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Flashcards in Pelvic Mass Deck (44):
1

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

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

2

What are the gynaecological locations of a pelvic mass?

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

3

What are the gynaecological causes of a uterine mass?

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

4

Describe uterine fibroids

Very common, especially >40yo
Usually few cm, but may be bigger + multiple

5

What are some possible locations/classes of fibroids?

Pedunculated
Intracavitary
Intramural
Subserous
Submucous

6

How may uterine fibroids present?

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

7

What Ix should be carried out in suspected fibroids?

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

8

How are fibroids treated?

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

9

What may cause tubal swellings?

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

10

Describe functional ovarian cysts

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

11

What can cause endometriotic cysts?

Endometriosis

12

What are endometriotic cysts associated with?

Severe dysmenhorrhoea
Premenstrual pain
Dyspareunia
Subfertility

13

Describe an endometriotic cyst(s)

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

14

Describe primary ovarian tumours arising from surface epithelium

Serous, mucinous, endometrioid, clear cell, Brenner
If benign cystadenoma, malignant cystadenocarcinoma

15

Describe primary ovarian tumours arising from germ cells

Benign cystic teratoma (dermoid cyst, common)
Malignant germ cell tumours (rare)

16

Describe primary ovarian tumours arising from stroma

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

17

What are rare stigmata of dermoid ovarian cyst?

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

18

What are rare stigmata of granulosa cell ovarian tumours?

May produce oestrogens leading to precocious puberty, PMB

19

What are rare stigmata of thecal tumours?

May produce androgens, leading to hirsutism and virilisation

20

What are rare stigmata of ovarian fibromas?

Meig's syndrome benign fibroma but pleural effusion

21

Where do 2' ovarian tumours commonly come from?

Breast
Pancreas
Stomach
GIT

22

How will ovarian cancer usually present?

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

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

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

24

How can the presentation of ovarian cancer vary?

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

25

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

BRCA1 & 2

26

What % of ovarian cancers have a genetic basis?

5%

27

What does HNPCC predispose to?

Bowel, endometrial, ovarian cancer and others

28

What are the RFs for ovarian cancer?

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

29

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

CA 125
Carcino-embryonic antigen CEA

30

What imaging should be used Ix of suspected ovarian cancer?

US better for nature of cyst
CT better for assessing disease outwith ovary, especially omental and peritoneal disease, and LNs

31

In how many ovarian cancers is CA 125 raised?

~80%

32

What is a moderate raise of CA 125 associated with?

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

33

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

Mucinous tumours

34

What is the main function of CEA testing?

Exclude mets from GI primary

35

What US findings should make you suspicious of ovarian cancer?

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

36

What is the risk of malignancy index?

Menopausal status x CA 125 x US score

37

How are ovarian cysts/mass treated?

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

What cyst 'accidents' can present as an emergency?

Rupture
Haemorrhage (into cyst)
Torsion

39

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

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

40

What Ix should be carried out in pelvic mass?

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

41

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

MRI

42

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

CT

43

Is tissue aspiration for cytology helpful in pelvic mass investigation?

No

44

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

CT/US