# data[].attributes.body
1. Charaterize adenexal mass

2. Evaluate abnormal bleeding

3. Assess infertility

4. Monitor follicular growth

5. Perform endovaginal procedures

6. Screen for ovarian cancer

# data[].attributes.headline
Transvaginal is better for charaterizing   

# data[].attributes.subject
Transvaginal is better for charaterizing   

# data[].attributes.body
internal structure of ovary

vascualr anatomy

adenxal area

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MUST note and use information from clincial pelvic exam

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Normal Sonographic Appearance of Ovaries 

# data[].attributes.subject
Normal Sonographic Appearance of Ovaries 

# data[].attributes.body
Homogeneous echotexture

May exhibit central, more echogenic medulla

Small anechoic or cystic follicles may be seen peripherally in cortex.

Appearance varies with age and menstrual cycle.

# data[].attributes.headline
Mural nodule with blood flow within cystic lesion of ovary 

# data[].attributes.subject
Mural nodule with blood flow within cystic lesion of ovary 

# data[].attributes.body
Endometrioma

# data[].attributes.body
Dermoid

# data[].attributes.body
Normal corpus luteum

# data[].attributes.body
Usually 1 dominat follicle develops each cycle
Ovulation occurs
Corpus Luteum forms OR an abnormal unruputed follicle can persist as

simple cyst

complex cystic structure

These are referred to as Functional Cysts

# data[].attributes.body
May cause

pain or discomfort

delayed menses

Should regress within 8 weeks

serial ultrasounds may be ordered to F/U

If Functional Cyst measures >6cm for >8wks  surgical intervention may be considered in order to

prevent torision

eval pathology of lesion

# data[].attributes.body
1. smooth walled

2. anechoic

3. acoutic enhamcement

# data[].attributes.headline
Differential Considerations for Simple Adnexal Cysts - MUST KNOW THESE and HOW EACH PRESENTS SONOGRAPHICALLY 

# data[].attributes.subject
Differential Considerations for Simple Adnexal Cysts - MUST KNOW THESE and HOW EACH PRESENTS SONOGRAPHICALLY 

# data[].attributes.body
1. Follicular (Functional) cyst

2. Corous Luteum

resolving

of pregnancy

3. Cystic teratoma

4. Paraovarian Cyst

5. Hydrosalpinx

6. Endometrioma (chocolate cyst)

7. Hemorrhagic cyst

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More sonographically COMPLEX the tumor the more likely it is CANCER- epically is ascites is present

# data[].attributes.subject
More sonographically COMPLEX the tumor the more likely it is CANCER- epically is ascites is present

# data[].attributes.body
During most fertile years (<age 40) 1 in 15 is malignant

After age 40 1 in 3 in malignant

# data[].attributes.headline
Differential Diagnosis of Solid-Appearing Adnexal Masses - MUST KNOW THESE and HOW EACH PRESENTS SONOGRAPHICALLY 

# data[].attributes.subject
Differential Diagnosis of Solid-Appearing Adnexal Masses - MUST KNOW THESE and HOW EACH PRESENTS SONOGRAPHICALLY 

# data[].attributes.body
Solid teratoma
Adenocarcinoma
Arrhenoblastoma
Fibroma
Dysgerminoma
Torsion

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Mixed solid to cystic ovarian masses are usually epithelial ovarian tumors 

# data[].attributes.subject
Mixed solid to cystic ovarian masses are usually epithelial ovarian tumors 

# data[].attributes.body
Most common are

1. Cystadenoma

Benign

1. Cystadenocarcinoma

Malignant

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Color Doppler helpful in

differentiating potential cyst from adjacent vascular structures

localize flow to further determine flow velocity with pulsed Doppler; can be obtained on all ovarian masses

Pulsed Doppler interrogation of adnexal branch of uterine artery, ovarian artery, intratumoral flow performed to determine resistive index or pulsatility index

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Patients with normal menstrual cycles best scanned in first 10 days of cycle

# data[].attributes.subject
Patients with normal menstrual cycles best scanned in first 10 days of cycle

# data[].attributes.body
This avoids confusion with normal changes in intraovarian blood flow because high diastolic flow occurs in luteal phase.

