A 2 cm left<unk> <unk>  as seen on ultrasound Four kinds of<unk> <unk> s on MRI<unk> <unk> s are usually diagnosed by ultrasound, CT scan, or MRI, and correlated with clinical presentation and endocrinologic tests as appropriate. Ultrasound Follow-up imaging in women of reproductive age for incidentally discovered simple<unk> s on ultrasound is not needed until 5 cm, as these are usually normal<unk>  follicles. Simple<unk> s 5 to 7 cm in premenopausal females should be followed yearly. Simple<unk> s larger than 7 cm require further imaging with MRI or surgical assessment. Because they are large, they cannot be reliably assessed by ultrasound alone; it can be difficult to see posterior wall soft tissue nodularity or thickened septation due to limited ultrasound beam penetrance at this size and depth. For the corpus luteum, a dominant ovulating follicle that typically appears as a<unk>  with circumferentially thickened walls and crenulated inner margins, follow up is not needed if the<unk>  is less than 3 cm in diameter. In postmenopausal patients, any simple<unk>  greater than 1 cm but less than 7 cm needs yearly follow-up, while those greater than 7 cm need MRI or surgical evaluation, similar to reproductive age females. An Axial CT demonstrating a large hemorrhagic<unk> <unk> . The<unk>  is delineated by the yellow bars with blood seen anteriorly. For incidentally discovered dermoids, diagnosed on ultrasound by their pathognomonic echogenic fat, either surgical removal or yearly follow up is indicated, regardless of patient age. For peritoneal inclusion<unk> s, which have a crumpled tissue-paper appearance and tend to follow the contour of adjacent organs, follow up is based on clinical history. Hydrosalpinx, or fallopian tube dilation, can be mistaken for an<unk> <unk>  due to its anechoic appearance. Follow-up for this is also based on clinical presentation. For multiloculate<unk> s with thin septation less than 3 mm, surgical evaluation is recommended. The presence of multiloculation suggests a neoplasm, although the thin septation implies that the neoplasm is benign. For any thickened septation, nodularity, vascular flow on color doppler, or growth over several ultrasounds, surgical removal may be considered due to concern of cancer. Scoring systems There are several systems to assess risk of an<unk> <unk>  of being an<unk>  cancer, including the RMI (risk of malignancy index), LR2 and SR (simple rules). Sensitivities and specificities of these systems are given in tables below: Scoring systems Premenopausal Postmenopausal Sensitivity Specificity Sensitivity Specificity RMI I 44% 95% 79% 90% LR2 85% 91% 94% 70% SR 93% 83% 93% 76%<unk> <unk> s may be classified according to whether they are a<unk> t of the normal menstrual cycle, referred to as a functional or follicular<unk> .<unk> <unk> s are considered large when they are over 5 cm and giant when they are over 15 cm. In children,<unk> <unk> s reaching above the level of the umbilicus are considered giant. Associated conditions In juvenile hypothyroidism multicystic ovaries are present in about 75% of cases, while large<unk> <unk> s and elevated<unk>  tumor marks are one of the symptoms of the Van Wyk and Grumbach syndrome. The CA-125 marker in children and adolescents can be frequently elevated even in absence of malignancy and conservative management should be considered. Polycystic<unk>  syndrome involves the development of multiple small<unk> s in both ovaries due to an elevated ratio of leutenizing hormone to follicle stimulating hormone, typically more than 25<unk> s in each ovary, or an<unk>  volume of greater than 10 mL. Larger bilateral<unk> s can develop as a result of fertility treatment due to elevated levels of HCG, as can be seen with the use of clomifene for follicular induction, in extreme cases resulting in a condition known as<unk>  hyperstimulation syndrome. Certain malignancies can mimic the effects of clomifene on the ovaries, also due to increased HCG, in particular gestational trophoblastic disease.<unk>  hyperstimulation occurs more often with invasive moles and choriocarcinoma than complete molar pregnancies. Risk of cancer A widely recognised method of estimating the risk of malignant<unk>  cancer based on initial workup is the risk of malignancy index (RMI). It is recommended that women with an RMI score over 200 should be referred to a centre with experience in<unk>  cancer surgery. The RMI is calculated as follows: :RMI = ultrasound score × menopausal score × CA-125 level in U/ml. There are two methods to determine the ultrasound score and menopausal score, with the resultant RMI being called RMI 1 and RMI 2, respectively, depending on what method is used: Feature RMI 1 RMI 2 Ultrasound abnormalities: * Multilocular<unk>  * Solid areas * Bilateral lesions * Ascites * Intra-abdominal metastases Menopausal score CA-125 Quantity in U/ml Quantity in U/ml An RMI 2 of over 200 has been estimated to have a sensitivity of 74 to 80%, a specificity of 89 to 92% and a positive predictive value of around 80% of<unk>  cancer. RMI 2 is regarded as more sensitive than RMI 1. Histopathology In case an<unk> <unk>  is surgically removed, a more definite diagnosis can be made by histopathology: Type Subtype Typical microscopy findings Image Functional<unk>  Follicular<unk>  * A variable inner layer of granulosa cells which are luteinized after puberty * An outer layer of usually luteinized theca interna 100px Corpus luteum<unk>  * A convoluted<unk>  lining of luteinized granulosa cells * A prominent inner layer of fibrous tissue * An outer layer of theca cells 150px<unk> adenoma Serous<unk> adenoma<unk>  lining consisting of a simple epithelium, whose cells may be either: * columnar and tall and contain cilia, resembling normal tubal epithelium * cuboidal and have no cilia, resembling<unk>  surface epithelium 150px Mucinous<unk> adenoma Lined by a mucinous epithelium 200px Dermoid<unk>  Well-differentiated components from at least two germ layers (ectoderm, mesoderm and/or endoderm). 150px Endometriosis At least two of the following three criteria: * Endometrial type stroma * Endometrial epithelium with glands * Evidence of chronic hemorrhage, mainly hemosiderin deposits 150px Borderline tumor Atypical epithelial proliferation without stromal invasion. 120px<unk>  cancer Many different types, but generally severe dysplasia/atypia and invasion. Serous carcinoma. Simple squamous<unk>  Simple squamous epithelium and not conforming to diagnoses above (a diagnosis of exclusion) 150px
complications of Ovarian cyst
complications of Epididymitis
medical cause of Endometritis
complications of Pelvic inflammatory disease
medical cause of Epididymitis
complications of Testicular torsion
complications of Uterine fibroid
symptoms of Endometriosis