
Follicular Cyst
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
Tumor markers for Ovarian Masses | -CA-125 -LDH (lactate dehydrogenase) -AFP -hCG |
Germ Cell Tumor Markers | –Alpha fetoprotein (AFP): endodermal sinus tumors –Lactate dehydrogenase (LDH): dysgerminoma –hCG (choricarcinoma) |
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: