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Pelvic Mass Flashcards

1
Q

What are the non-gynaecological causes of a pelvic mass?

A

Bowel- constipation, caecal carcinoma, appendix abscess, diverticular abscess
Bladder/urological- urinary retention, pelvic kidney
Other- retroperitoneal tumour

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2
Q

What are the gynaecological locations of a pelvic mass?

A

Uterine- body, cervix
Tubal (& para-tubal)
Ovarian

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3
Q

What are the gynaecological causes of a uterine mass?

A

Pregnancy
Commonest fibroids
Endometrial cancer- early presentation (PMB), therefore mass unusual
Cervical cancer- also late mass presentation +- renal failure/bleeding/pain

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4
Q

Describe uterine fibroids

A

Very common, especially >40yo

Usually few cm, but may be bigger + multiple

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5
Q

What are some possible locations/classes of fibroids?

A 
Pedunculated
Intracavitary
Intramural
Subserous
Submucous
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6
Q

How may uterine fibroids present?

A 
May be asymptomatic/incidental finding
Menhorrhagia
Pelvic mass
Pain/tenderness (Only disproportionate if red generation e.g. pregnancy, menopause)
Pressure symptoms
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7
Q

What Ix should be carried out in suspected fibroids?

A

Hb if heavy bleeding
US usually diagnostic- smooth echogenic mass (often multiple)
MRI for more precise localisation

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8
Q

How are fibroids treated?

A

Expectant if asymptomatic
Otherwise hysterectomy if family complete
Alternatives- myomectomy, uterine artery embolisation, hysteroscopic resection

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9
Q

What may cause tubal swellings?

A

Ectopic pregnancy- may detect adnexal mass on US
Hydrosalpinx- often longstanding/incidental
Pyosalpinx- acute/inflammatory
Paratubal cysts (small/incidental)

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10
Q

Describe functional ovarian cysts

A

Related to ovulation- follicular and luteal cysts
Rarely >5cm diameter
Usually resolve spontaneously
Often asymptomatic/incidental
Expectant management appropriate
May be menstrual disturbance, bleed, rupture and cause pain

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11
Q

What can cause endometriotic cysts?

A

Endometriosis

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12
Q

What are endometriotic cysts associated with?

A

Severe dysmenhorrhoea
Premenstrual pain
Dyspareunia
Subfertility

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13
Q

Describe an endometriotic cyst(s)

A

Typically tender mass with nodularity and tenderness behind uterus
Occasional asymptomatic until large chocolate cyst, may rupture

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14
Q

Describe primary ovarian tumours arising from surface epithelium

A

Serous, mucinous, endometrioid, clear cell, Brenner

If benign cystadenoma, malignant cystadenocarcinoma

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15
Q

Describe primary ovarian tumours arising from germ cells

A

Benign cystic teratoma (dermoid cyst, common)

Malignant germ cell tumours (rare)

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16
Q

Describe primary ovarian tumours arising from stroma

A

If from granulosa cell may secrete oestrogens
If theca/leydig cell may secrete androgens
Also fibroma (beware Meig’s syndrome)

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17
Q

What are rare stigmata of dermoid ovarian cyst?

A

Totipotential
Teeth, sebaceous material, hair
Thyroid tissue-> thyrotoxicosis

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18
Q

What are rare stigmata of granulosa cell ovarian tumours?

A

May produce oestrogens leading to precocious puberty, PMB

19
Q

What are rare stigmata of thecal tumours?

A

May produce androgens, leading to hirsutism and virilisation

20
Q

What are rare stigmata of ovarian fibromas?

A

Meig’s syndrome benign fibroma but pleural effusion

21
Q

Where do 2’ ovarian tumours commonly come from?

A

Breast
Pancreas
Stomach
GIT

22
Q

How will ovarian cancer usually present?

A

May be mass, swelling, pressure symptoms
But if early transperitoneal spread- deposits on all peritoneal surfaces, omental disease/infiltration/malignant ascites with protein exudate

23
Q

What are the clinical features of ovarian cancer with early transperitoneal spread?

A

Deposits on all peritoneal surfaces
Omental disease/infiltration
Malignant ascites with protein exudate
Usually more insidious symptoms

24
Q

How can the presentation of ovarian cancer vary?

A 
Heartburn/indigestion
Early satiety
Weight loss/anorexia.
Bloating 
‘Pressure’ symptoms (esp bladder)
Change of bowel habit
SOB/ Pleural effusion
Leg oedema  or DVT
25
Q

What genes lead to a predisposition of breast and ovarian cancer?

A

BRCA1 & 2

26
Q

What % of ovarian cancers have a genetic basis?

A

5%

27
Q

What does HNPCC predispose to?

A

Bowel, endometrial, ovarian cancer and others

28
Q

What are the RFs for ovarian cancer?

A

Age (old>young)
Nulliparity
FHx
(OCP protective)

29
Q

What tumour markers should be looked for in suspected ovarian cancer?

A

CA 125

Carcino-embryonic antigen CEA

30
Q

What imaging should be used Ix of suspected ovarian cancer?

A

US better for nature of cyst

CT better for assessing disease outwith ovary, especially omental and peritoneal disease, and LNs

31
Q

In how many ovarian cancers is CA 125 raised?

A

~80%

32
Q

What is a moderate raise of CA 125 associated with?

A 
Endometriosis
Peritonitis/infection
pregnancy
Pancreatitis
Ascites from any cause e.g. liver disease
Other malignancies gynae/non gynae
33
Q

In what specific type of ovarian cancer is CEA often moderately elevated in?

A

Mucinous tumours

34
Q

What is the main function of CEA testing?

A

Exclude mets from GI primary

35
Q

What US findings should make you suspicious of ovarian cancer?

A 
Complex mass with solid & cystic area
Multi-loculated
Thick septations
Associated ascites
Bilateral disease
36
Q

What is the risk of malignancy index?

A

Menopausal status x CA 125 x US score

37
Q

How are ovarian cysts/mass treated?

A

Removal or drainage if likely benign
Other ovary/uterus removal with removal/biopsy of omentum
Debulking of tumour and inspection of all peritoneal surfaces
Chemo pre/post surgery

38
Q

What cyst ‘accidents’ can present as an emergency?

A

Rupture
Haemorrhage (into cyst)
Torsion

39
Q

How may fibroid degeneration present as an emergency with acute abdomen?

A

Usually red degeneration
Compromised blood supply
Seen in pregnancy, peri-menopause

40
Q

What Ix should be carried out in pelvic mass?

A 
Hb
WCC/CRP if suspect inflammatory mass
Biochemistry esp serum albumin
Tumour markers (CA125, CEA, HCG,AFP)
(CXR)
Ultrasound TA/TV
41
Q

What specific imaging could be carried out for fibroids/uterine mass?

A

MRI

42
Q

What specific imaging could be carried out for suspected ovarian cancer?

A

CT

43
Q

Is tissue aspiration for cytology helpful in pelvic mass investigation?

A

No

44
Q

What imaging could be used in a guided tissue biopsy for pelvic mass?

A

CT/US

Reproduction (40 decks)

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