# data[].attributes.headline
What is the value of RI in distinguishing between benign and malignant adnexal masses?

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What is the value of RI in distinguishing between benign and malignant adnexal masses?

# data[].attributes.body
1. Largest study uses cutoff of >0.4 as normal RI in nonfunctioning ovary.

2. Other investigators use PI of >1 as normal.

3. Signs that may be worrisome for malignancy:

intratumoral vessels,

low-resistance flow,

absence of normal diastolic notch in Doppler waveform

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RI is not a sensitive indicator of malignancy

# data[].attributes.subject
RI is not a sensitive indicator of malignancy

# data[].attributes.body
Abnormal waveforms can be seen in inflammatory masses, metabolically active masses (including ectopic pregnancy), and corpus luteum cysts.

# data[].attributes.headline
Although indices have different cut-off values, increased diastolic flow suggests neovascularity and the likelihood of a malignancy

# data[].attributes.subject
Although indices have different cut-off values, increased diastolic flow suggests neovascularity and the likelihood of a malignancy

# data[].attributes.body
Pulsatility index (PI) calculated as peak-systolic velocity minus end-diastolic velocity divided by mean velocity.

Resistive index (RI) is peak-systolic velocity minus end-diastolic velocity divided by peak-systolic velocity

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Inflammatory masses, active endocrine tumors, and trophoblastic disease (ectopic pregnancies) may give low indices, mimicking cancer

# data[].attributes.subject
Inflammatory masses, active endocrine tumors, and trophoblastic disease (ectopic pregnancies) may give low indices, mimicking cancer

# data[].attributes.body
Cut-off value for
PI is 1.0
RI is 0.4

malignancy considered more likely below these values

benign disease more likely above these values

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Mass showing complete absence or minimal diastolic flow (very elevated RI and PI values) usually benign

# data[].attributes.subject
Mass showing complete absence or minimal diastolic flow (very elevated RI and PI values) usually benign

# data[].attributes.body
PI and RI values may vary considerably in fertile patient during menstrual cycle.

In first 7 days, flow to ovaries has the greatest resistance with the lowest diastolic flow, and indices are at their highest.

Later in each cycle, diastolic flow increases, particularly to dominant ovary, and may lower indices sufficiently to falsely suggest malignant process

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Most common cause of ovarian enlargement in young women

# data[].attributes.subject
Most common cause of ovarian enlargement in young women

# data[].attributes.body
Functional cysts result from normal function of ovary

Functional cysts include

follicular,

corpus luteum,

hemorrhagic,

theca-lutein cysts

Hormonal therapy sometimes administered to suppress cyst

Most cysts measure <5 cm in diameter and regress during subsequent menstrual cycle.

Follow-up sonographic examination in 6 weeks usually documents change in size

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Occur when dominant follicle does not succeed in ovulating and remains active though immature

Are usually unilateral

Are thin-walled, translucent, have watery fluid; may project above or within surface of ovary

May grow 1 to 8 cm

Usually disappear spontaneously by resorption or rupture

Clinical: asymptomatic to dull, adnexal pressure and pain, abnormal ovarian function, torsion of ovary resulting in severe pain

Sonographic findings: simple cyst

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Result from hemorrhage within persistently mature corpus luteum

# data[].attributes.subject
Result from hemorrhage within persistently mature corpus luteum

# data[].attributes.body
Filled with blood and cystic fluid

May grow 1 to 10 cm in size

May accompany intrauterine pregnancy (IUP)

Clinical: irregular menstrual cycle, pain, mimic ectopic pregnancy, rupture

Sonographic findings: “cystic” type of lesion; may have internal echoes secondary to hemorrhage and increased color

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Internal hemorrhage may occur in follicular cysts or, more commonly, in corpus luteal cysts

# data[].attributes.subject
Internal hemorrhage may occur in follicular cysts or, more commonly, in corpus luteal cysts

# data[].attributes.body
Clinically

Patient may present with acute onset of pelvic pain.

Sonographically

Acute hemorrhagic cyst usually hyperechoic; may mimic solid mass

Usually has smooth posterior wall and shows posterior acoustic enhancement indicating its cystic component

Diffuse low-level echoes may be seen, but are more commonly seen in endometriomas.

