A 38-year-old woman presents with an ultrasound scan report showing a unilocular anechoic
left ovarian cyst measuring 5.6 x 5.2 x 5 cm. The CA-125 is 25.
18.
What is the risk of malignancy index?

A 54-year-old woman presents with abdominal pain and has had an ultrasound scan done. It
showed an ovarian cyst which triggered a transvaginal scan. Pain has resolved now. A 46-mm
cyst with a thin wall within with normal CA 125 is noted. She has a repeat scan after 2 months
that shows a 58 mm cyst with similar features and normal tumour markers. No new symptoms
are noted.

A cyst is sent for histologic investigation and the report shows an insular pattern of round
uniform cells with 80% neurosecretory granules. This patient also has 5- hydroxyindoleacetic
acid (5-HIAA) in her urine sample.
12.
Which of the following cysts is the most likely diagnosis?

A 65-year-old woman presented with lower abdominal pain and bloating. A pelvic ultrasound
scan demonstrated a complex ovarian cyst and this, with a serum CA125, gave a risk of
malignancy index (RMI) score of 280.
19.
What further imaging is now required?

A healthy 60-year-old woman with a BMI of 28 kg/m2 presents with lower abdominal pain
and bloating. An ultrasound scan demonstrates a unilocular cyst of 4 cm diameter with a solid
component. There is no ascites. Her serum CA125 is 40 IU/l.

It is recommended that RMI should be used to triage post- menopausal women with ovarian
cyst to assess low, moderate or high risk of malignancy
8.
This is calculated as U (ultrasound score) × M (menopausal status) × CA125.
What is the risk of ovarian cancer in a woman who has an RMI of 25–250 (moderate risk)?

Ms. XY is 64 years old, postmenopausal. Her recent TV ultrasound scan reveals the presence of
a 4 cm right ovarian cyst. The cyst shows anechoic fluid with no solid areas. There is no free
fluid. The left ovary is normal. Her CA125 is 5 u/ml. Which of the following treatment options
are best suited to her?
3.

A 21-year-old woman presents with an abdominal mass and constipation. She also has lower
abdominal pain. At laparotomy, the tumour appeared solid, fleshy and pink. Unilateral
salphingo-oophorectomy was performed. The histology showed T- cell lymphoid infiltration of
the fibrous stroma. Which of the following is the most likely diagnosis?

Who should be responsible for the management of women with intermediate risk of
malignancy (RMI of 25–250)?

You are reading the histology report of a patient who had a laparotomy for an abdominal
mass. A biopsy was taken as the mass was deemed to be inoperable. The histology report
showed a tumour with an appearance of mucin-filled epithelial glandular cells ( signet-ring
cells)..
Which of the following organs is the most likely origin of the primary cancer?

Ms. XY is 64 years old, postmenopausal. Her recent TV ultrasound scan reveals the presence of
a 4 cm right ovarian cyst. The cyst is multiloculated and shows the pres- ence of a solid area.
There is no free fluid. The left ovary is normal. Her CA125 is 50 u/ml. She has been explained
of her RMI results. What is her RMI score based on the information provided?

A 26-year-old woman presents to the gynaecology OPD with an ultrasound scan of her pelvis
for menorrhagia. It reports an anechoic ovarian cyst of 28 mm × 37 mm on the right side. No
other abnormal findings are reported.

A 28-year-old woman presents to the antenatal clinic at 14 weeks pregnant with mild lower
abdominal pain and frequency in micturition. An ultrasound scan notes a solid adnexal mass.
Her serum lactate dehydrogenase (LDH) and human chorionic gona- dotropin (hCG) levels are
raised.
10.
Which of the following tumours is the most likely cause of her symptoms?

An 8-year-old girl presents with symptoms and signs of precocious puberty. Which of the
following tumours should not be included in the differential diagnosis?

Ms. XY is 64 years old, postmenopausal. Her recent TV ultrasound scan reveals the presence of
a 4 cm right ovarian cyst. The cyst is multiloculated and shows the presence of a solid area.
There is no free fluid. The left ovary is normal. Her CA125 is 50 u/ml. She has been explained
of her RMI results (450). Which of the following treatment options are best suited to her?

. A 65-year-old woman has an incidental finding of an ovarian cyst during an MRI scan to
evaluate her spine. A follow-up ultrasound confirms this to be a simple cyst with a maximum
diameter of 4.5 cm. Her serum CA125 is 5 IU/l. The woman is asymptomatic.

Your ST1 asks you about a 42-year-old patient with a 5-cm right-sided ovarian cyst. The patient
has occasional right iliac fossa pain. She would like to know the overall chance of a
symptomatic ovarian cyst in a premenopausal female being malignant.
16.
Which of the following statements is most accurate?

A 65-year-old woman is referred urgently with weight loss, abdominal bloating and urinary
urgency. An ultrasound scan demonstrates a multicystic mass with solid areas and ascites. Her
serum CA125 is 100 IU/l. A CT scan confirms a suspicious mass. Which management should be

18) recommended by the multidisciplinary team?

19) It is recommended that risk of malignancy index (RMI) should be used to triage postmenopausal women with an ovarian cyst to assess low, moderate or high risk of malignancy.

This is calculated as U (ultrasound score) X M (menopausal status) X CA125.
What is the RMI of a post-menopausal woman with a CA125 of 15, ultrasound showing 6 cm
bilateral, multiloculated cyst?

An 18-year-old girl presents with a large abdominal mass with abdominal pain. She claims the
mass has increased in size within the last three months. A laparotomy and unilateral
salphingo-oophorectomy is performed. The histology report shows a meso- dermal core with a
central capillary (Schiller–Duval body).

20) Which ovarian tumour is this most likely to be?

Ovarian cysts are common in postmenopausal women, although their prevalence is lower
than in premenopausal women.
6.
A 59-year-old woman is referred to the clinic with fullness in the lower abdomen and a serum CA125
level of 64iu/l.
What is the first line of investigation?

. A 56-year-old patient has had an ultrasound scan, which shows a right adnexal unilocular
cystic mass, and subsequent computed tomography scan which has conf rmed the same f
ndings but with evidence o peritoneal deposits. Her CA-125 is 10 and the RMI is 30.
Where should she receive her treatment?

A frail 90-year-old woman presents with abdominal discomfort and bloating. She has mitral
stenosis and atrial fibrillation. She has urinary frequency and nocturia. An ultrasound scan
reveals a 10 cm simple ovarian cyst. Her serum CA125 is 2 IU/l.

A 60-year-old woman has an ultrasound scan done for non-specific abdominal pain and is
found to have an ovarian cyst of 28 mm which is fluid filled. The Ca 125 is normal and the RMI
is 100. She is advised a further scan after 4 months. The cyst has not changed in nature and
the size is 22 mm.

A 15-year-old patient presents with le lower abdominal pain. Transvaginal and transabdominal
ultrasound scans show a 10-cm solid ovarian mass. e lactate dehydrogenase is elevated with a
normal alpha etoprotein and human chorionic gonadotropin.
What is the most likely diagnosis?

You are reading an ultrasound scan report concerning a patient with left-sided pelvic pain. Thereport reads a 6 x 5 x 5-cm left adnexal mass possibly ovarian in origin .
In adnexal masses, what is the incidence of a non-ovarian origin?