Pelvic masses Flashcards
(28 cards)
adnexal is in reference to which structures?
ovaries
oviducts
ligaments
most functional ovarian cysts regress over what period of time?
1-2 months
what is the role of hormonal suppression for ovarian cysts?
not better than waiting, but might prevent new cyst formation
when is operative management indicated for an ovarian cyst?
- child with pelvic mass
- reproductive woman with persistent cyst over 6 cm, complex, or symptomatic
- any menopausal woman with persistent or complex mass
what are the risks of an ovarian cysts / pelvic masses?
rupture
torsion
what are the sequelae of an ovarian rupture?
- pain due to leakage of blood / PGs
- midcycle pain
- hemoperitoneum from ruptured hemorrhagic corpus luteum cyst
what is the pathogenesis of an ovarian torsion?
compromised vascular supply - ischemia
what is the most common cause of an ovarian torsion?
benign cystic teratoma
what is the treatment for an ovarian torsion?
surgical - untwisting vs removal
what are the main cell types of origin of ovarian tumors?
epithelial cells
germ cells
presentation: sudden onset of extreme pelvic pain
what do you do?
ovarian torsion
color doppler / US
what is the most common MALIGNANT ovarian tumor? what is seen on histology?
serous cystadenocarcinoma
psammoma bodies
what is the most common malignant tumor among children and adolescents? what are the tumor markers?
dysgerminoma
HCG and LDH
what factors (epidemiological, clinical, US) make it more or less likely that a particular ovarian tumor is malignant?
benign:
- unilateral
- cystic
- thin walled
- mobile
- smooth
- no ascites
- slow growth
- younger women
malignant
- bilateral
- solid
- thick walled
- fixed
- irregular
- ascites
- rapid growth
- older women
what are the nonovarian gynecologic neoplasms?
- leiomyoma
- endometrial carcinoma
- tubal carcinoma
what is a uterine leiomyoma?
proliferation of smooth muscle surrounded by a pseudocapsule of compressed muscle fibers
highest prevalence of leiomyoma is in which decade?
5th decade
what is the most common indication for hysterectomy?
leiomyoma
what are the subcategories of leiomyomas?
- intramural
- subserosal
- submucosal
are leiomyomas responsive to hormones? how are they impacted by pregnancy?
yes
pregnancy may induce their growth due to high estrogen
what is the most common presenting symptom in a leiomyoma? what is the sensation on exam? what is the cause?
- bleeding
- “lumpy bumpy”
- alteration of normal myometrial contractile function
- inability of overlying endometrium to respond to normal E/P - incomplete sloughing
- pressure necrosis of overlying endometrial bed
fibroids are usually diagnosed with which method?
US
sometimes CT / MRI if large enough
what are the medical treatments options for fibroids?
- progestins
- high dose NSAIDs or antifibrinolytics
- GnRH agonists
what are the surgical treatment options for fibroids?
- myomectomy
- hysterectomy
- endometrial ablation
- myolysis