Internal pattern becomes more complex

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Are large, bilateral, multiloculated cysts  associated with high levels of human chorionic gonadotropin -seen in 30% of patients with trophoblastic disease

# data[].attributes.subject
Are large, bilateral, multiloculated cysts  associated with high levels of human chorionic gonadotropin -seen in 30% of patients with trophoblastic disease

# data[].attributes.body
Clinical: nausea and vomiting

Sonographic findings: multilocular cysts in both ovaries

# data[].attributes.body
OHS is frequent iatrogenic complication of ovulation induction.

In mild form, patient presents with pelvic discomfort, but no significant weight gain.

Ovaries enlarged; measure <5 cm in diameter

# data[].attributes.body
Clinically

Patient has severe pelvic pain, abdominal distention, and notably enlarged ovaries, measuring >10 cm in diameter.

Associated ascites, pleural effusions, numerous large, thin-walled cysts throughout periphery of ovary

When treated, condition usually resolves within 2 to 3 weeks.

# data[].attributes.body
Bilaterally enlarged polycystic ovaries

Occurs in late teens through 20s patients may have endocrine imbalance

Clinical: amenorrhea, obesity, infertility, hirsutism

Sonographic findings: multiple tiny cysts around periphery of ovary; ovary may be normal size or enlarged

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Are formed when adhesions trap peritoneal fluid around ovaries, resulting in large adnexal mass

# data[].attributes.subject
Are formed when adhesions trap peritoneal fluid around ovaries, resulting in large adnexal mass

# data[].attributes.body
Peritoneal inclusion cysts lined with mesothelial cells

Clinically, most patients have pelvic pain and/or pelvic mass.

# data[].attributes.body
Usually simple

Can bleed or torse

Ten percent of all adnexal masses

Located in broad ligament

Clinical: asymptomatic

Sonographic findings: simple cyst adjacent to ovary

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Functioning endometrial tissue is present outside the uterus

# data[].attributes.subject
Functioning endometrial tissue is present outside the uterus

# data[].attributes.body
Ectopic tissue can be found almost anywhere in pelvis,
ovary,
fallopian tube,
broad ligament,
external surface of uterus,
scattered over peritoneum,
cul-de-sac, even bladder.

# data[].attributes.headline
Endometrial tissue cyclically bleeds and proliferates

# data[].attributes.subject
Endometrial tissue cyclically bleeds and proliferates

# data[].attributes.headline
Two forms of endometriosis described: diffuse and localized (endometrioma)

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Two forms of endometriosis described: diffuse and localized (endometrioma)

# data[].attributes.body
more common
consists of endometrial plantings within peritoneum

Rarely diagnosed by sonography

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Localized form consists of discrete mass called

endometrioma,

chocolate cyst,

frequently found in multiple sites

# data[].attributes.body
Endometriosis may appear as bilateral or unilateral ovarian cysts.

Patterns ranging from anechoic to solid

Depends on amount of blood and its organization

# data[].attributes.body
Well-defined unilocular or multilocular

Predominantly cystic mass

Containing diffuse homogeneous, low-level internal echoes

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Caused by partial or complete rotation of ovarian pedicle on its axis

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Caused by partial or complete rotation of ovarian pedicle on its axis

# data[].attributes.body
Produces enlarged edematous ovary, usually >4 cm in diameter

Sonographic:
Multiple tiny follicles around hypoechoic mass to completely solid adnexal mass

Free fluid often present in pelvis

Doppler examination usually reveals absent blood flow to torsed ovary.

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Acute abdominal condition requiring prompt diagnosis and surgical intervention

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Acute abdominal condition requiring prompt diagnosis and surgical intervention

# data[].attributes.body
Accounts for 3% of gynecologic operative emergencies

# data[].attributes.body
Causes edema and eventual loss of arterial perfusion with subsequent infarct

Torsion typically involves not only ovary but also fallopian tube

Once torsion has occurred, 10% increased incidence of torsion occurring in contralateral adnexa

Torsion of normal ovary usually occurs in children and younger females with mobile adnexa, preexisting ovarian cyst or mass, or pregnancy.

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Usually associated with mass

Hypoechoic enlarged ovary, with or without peripheral follicles

Absent blood flow on Doppler examination

Free fluid in cul-de-sac

Surgical emergency

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Acute severe unilateral pain

Right ovary is three times more likely to torse than the left.

