Patología ovárica benigna

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PATOLOGÍA OVÁRICA BENIGNA

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PATOLOGA OVRICA BENIGNA

PATOLOGA OVRICA BENIGNA GeneralidadesSituacin lateral o post lat respecto al tero. Forma elipsoide.

El ovario adulto mide:2.5-5 cm de largo1.5-3 cm de ancho1-2 cm grosor

Imaging of Benign Adnexal Masses Characteristic Presentations on Ultrasound, Computed Tomography, and Magnetic Resonance Imaging Marta E. Heilbrun, MD. Top Magn Reson Imaging & Volume 21, Number 4, July/August 2010

Aspecto en el ciclo menstrualFase proliferativa folculos estimulados por FSH y LH.

Aumentan de tamao hasta el da 8 9.Folculo dominante 2-2.5 cm.

Volumen: largo x ancho x alto x 0.523.

1 ao 1cc.2 aos 0.7 cc. 8 cc como mximo antes de la menarca.Mujeres menstruando: 22 cc Abdominal y 18 cc TV.Mujeres en postmenopausia: Rango de 28 cc.

Quiste postmenopusico > 5 cm con ndulos y tabiques. ciruga.Quiste postmenopusica < 5 cc sin tabiques baja pb de neoplasia.

CAUSA MS FRECUENTE DE > DE TAMAO OVRICO QUISTES

FUNCIONALESFOLICULARES

CUERPO LUTEO

TECA LUTEINICAEl folculo madura no ovula ni involuciona.1 20 mm.Unilaterales, asintomticosRemiten espontneamente.

Por falta de absorcin.Por hemorragia del cuerpo L.Unilateral.Anillo perifrico.

+ hCGSx de hiperestimulacin OV.Enfermedad trofoblstica.bilateralAdnexal Masses: US Characterization and Reporting. Douglas L. Brown, et. al. Radiology. February 2010. 254:2 342-354.

Corpus luteum in a 35-year-old woman. (a) Transvaginal US scan demonstrates a typical appearanceof a corpus luteum within the ovary. It has a slightly thick, crenulated wall (arrows) and a smallcystic center. (b) Color Doppler US scan shows abundant fl ow in the wall of the corpus luteum.9Fig 3. Adnexal Masses: US Characterization and Reporting. Douglas L. Brown, et. al. Radiology. February 2010. 254:2 342-35

Corpus luteum in a 19-year-oldwoman. Transvaginal US scan demonstrates anothertypical appearance of the corpus luteum (calipers)within the ovary. This corpus luteum appears as aslightly hypoechoic area without the identifi able walland obvious cystic center that was illustrated inFigure 10. Color Doppler US scan (not shown) demonstratedfl ow around the periphery of the corpusluteum similar to that seen in Figure 10, but nointernal fl ow.10Fig 5. Adnexal Masses: US Characterization and Reporting. Douglas L. Brown, et. al. Radiology. February 2010. 254:2 342-354

Simple ovarian cyst in a 29-year-oldwoman. Transvaginal US scan reveals a 3.5-cmsimple ovarian cyst (calipers). Normal-appearingovarian tissue (arrows) with a few follicles aroundthe periphery confi rms the ovarian origin of the cyst.11Quiste hemorrgico Se producen por hemorragia interna de quistes funcionales y quistes del cuerpo lteo.

Dolor plvico agudo, se resuelve de 2 a 8 semanas.

Caractersticas variables dependen de cantidad y tiempo de hemorragia.

Subacute hemorrhagic cyst in a 37-year-old woman. Color Doppler transvaginal US scanshows a complex ovarian cyst with a seemingly solidarea due to a clot (C). This could be mistaken for thesolid area of a neoplasm. No fl ow was evident withinthe solid-appearing area and the cyst resolved atfollow-up US 2 months later.13Diagnostic ultrasound. Carol M. Rumack [et al.] 4th ed. 2011. Pag. 577

Hemorrhagic cysts on transvaginal scans: spectrum of appearances. A, Acute hyperechoic hemorrhagiccyst. B, Acute hemorrhagic cyst mimicking a solid lesion14Diagnostic ultrasound. Carol M. Rumack [et al.] 4th ed. 2011. Pag. 577

Large cyst containing multiple internal low-level echoes.E, Reticular pattern of internal echoes and septations within cyst. F, Reticular pattern. G, H, and I, Variations in clot retraction. Theclot in I suggests a solid mass. Lack of color Doppler ultrasound signal supports its benign nature.15Diagnostic ultrasound. Carol M. Rumack [et al.] 4th ed. 2011. Pag. 577

G, H, and I, Variations in clot retraction. Theclot in I suggests a solid mass. Lack of color Doppler ultrasound signal supports its benign nature.16Sndrome de ovario poliqusticoTambin llamado sndrome de Stein-Leventahl, complejo desorden endocrino.

