Pelvic Mass Flashcards
(42 cards)
what are some non-gynaecological causes of a pelvic mass
Constipation
Caecal carcinoma
Appendic abscess
Diverticular abscess
urinary retention
pelvic kidney
where can gynaecological pelvic masses come from
Uterus - body, cervix
Tubal (and para tubal)
Ovary
what are the causes of uterine pelvic mass
Fibroids
Pregnancy
Endometrial cancer (however usually presents early so pelvic mass unlikely)
Cervical cancer
what are uterine fibroids
Leiomyomas (benign smooth muscle tumours)
v common esp >40 years
what are the different types of fibroids
pedunculate - protrudes outside the muscle intracavitary - inside the uterus intramural - middle of muscle wall submucous -bulge into cavity subserous - under the serosa
how do uterine fibroids present
asymptomatic/incidental finding menorrhagia (V heavy periods) pelvic mass pain/tenderness 'pressure' symptoms
how do you investigate fibroids
Hb if heavy bleeding
US usually diagnostic
MRI for more precise localisation
how do you treat fibroids
expectant (leave it alone)
traditional hysterectomy if family complete
myomectomy
uterine artery embolisation
hysteropoc resection
what are causes of tubal swellings
Ectopic pregnancy
Hydrosalpinx (tube filled with fluid)
Pyosalpinx (tube filled with puss)
Paratubal cysts
causes of ovarian masses
tumours/neoplasm
-benign or malignant
non-tumours
- functional cysts
- endometriotic cysts (endometriosis on the ovary)
what is a functional cyst
cyst related to ovulation
- follicular cysts
- luteal cysts
usually resolve spontaneously
asymptomatic/incidental finding (my be mistral disturbance, bleeding, rupture and pain)
expectant management appropriate
what is an endometriotic cyst
endometriosis (endometrium in wrong place) causes endometrial deposits on the ovary
can cause blood filled cysts on ovaries (chocolate cysts)
how do endometriosic cysts present
severe dysmenorrhoea and premenstrual pain
dyspareunia (painful sex)
subfertility
tender mass with ‘nodularity’ and tenderness behind uterus
occasionally asymptomatic until large chocolate cyst which ruptures
where can primary ovarian tumours arise from
Surface epithelium
Germ Cells
Stroma
what primary ovarian tumours arise from the surface epithelium
serous mucinous endometrioid clear cell Brenner
what primary ovarian tumours arise from germ cells
benign cystic teratoma (dermoid cyst)
malignant germ cell tumours (v rare)
what primary ovarian tumours arise from stroma
fibroma
if theca/leydig cell it secretes androgens
if granuloma cell it secretes oestrogen
what do malignant germ cell tumours produce
HCG causing false positive pregnancy test of AFP
what do dermoid cysts produce
totipotential
produce teeth, sebaceous material, hair
thyroid tissue - thyrotoxicosis
what do granuloma cell tumours produce
oestrogen
leads to precocious puberty, post menopausal bleeding
what syndrome are fibromas related to
Meig’s syndrome - benign fibroma with pleural effusion and ascites
where do secondary (metastatic). ovarian tumours most commonly come from
breast
pancreas
stomach
GI primaries
how does ovarian cancer usually present
mass, swelling or pressure symptoms
early transperitoneal spread - deposits on all peritoneal surfaces
malignant ascites with protein exudate
more insidious symptoms
bloating heart burn weight loss 'pressure' symptoms eg. bladder change of bowel habit SOB/pleural effusion leg oedema or DVT
what genes can predispose to ovarian cancer
BRACA 1 & 2 (breast and ovarian)
HNPCC (Lynch syndrome- bowel, endometrial, ovarian and others)