Intermittent pain may precede acute pain by weeks

Symptoms mimicked by many other pelvic or lower abdominal processes, and quite frequently torsion part of differential diagnostic list

Patient may have fever, nausea, vomiting

Palpable mass felt in more than 50% of patients

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Additional Information for Ovarian Torsion

# data[].attributes.subject
Additional Information for Ovarian Torsion

# data[].attributes.body
Torsed ovary typically enlarged and heterogeneous in appearance, owing to edema, hemorrhage, and/or necrosis

Is often a lead mass, but in some cases mass not appreciated because it is mixed in with the necrosis and hemorrhage of the torsed mass

Torsed masses often large (>4 cm in diameter); vary in appearance from cystic to solid; vary in echogenicity from relatively anechoic to markedly hyperechoic

Palpable mass may be present.

Torsion occurs more frequently on right side, and pain may mimic acute appendicitis.

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Cyst >5 cm recommended for surgical removable

# data[].attributes.subject
Cyst >5 cm recommended for surgical removable

# data[].attributes.body
Only 3% of ovarian cysts <5 cm are malignant

In postmenopausal woman, ovaries enlarged; if mass seen, may be mixed texture to solid with papillae within

Well-defined anechoic lesions more likely to be benign; lesions with irregular walls, thick irregular septations, mural nodules, and solid echogenic elements favor malignancy

Doppler examination shows low-resistive pattern.

Extension beyond ovary into omentum or peritoneum and liver metastases should be evaluated.

Malignant ascites may be present.

Unilocular or thinly septated cysts more likely to be benign

Multilocular, thickly septated masses and masses with solid nodules are more likely to be malignant.

In advanced stages, peritoneal carcinomatosis with malignant ascites and peritoneal implants can be seen.

Any change in ovarian echogenicity or volume of more than 20 ml should be considered suspicious.

In postmenopausal women, ovaries become atrophic and often do not have follicles.

Only women receiving hormone replacement therapy continue to have normal-sized ovaries.

Abnormal ovaries suggestive of malignancy defined as enlarged echogenic ovaries.

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Approximately 1 in 70 women develop the disease

# data[].attributes.subject
Approximately 1 in 70 women develop the disease

# data[].attributes.body
Ovarian carcinoma kills more women than cancer of uterine cervix and body combined and is the fourth leading cause of cancer death

60% of ovarian malignancies occur in women between 40 and 60 years of age

Relative absence of symptoms early in disease

Commonly not detected until advanced, having spread beyond capsule but still within pelvis (stage II) or into abdomen (stage III).

Adnexal finding on physical examination variable, ranging from almost “normal” to slightly enlarged firm irregular ovaries to pelvic masses

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In advanced disease, ascites and omental masses may be palpated.

Blood chemistry test CA 125 helpful in some patients; disappointing as screening test because of inability to detect many cases of ovarian cancer

Has many false-positive and false-negative results; elevated levels found in only 50% of patients with stage III ovarian cancer

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Can present as either complex, cystic, or solid mass

More likely predominantly cystic

As many as 20% bilateral

Differential diagnoses include

endometriosis,

hemorrhagic ovarian cyst,

ovarian torsion,

PID,

benign ovarian neoplasms

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Masses <5 cm in longest axis more likely to be benign

Masses >10 cm more likely to be malignant

Increasing patient age correlates with increased incidence of malignancy.

Strongest risk factor is family history of ovarian or breast cancer.

Women with carcinoma of breast have increased risk of developing ovarian cancer; women with ovarian cancer 3 to 4 times more likely to develop breast cancer.

Other risk factors include increasing age, nulliparity, infertility, uninterrupted ovulation, and late menopause

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include vague abdominal pain, swelling, indigestion, frequent urination, constipation, and weight change (ascites).

Over 70% of women first seen by doctors are in advanced stages of disease.

