Ovarian Cysts
-
Common, usually benign, but should always be
evaluated
-
Follicle Cysts and Corpus Luteum Cysts – most commonly
related to the menstrual cycle.
o
These can be watched and can go away or they can be
treated with OCPs (Oral Contraceptive Pills).
o
Surgery is uncommon.
-
Benign non-functional (meaning non-hormonal) cysts often
come to cystectomy. Sometimes laparoscopic – not really
addressed. All that was said was that these ovarian
cysts sometimes need surgery.
-
May
have no symptoms or may cause pain/pressure.
-
Looks much like an antral follicle only bigger. If the
cysts is just a big balloon with nothing in it, then
great. But if it’s multi-loculated or has solid areas,
that’s not as great.
Endometriomas
-
mass
in the ovaries
-
Can
be asymptomatic
-
Can
cause pain
-
Can
result in infertility
-
Chocolate cyst
– contains brown blood
Polycystic Ovary Disease
-
Stein & Leventhal described it in 1935 so it’s also
called Stein & Leventhal Disease…for some reason, I
can’t care about this fact too much.
-
No
one knows what causes this.
-
Sclerocystic ovaries
– “sclerocystic” meaning the ovaries have a thick
capsule and lots of cysts. These don’t ovulate.
-
Some
effects:
o
Inappropriate gonadotropin secretion (steady LH level,
instead of the cycling), hyperandrogenemia (b/c
the ovaries produce androstenediol which is a weak
androgen), insulin resistance.
§
The
hyperandrogenemia causes masculinity
o
Patients are obese, oligoamenorrheic (few
or no menstruations), hirsute (hairy), infertile
§
The
obesity causes hyperestrogenism b/c of increased
estrone in the peripheral fat
o
Risk
of endometrial cancer – the endometrial cancers that
occur in premenopausal women are often associated with
this condition.
-
Surgery isn’t really done on these anymore, medical
treatment is preferred.
Fallopian tubes
-
Epithelium: a combo of ciliated columnar, noncialiated
columnar, and intercalated
o
The
role of intercalated epithelium is unknown
-
Muscular wall: The inner wall is circular, the
outer wall is longitudinal
-
The
lumen is made of delicate folds
o
These
function in fertilization which happens at day 6.5 after
the sperm enter the tube.
-
Disease
o
PID –
most are treated with antibiotics
o
Ectopic
pregnancy – most happen in tubes
o
Neoplasia – rare
o
Follicular salpingitis – the delicate folds are fused together forming blind sacs.
§
Can
lead to a tubal ectopic pregnancy
·
This
can rupture
o
TB
salpingitis – leads to granulomas; didn’t really talk
about this too much.
o
P.S.
Salpingitis means inflammation of the fallopian tube.
Ectopic Pregnancy
-
Classic
presentation – early suggestion of pregnancy with
amenorrhea, other symptoms, then bleeding, then pain.
-
Most
cases are atypical in presentation; so this is a
diagnostic challenge.
-
It is
critical to suspect this – always think of this when the
patient is showing any symptoms.
-
Therapy
– salpingostomy vs salpingectomy
-
It
detected via ultrasound
-
Histological appearance – tube with blood clots and
folds
-
Rupturing and hemorrhage (into the peritoneal cavity for
example) can occur.
Cancer
of the Fallopian Tubes
-
Uncommon
-
Histologically, looks like ovarian cancer
-
Treated
in a similar fashion to ovarian cancer.
-
Staging
system is different from the staging of ovarian cancer
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