Flashcards in Benign Tumour Deck (37):
What are fibroids also known as?
What are fibroids?
Benign tumours of the smooth muscle cells of the myometrium
What is the cause of fibroids?
*Oestrogen and progesterone dependent
What makes it more likely of having fibroids? Less likely?
*increasing age during reproductive years
*Those who had early menarche <11
i.e. factors that increase lifetime exposure to oestrogen and progesterone
*COCP or Depo takers
How common are fibroids?
By age 50 70% white women and 80% of black women have had at least one fibroid
What can fibroids be like? Size Placement?
*single or multiple
*few mm to massive tumours
*Intramural, subserosal or submucosal
*majority are intramural
Where do intramural fibroids grow?
Within the myometrium
Where do subserous fibroids grow?
Grow from the outside wall of the uterus into the pelvis
Where do submucous fibroids grow?
Grow from the inner wall into the cavity of the uterus
What are the symptoms of firbroids?
*50% are asymptomatic
*present aged 30-50years old
*menorrhagia (30%) = iron deficiency anaemia
>urinary symptoms -frequency, retention, hydronephrosis
>Infertility -due to pressing on tubal ostia
What signs may be present on examination of someone with fibroids?
*solid mass palpable on pelvic or even abdo examination
*knobbly enlargement of the uterus
What investigations should be done to confirm fibroids?
*MRI if USS not definitive
What is the cause of fibroid degeneration? What can this result in?
*Normally the result of inadequate blood supply
*'red degeneration' characterised by pain and uterine tenderness
When is treatment of fibroids appropriate?
*Only if symptomatic and patient wants treatment
What is the pharmological management of fibroids?
>Tranexamic Acid 3-4 times a day for the duration of each period
>NSAIDs during periods =reduce pain and high levels of prostaglandin in lining of womb
>COCP or LNG-IUS or progesterone only tablets/depo
>GnRH agonists to reduce size
When is surgical management of fibroids indicated? What is the surgical management of fibroids?
*indicated when enlarged uterus, pressure symptoms present, and pharmacological management doesn't work
>Myomectomy =in patients who wish to maintain reproductivity
>Hysteroscopic endometrial ablation =women presenting with menorrhagia
>Total hysterectomy =use to be the mainstay of treatment for many years
>Uterine artery embolisation
What happens to fibroids with menopause?
*They typically regress as they are oestrogen dependent
*symptoms resolves with regression
What are the types of ovarian cyst?
*Benign germ cell tumour
*Benign epithelial tumour
*Benign sex cord stromal tumour
What are physiological (functional) follicular cysts? How common?
*Commonest type of ovarian cyst
*Due to non-rupture of the dominant follicle or failure of atresia in a non-dominant follicle
What happens to a follicular cyst?
*commonly regress after several menstrual cycles
What is a corpus luteum cyst?
*Also a phsyiological cyst
*if pregnancy doesn't occur the corpus luteum usually breaks down
*if the corpus luteum doesn't break down it may fill with blood or fluid forming a cyst
What is a corpus luteum cyst more likely to present with than a follicular cyst?
What is a dermoid ovarian cyst?
*also called a cystic teratoma
*Usually lined with epithelial tissue and hence may contain skin appendages, hair and teeth
*It is a benign germ cell tumour
How does a dermoid ovarian cyst usually present? Increased risk of?
*median age 30years old
*Torsion is more likely
What types of benign epithelial ovarian tumours are there?
Arise from ovarian surface epithelium:
How does mucinous cystadenoma ovarian cysts present?
*Typically large and may become massive
*if it ruptures, may become pseudomyxoma peritonei
What is the usual presentation of of ovarian cysts?
*dull ache in lower abdomen
*pressure effects -urinary frequency
(If torsion or rupture =severe pain and fever)
What investigations should be done if an ovarian cyst is suspected?
*Pelvic USS -TVUS
*Can do CT/MRI
*Fine needle aspiration + cytology may be used to confirm benign
What is the management of ovarian cysts?
*simple cysts usually do not require any treatment
*depending on size
*watchful waiting for 2-3months
*cysts with 50-70mm should have yearly USS
*Persistent simple cysts larger than 5-10cm should be considered for surgical removal
What are the complications of an ovarian cyst?
*Rupture of an ovarian cyst
*Infertility (however surgical intervention may increase this risk)
What is an intrauterine polyp? Common in who?
Small, benign tumours that grow into the uterin cavity
*most are endometrial in origin but some form from submucous fibroids
*common in 40-50year olds when oestrogen levels are high
When are intra-uterine polyps found in post-menopausal woman?
Patient on tamoxifen for breast carcinoma
What are the presenting features of intrauterine polyps?
*very occasionally prolapse through the cervix
What is Adenomyosis?
Presence of endometrium and underlying stroma within the myometrium
What are the clinical presentation of adenomyosis?
*Painful, regular heavy menstruation
>Uterus mildly enlarged and tender
Treatment of adenomyosis?
*COCP with or without NSAIDs
*Trial of GnRH analogue therapy then hysterectomy