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Cancer Is Classified into One of the Following Stages

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Cancer Is Classified into One of the Following Stages

# data[].attributes.body
STAGE I: Limited to ovary

a.Limited to 1 ovary

b.Limited to 2 ovaries

c.Positive peritoneal lavage (ascites)

STAGE II: Limited to pelvis

a.Involvement of uterus/fallopian tubes

b.Extension to other pelvic tissues

c.Positive peritoneal lavage (ascites)

STAGE III: Limited to abdomen: intraabdominal extension outside pelvis/retroperitoneal nodes/extension to small bowel/omentum

STAGE IV: Hematogenous disease (liver parenchyma)/spread beyond abdomen

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Gynecologic tumors that arise from surface epithelium and cover ovary and underlying stroma are called surface epithelial-stromal tumors

# data[].attributes.subject
Gynecologic tumors that arise from surface epithelium and cover ovary and underlying stroma are called surface epithelial-stromal tumors

# data[].attributes.body
Account for 65% to 75% of all ovarian neoplasms and 80% to 90% of all ovarian malignancies

Most common types are serous and mucinous tumors.

Serous tumors most common; comprise 30% of all ovarian neoplasm

Mucinous tumors account for 20% to 25% of ovarian neoplasms

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Benign or low-malignancy potential form termed adenoma and malignant form termed adenocarcinoma.

Prefix cyst- added to term if lesion cystic; fibroma added if tumor is more than 50% fibrous

Mucinous tumors less frequently bilateral than are serous type

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Direct extension to surrounding structures and lymphatics not uncommon

Hematogeneous spread usually occurs late in course of disease.

# data[].attributes.headline
Constitutes 20% to 25% of all benign ovarian neoplasms

# data[].attributes.subject
Constitutes 20% to 25% of all benign ovarian neoplasms

# data[].attributes.body
Type of epithelial tumor lined by mucinous elements of endocervix and bowel

When benign, mucinous cystadenoma; when malignant, cystadenocarcinoma

Is usually found in woman between ages of 13 and 45 years old

80% to 85% of mucinous tumors benign

Can be very large, measuring 15 to 30 cm in diameter, and weighing more than 100 pounds

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In 75% of patients with mucinous tumors, ultrasound examination shows simple or septate thin-walled multilocular cysts

Contain internal echoes with compartments differing in echogenicity caused by mucoid material in dependent portions

# data[].attributes.body
Unusually large (15 to 30 cm)

Most common cystic tumor
Usually unilateral

Cyst filled with sticky, gelatin-like material
Multilocular cystic spaces

Benign type more common than malignant

Clinical: pressure, pain, increased abdominal girth

Sonographic findings: simple or septate thin-walled multilocular cysts

# data[].attributes.headline
Most frequently occurs in women 40 to 70 years old

# data[].attributes.subject
Most frequently occurs in women 40 to 70 years old

# data[].attributes.body
Accounts for 5% to 10% of all primary malignant ovarian neoplasms

15% to 20% bilateral when malignant
10% occur in menopausal women

Can also become very large and more likely than benign form to rupture

If tumor ruptures, associated with pseudomyxoma peritoneum

Causes loculated ascites with mass effect

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Malignant cysts tend to have thick, irregular walls and septations with papillary projections and echogenic material.

Generally have sonographic appearance similar to serous cystadenocarcinomas

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Bilateral

May occur in menopausal women (10%)

Large, likely to rupture—ascites

Clinical: pelvic pressure; pain when ruptured

Sonographic findings: ascites appears as hypoechoic fluid with bright punctate echoes; thick, irregular walls and septations

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Second most common benign tumor of ovary (after dermoid cyst)

# data[].attributes.subject
Second most common benign tumor of ovary (after dermoid cyst)

# data[].attributes.body
Represents 20% to 25% of all benign ovarian neoplasms

Is usually unilateral; 20% are bilateral

# data[].attributes.body
Usually unilocular or multilocular with thin septations

External papillary mass adhesions and infection lead to bilateral involvement

Loss of capsular definition and tumor fixation; calcifications

Peritoneal implants; ascites; metastases to omentum, lymph nodes, liver, and lungs

Smaller than mucinous cysts (up to 20 cm); borders irregular with loss of capsular definition

Clinical: pelvic pressure, bloating

Sonographic
cystic structure with septations and/or papillary projections; internal and external papillomas usually present

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Germ cell tumors derived from primitive germ cells of embryonic gonad

# data[].attributes.subject
Germ cell tumors derived from primitive germ cells of embryonic gonad

# data[].attributes.body
Account for 15% to 20% of ovarian neoplasms,

with approximately 95% being benign cystic teratomas

Besides teratomas, germ cell tumors include dysgerminoma, embryonal cell carcinoma, choriocarcinoma, and transdermal sinus tumor.

