Pelvic Mass

Question 1

Bowel causes of pelvic mass

Answer 1

Constipation
Caecal carcinoma
Appendix abscess
Diverticular abscess

Question 2

Uterine causes of a pelvic mass

Answer 2

Pregnancy
Fibroids
Cancer?

Question 3

What would the difference in surgery be if you thought it was benign/malignant ovarian mass?

Answer 3

Malignant–> Open Surgery (Laparotomy)

Benign–> Laproscopically

Question 4

What are the 5 types of Fallopian tube pathology

Answer 4

1. Inflammation
2. Cysts/tumours
3. Serous tubal intraepithelial carcinoma
4. Endometriosis
5. Ectopic pregnancy

Question 5

What diagnosis should always be considered in any female of reproductive age with amenorrhoea + acute hypotension or an acute abdomen

Answer 5

Ectopic pregnancy

Question 6

What are functional cysts related to

Answer 6

Ovulation

Question 7

Are functional cysts something to worry about?

Answer 7

No. Rarely >5cm in diameter, usually resolve spontaneously, often incidental finding

Question 8

What is an example of a follicular cyst?

Answer 8

Polycystic ovaries

Question 9

How does endometrial cysts present?

Answer 9

Severe dysmetnnorhoea
Premenstural pain
Dyspareunia
Tender mass

Question 10

What is the risk with large chocolate cysts?

Answer 10

It may rupture

Question 11

What are the 4 types of cyst

Answer 11

Functional
Endometrial
Epithelial
Mesothelial

Question 12

What is the appearance of endometriosis?

Answer 12

Shiny surface with lots of vascularity

Question 13

What are the potential complications of endometriosis?

Answer 13

Pain
Cyst formation
Adhesions
Ectopic pregnancy
Malignancy (endometrial carcinoma)

Question 14

Name 3 protective factors for ovarian tumours

Answer 14

OCP
Pregnancy
Breastfeeding

Question 15

What 4 things increase the risk of ovarian tumours?

Answer 15

Genetics
- BRACA
-Lynch Syndrome (HNPCC)
PCOS
Endometriosis

Question 16

What are the two tumour markers used in ovarian cancer?

Answer 16

CA125

CEA

Question 17

How is the risk of malignancy (RMI) calculated

Answer 17

Menopausal status x serum CA125 x US score

Question 18

3 modes of spread of ovarian cancer

Answer 18

1. Transcoelomic spread/peritoneal seeding within pelvis
2. Haematogenous spread
3. Brain mets

Question 19

What does optimal surgical resection mean?

Answer 19

<1cm left

Question 20

What is suboptimal resection of ovarian tumour?

Answer 20

> 1cm left

Question 21

TRUE/FASLE

Chemotherapy can be given pre/post surgery. Tend to be given first if the tumour is a higher stage

Answer 21

TRUE
1A or 1B- Chemo afterwards
IIIc or IV- Chemo first

Question 22

Give an example of a platinum agent?

Answer 22

Carboplatin

Question 23

When is hormonal therapy used?

Answer 23

Women with recurrent, platinum-resistant, ovarian cancer
OR
In those wishing to avoid/delay further chemotherapy

Question 24

Why is BRACA phenotype good if you are diagnosed with ovarian cancer?

Answer 24

Repeated good response to platinum based chemotherapy
Longer remissions
Improved overall survival stage for stage

Question 25

What is the most common type of ovarian tumour (90%)?

Answer 25

Epithelial ovarain tumour

Question 26

What are the five types of epithelial ovarian tumour?

Answer 26

``` Serous Mucinous Endometriod Clear cell Brenner ```

Question 27

What does endometriosis and clear cell carcinoma have an association with?

Answer 27

Lynch syndrome

Question 28

TRUE/FALSE | Dermoid cysts are almost always benign in women and men

Answer 28

FALSE - Almost always benign in women - Almost always malignant in men

Question 29

Germ cell tumours make up what percentage of ovarian tumours?

Answer 29

10% (some say up to 20%)

Question 30

What is the most common type of germ cell tumour?

Answer 30

Mature benign cystic teratoma | "dermoid cyst"

Question 31

What does a dermoid cyst look like on XR?

Answer 31

Rim calcification | Fat inside which is a different density

Question 32

What is the most common malignant primitive germ cell tumour?

Answer 32

Dysgerminoma

Question 33

Who is dysgerminoma most common in?

Answer 33

Almost exclusively children and young women (average age 22)

Question 34

What are the three types of sex cord/stromal tumours?

Answer 34

Fibroma/Thecoma Granulosa cell tumour Sertoli-Leydig tumour

Question 35

Granulosa cell tumours may be associated with what type of malformation?

Answer 35

Osteogenic

Question 36

Metastatic tumours to the ovaries are classically from

Answer 36

Stomach Colon Breast Pancreas

Question 37

If Crookenburg tumour (Signet ring cancer cell) on the ovary is a metastasis from the ...

Answer 37

breast

Question 38

Malignant germ cell tumours may produce which hormone?

Answer 38

hCG or AFP