Anovulacin crnica.Hirsutismo ObesidadInfertilidad. Exceso de andrgenos..Imagen 18: http://3.bp.blogspot.com/-8dYbtA8QcTg/Tgdtro3YZ_I/AAAAAAAAAAY/dm_YmUwBdqo/s1600/ovarios_poliquisticos_quisticos.jpg

Ambos ovarios aumentados de tamao con, mltiples folculos pequeos, mas redondeados.

Incremento de la ecogenicidad del estroma.

12 o mas folculos de 2 a 9 mm alrededor del estroma ovrico ( collar de perlas).

Volumen mayor de 10 cc.

El 30% de las mujeres tienen hallazgos ecogrficos normales.

Diagnostic ultrasound. Carol M. Rumack [et al.] 4th ed. 2011. Pag. 582

Polycystic ovaries: typical appearance on transvaginal scans. A and B, Enlarged round ovaries(outlined by cursors) with mildly increased stromal echogenicity and multiple peripheral follicles, string of pearls sign, and centralfollicles.19Ultrasonography in Obstetrics and Ginecology. Callen Peter. 5 ed. 2007. pag. 998

Hiperestimulacin ovrica Secundario a iatrogenia por medicamentos para la fertilizacin asistida. Pero puede ocurrir espontneamente.

Se asocia a acumulacin de lquidos: ascitis, derrame pleural, aumento de peso, hemoconcentracin, oliguria.

Los sntomas principales son dolor, distensin abdominal, nausea, vomito.

Forma leve, ovarios aumentados menos de 5 cm de dimetro.

En la forma grave existe aumento de peso , dolor abdominal intenso, ovarios aumentados con dimetro mayor a 10 cm, con mltiples quistes grandes, de paredes finas, sustituyen al ovario.

Ascitis, derrame pleural, hemoconcentracin, hipotensin y oliguria.

Ovarian hyperstimulation syndrome ina 27-year-old woman. Sagittal transabdominal USscan demonstrates a markedly enlarged left ovary(arrows) with multiple adjacent simple cysts in apatient undergoing in vitro fertilization. The rightovary (not shown) looked similar. This appearance issimilar to that of theca lutein cysts that can be seenwith gestational trophoblastic disease.23Ultrasonography in Obstetrics and Ginecology. Callen Peter. 5 ed. 2007. pag. 1008

Gynecologic Causes of Acute Pelvic Pain: Spectrum of CT Findings.Genevieve L. Bennet.RadioGraphics 2002; 22:785801

Figure 9. Ovarian hyperstimulation syndrome in a 37-year-old woman who was undergoing ovulation induction. CT scan of the pelvis shows massive enlargement of the ovaries by multiple corpus luteum cysts surrounding a core of central ovarian stroma with relatively higher attenuation (*). More cephalad images (not shown) demonstrated a large amount of intraabdominal ascites.25Endometrioma Llamado quiste de chocolate, implantacin ectpica de glndulas endometriales en el ovario

Se puede presentar durante el embarazo, y ser unilaterales o bilaterales y presentar distinta ecogenicidad.

Se realiza diagnostico diferencial con quiste hemorrgico, teratoma (quiste dermoide), adenofibroma de ovario, quiste mucinoso, cistoadenoma seroso.Caractersticas Masa qustica compleja homognea.Ecos de bajo nivel con aspecto de vidrio despulido. Pared gruesa, uni o multiloculado, sin vascularidad al Doppler color.Nivel liquido-liquido.Focos ecogenicos en la pared y zonas solidas o ndulos. En raras ocasiones un carcinoma de clulas claras se desarrolla dentro de un Endometrioma, mas probable en mujeres mayores de 45 aos y con mayores de 9 cm.

Gynecologic Causes of Acute Pelvic Pain: Spectrum of CT Findings.Genevieve L. Bennet.RadioGraphics 2002; 22:785801