Often occur as mixed tumors with elements of two or three varieties of germ cell tumors

Associated with elevated alpha-fetoprotein (AFP) and hCG levels

Clinical symptoms include pelvic and/or abdominal pain and palpable mass (average diameter 15 cm)

Usually unilateral; 40% of tumors will calcify

Ranges in texture from homogeneously solid (3%), predominantly solid (85%), to predominantly cystic (12%)

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Contains fatty, sebaceous material, hair, cartilage, bone, teeth

# data[].attributes.subject
Contains fatty, sebaceous material, hair, cartilage, bone, teeth

# data[].attributes.body
Size ranges from small to 40 cm

Unilateral, round to oval mass

Clinical: asymptomatic to abdominal pain, enlargement and pressure; pedunculated; subject to torsion

Sonographic findings: cystic/complex/solid mass; echogenic components; acoustic

# data[].attributes.body
1)Completely cystic mass

2)Cystic mass with very echogenic nodule along mural wall representing “dermoid plug”

3)Fat-fluid level

4)High-amplitude echoes with shadowing (e.g., teeth or bone)

5)Complex mass with internal septations

# data[].attributes.body
Immature teratomas uncommon; occur in girls and young women 10 to 20 years of age

Rapidly growing, solid malignant tumors with many tiny cysts

Unilateral and small in size; may grow to larger dimension

# data[].attributes.headline
Entirely solid ovarian mass in woman <30 years of age usually dysgerminoma

# data[].attributes.subject
Entirely solid ovarian mass in woman <30 years of age usually dysgerminoma

# data[].attributes.body
Rare malignant germ cell tumor bilateral in 15% of cases

Mass constitutes 1% to 2% of primary ovarian neoplasms and 3% to 5% of ovarian malignancies

Dysgerminoma and serous cystadenoma are two most common ovarian neoplasms seen in pregnancy.

# data[].attributes.headline
rare rapidly growing tumors also called yolk sac tumors 

# data[].attributes.subject
rare rapidly growing tumors also called yolk sac tumors 

# data[].attributes.body
Usually occurs in women <20 years of age; is almost always unilateral

Increased serum AFP may be seen

Endodermal sinus tumor has poor prognosis.

Second most common malignant ovarian germ cell neoplasm after dysgerminoma

Sonographic appearance similar to dysgerminoma

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Includes granulosa cell tumor, thecoma, fibroma, and Sertoli-Leydig cell tumors (androblastoma)

# data[].attributes.subject
Includes granulosa cell tumor, thecoma, fibroma, and Sertoli-Leydig cell tumors (androblastoma)

# data[].attributes.body
Sex cord-stromal tumors typically solid adnexal masses that arise from sex cords of embryonic gonadal and/or ovarian stroma

Accounts for 5% to 10% of all ovarian neoplasms and 2% of all ovarian malignancies

# data[].attributes.body
Both fibroma and thecoma tumors arise from ovarian stroma; are pathologically similar

Tumors with abundance of thecal cells called thecomas, and those with abundance of fibrous tissue called fibromas

Thecomas usually benign and unilateral, comprising 1% of all ovarian neoplasms; 70% occur in postmenopausal women

Frequently show signs of estrogen production

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Ascites has been reported in up to 50% of patients with fibromas >5 cm in diameter

Associated ascites along with pleural effusion

Referred to as Meigs syndrome; occurs in 1% to 3% of patients with fibroma

Not specific; it can occur with other ovarian neoplasms as well

Found in postmenopausal women

Comprise 4% of ovarian neoplasms

Rarely associated with estrogen production

Clinical signs include lack of symptoms if tumor small

If large, increasing pressure and pain apparent

Sonographic findings

Usually unilateral (90%)

Size ranges from small to melon size, with variable sonographic appearance.

