262 Obstetrics and Gynecology Board Review •••
❍ What are the Rotterdam criteria for diagnosing polycystic ovary syndrome (PCOS)?
Two out of three of the following:
- Oligo- and/or anovulation.
- Clinical and/or biochemical signs of hyperandrogenism.
- Polycystic ovaries by ultrasound.
Other etiologies must also be excluded.
❍ What percentage of patients with anovulation associated with PCOS do not have the expected reversal of the
luteinizing hormone:follicle-stimulating hormone (LH:FSH) ratio?
Between 20% and 40% of patients with PCOS will not have the expected reversal of the LH:FSH ratio. For this
reason, it is not recommended to routinely measure FSH and LH levels in anovulatory patients and make the
diagnosis on clinical presentation alone.
❍ What is the most common benign, solid ovarian tumor?
The fibroma is the most common, with a malignant potential of under 1%. They are a type of sex cord stromal
ovarian neoplasm. These are slow growing tumors with <10% occurrence of bilaterality. On cut section a
homogeneous white or yellowish white solid tissue with a trabeculated appearance is seen.
❍ What is Meigs syndrome?
The clinical triad of an ovarian fibroma, ascites, and pleural effusion (classically right sided). These clinical
features are not specific to fibromas, and a similar clinical picture can be found with many other ovarian tumors.
The ascites and hydrothorax are most likely caused by substances such as vascular endothelial growth factor
(VEGF), which increases vessel permeability. Both the ascites and hydrothorax resolve after removal of
the tumor.
❍ A benign ovarian tumor is removed from a 50-year-old. The pathology report makes note of pale epithelial
cells with a “coffee bean” nucleus. What is the diagnosis?
Brenner tumors are rare transitional cell ovarian tumors that usually occur in women from 40 to 60 years of age.
They are rarely bilateral and <2% undergo malignant degeneration.
❍ What other neoplasms are frequently associated with Brenner tumors?
Dermoid cysts or mucinous cystadenomas are often found in the same or contralateral ovary.
❍ A 43-year-old woman presents 5 years following a TAH/BSO for benign disease with a palpable pelvic mass
and cyclical pelvic pain. An FSH level is in the premenopausal range. What is the most likely diagnosis?
The ovarian remnant syndrome occurs in patients who have undergone bilateral oophorectomy usually
complicated by endometriosis or pelvic inflammatory disease. This syndrome occurs when failure to skeletonize
the infundibulopelvic ligament or incorrect clamp placement results in retention of a piece of ovarian tissue. Many
patients present with cyclic pain and a mass. Sonography may aid in the diagnosis, as will FSH levels. CT/MRI
may be useful in defining the relation of the ovarian remnant to surrounding structures.
❍ What is a fibroid/leiomyoma?
These are benign smooth muscle tumors of the uterus. They are the most common tumor in the
female pelvis.