5: Pelvic masses

Question 1

Which organs may be involved in a patient with a pelvic mass?

Answer 1

Bladder

GI - large/small bowel, rectum

Gynae - uterus, Fallopian tubes, ovaries

Question 2

What is a common GI condition which can present with abdominal pain and a pelvic mass?

Answer 2

Constipation

Question 3

Which renal problem may cause an abdominal mass on examination?

Answer 3

Urine retention

Question 4

Which female genital tract structures may cause a pelvic mass?

Answer 4

Uterus (including endometrium and cervix)

Fallopian tubes

Ovaries

Question 5

What is the most common reason for a uterine mass?

Answer 5

Uterine fibroids

Question 6

Among women, what is the most straightforward reason for a uterine mass?

Answer 6

Pregnancy

Question 7

What are uterine leiomyomas also known as?

Answer 7

Fibroids

Question 8

What is the underlying pathology of uterine fibroids?

Answer 8

Leiomyomas

Benign smooth muscle tumours

Question 9

Which cancers can cause the uterus to enlarge?

Answer 9

Cervical cancer

Endometrial cancer

Question 10

What is a common presentation of endometrial cancer?

Answer 10

Post-menopausal bleeding

Question 11

In which age group are uterine fibroids common?

Answer 11

Women aged > 40

Question 12

Uterine fibroids are often an incidental finding on examination - why?

Answer 12

Asymptomatic

Question 13

If uterine fibroids are symptomatic, what do women complain of?

Answer 13

Menorrhagia (heavy bleeding)

Pelvic mass

Question 14

In which situation do uterine fibroids cause pain?

Answer 14

Infarction due to loss of blood supply

called ‘red degeneration’ because the fibroid has a red, ischaemic appearance

Question 15

How are suspected uterine fibroids investigated?

Answer 15

USS pelvis

Question 16

Which imaging modalities can be used to look at uterine fibroids?

Answer 16

USS pelvis

MRI scan

Question 17

What is the most common management of uterine fibroids?

Answer 17

Expectant management if woman is < 40 and wants to start a family

Surgical management i.e hysterectomy otherwise

Question 18

What are the surgical management options for uterine fibroids?

Answer 18

Hysterectomy (definitive, effective treatment - family planning issue)

Uterine artery embolisation

Myomectomy

Question 19

What is an obstetric emergency which causes the Fallopian tube to swell?

Answer 19

Ectopic pregnancy

Question 20

How does ectopic pregnancy present?

Answer 20

Initially: amenorrhoea, light bleeding, mild abdominal (maybe shoulder tip) pain

Ruptured: severe pain, heavy bleeding + signs of shock

Question 21

In any woman with amenorrhoea and gynae symptoms, what must you exclude using imaging?

Answer 21

Ectopic pregnancy

Question 22

Which diseases of the ovaries can cause a pelvic mass?

Answer 22

Tumours - benign and malignant

Cysts

Endometriosis

Polycystic ovarian syndrome (note these aren’t actually cysts)

Question 23

What is a benign disease of the ovaries which affects most women at some point in their lifetimes?

Answer 23

Ovarian cyst

Question 24

Do most ovarian cysts require treatment?

Answer 24

No

Usually resolves themselves

Question 25

Which disease causes patches of uterine tissue to grow in the Fallopian tubes, ovaries and peritoneal cavity?

Answer 25

**Endometriosis**

Question 26

What are the **symptoms** of **endometriosis**?

Answer 26

**Pelvic pain** **Painful periods** **Menorrhagia**

Question 27

Which kind of **ovarian cyst** is caused by **endometriosis?**

Answer 27

**Ovarian endometrioma** or 'chocolate cyst', because it's reddy/brown in appearance

Question 28

Which types of **tumour** are seen on the ovaries?

Answer 28

**Epithelial tumours** **Germ cell tumours** **Stromal tumours**

Question 29

What are **epithelial tumours** of the ovary called?

Answer 29

**Cystadenomas** (cystadenocarcinomas)

Question 30

Which **germ cell** tumour is commonly found in the ovary and is **highly** **keratinised?** What name does it commonly go by?

Answer 30

**Benign cystic teratoma** or **Dermoid cyst**

Question 31

What is a **dermoid cyst**?

Answer 31

**Mature cystic teratoma**

Question 32

On histology, **mature cystic teratomas** have the appearance of \_\_\_.

Answer 32

**skin, hair** highly keratinised epithelium, giving the name DERMOID CYST

Question 33

Which conditions make up the **triad** of **Meig's syndrome?**

Answer 33

**Ovarian tumour** **Ascites** **Pleural effusion**

Question 34

The **ovarian tumour** usually seen in **Meig's syndrome** is **(benign / malignant)**.

Answer 34

**benign**

Question 35

How is **Meig's syndrome** managed?

Answer 35

**Surgical removal of ovarian tumour** **Ascitic tap** **Chest drain**

Question 36

The **ovaries** are a common location of ___ tumours.

Answer 36

**secondary tumours** i.e metastatic disease