Hypoechoic mass with posterior attenuation seen from homogeneous fibrous tissue

Larger tumors pedunculated and prone to torsion, edema, and cystic degeneration

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Feminizing neoplasm composed of cells resembling graafian follicle

Most common hormone-active estrogenic tumor of ovary

More common after menopause (50%)

Also seen in reproductive ages (45%) and in adolescence (5%)

Clinical symptoms of estrogen production may include precocious puberty or vaginal bleeding and full breasts.

Pain, pressure, fullness may also be present.

May twist on itself to cause torsion or rupture, leading to Meigs syndrome

Malignant transformation rare, but when it occurs, lesion spreads via lymphatics and bloodstream

Sonographic findings

Variable appearance

Mass without torsion

Similar to endometrioma or cystadenoma, with low-level homogeneous echoes

If torsion occurs, multilocular cyst containing blood or fluid seen

Solid masses may have echogenicity similar to uterine fibroids.

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Ovaries more involved with metastatic disease than any other pelvic organ

# data[].attributes.subject
Ovaries more involved with metastatic disease than any other pelvic organ

# data[].attributes.body
Metastases often mimic appearance of advanced stage II to III primary ovarian cancer.

Approximately 5% to 10% of ovarian neoplasms are metastatic in origin.

Metastatic cancer can arise from

1. breast,

2. upper GI tract,

3. other pelvic organs by direct extension or by lymphatic spread.

Krukenberg tumors “drop” metastases to ovaries from

GI tract, primarily from stomach,

biliary tract,

gallbladder,

pancreas.

# data[].attributes.body
Metastatic disease to ovaries

frequently bilateral

often associated with ascites

Metastases usually completely solid or solid with “moth-eaten” cystic pattern that occurs when necrotic

# data[].attributes.body
usually diffuse and disseminated and also frequently bilateral

Sonographically, mass appears as solid hypoechoic tumor similar to lymphoma elsewhere in body.

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Least common (<1%) of all gynecologic malignancies

# data[].attributes.subject
Least common (<1%) of all gynecologic malignancies

# data[].attributes.body
Adenocarcinoma most common histological finding

Occurs most frequently in postmenopausal women with pain, vaginal bleeding, pelvic mass

Usually involves distal end; may involve entire length of tube

Sonographic findings

Appears as sausage-shaped, complex mass, with cystic and solid components often with papillary projections

Clinical and sonographic findings similar to those of ovarian carcinoma

# data[].attributes.headline
Distended impacted feces in rectosigmoid colon

# data[].attributes.subject
Distended impacted feces in rectosigmoid colon

# data[].attributes.body
Location, size, consistency, and source of adnexal masses can be defined.

Distinguish solid ovarian masses from pedunculated myomas by identifying uterine connection and searching for ovary.

Any fluid present in pelvis can be used to outline dependent portions of pelvic organs by tilting patient, using transvaginal approach, or both.

Obvious signs of malignancy, such as sonolucent liver metastases or nodular peritoneum outlined by ascites, assist in preoperative assessment.

Histological diagnosis made by pathologist

# data[].attributes.headline
Describe the normal echotexture of the ovaries - include the medulla and cortex 

# data[].attributes.subject
Describe the normal echotexture of the ovaries - include the medulla and cortex 

# data[].attributes.headline
Is a mass showing complete absence or minimal diastolic blood flow benign or malignant?

# data[].attributes.subject
Is a mass showing complete absence or minimal diastolic blood flow benign or malignant?

# data[].attributes.headline
List the differential considerations for a solid appearing adnexal mass including the sonographic appearance of each 

# data[].attributes.subject
List the differential considerations for a solid appearing adnexal mass including the sonographic appearance of each 

# data[].attributes.headline
The more sonographically complex an adnexal tumor the more benign or malignant it is? 

# data[].attributes.subject
The more sonographically complex an adnexal tumor the more benign or malignant it is? 

# data[].attributes.headline
Epithelial ovarian tumors that are mixed solid to cystic ovarian masses are most commonly these 2 types of tumors? 

# data[].attributes.subject
Epithelial ovarian tumors that are mixed solid to cystic ovarian masses are most commonly these 2 types of tumors? 

# data[].attributes.headline
If an adnexal mass is mostly cystic it is more likely benign or malignant?

# data[].attributes.subject
If an adnexal mass is mostly cystic it is more likely benign or malignant?