Flashcards in Pelvic Masses Deck (56):
Ovaries, fallopian tubes, and associated ligaments
What is the appropriate measure to take following the finding of a simple ovarian cyst?
F/u or do a laparoscopy if concerned for cancer
What is the role of placing mesh in the ovaries following excision of a cystic ovary?
Prevent scar tissue and the development of adhesions
True or false: most function cysts (follicular or corpus luteum) regress in 1-2 months
What is the role of hormonal suppression for ovarian cysts?
-Adds nothing to waiting, but might prevent new cyst formation
What are the indications for excision of an ovarian cyst? (3)
-Any child with pelvic mass
-Any reproductive age woman with persistent cyst greater than 6 cm
-Any menopausal woman w/ persistent or complex masses
What size of cyst indicates the need for surgical excision?
What are the risks of ovarian cysts? (2)
Pain/leakage of blood/prostaglandins leading to hemoperitoneum
What is a culdocentesis?
Drainage of the cul-de-sac if there is hemoperitoneum
What are the risks of ovarian torsion?
Compromised vascular supply leads to ischemia
What are the s/sx of ovarian torsion?
Sudden onset of constant or intermittent pain with TTP on exam
What is the most common cause of an ovarian torsion?
Ovarian cystic teratoma
What imaging modality is helpful in diagnosing an ovarian torsion?
US with color doppler sonography
What is the treatment for ovarian torsion?
Surgical untwisting vs removal
Why are teratomas more likely to result in ovarian torsion?
What are the two main cell lineages that give rise to ovarian neoplasms?
What are the 5 ovarian tumor that arise from epithelial tissue?
What is the most common malignant ovarian tumor? What are the histological characteristics of this?
What is the most common malignant ovarian tumor among children and adolescents? What are the chemical markers of this?
Dysgerminomas and hCG/LDH
What is more characteristics of a malignant ovarian tumor: unilateral or bilateral?
What is more characteristics of a malignant ovarian tumor: thin walled
Thick walled = malignant
Do ascites occur more often with malignant or benign ovarian tumors?
What is more characteristics of a malignant ovarian tumor: complex
What is more characteristics of a malignant ovarian tumor: mobile
What are the three major non-ovarian neoplastic masses?
What are the non-non-gynecologic, non-neoplastic causes of ovarian masses?
What is the urachus?
Remnant of the umbilical artery
What are the carcinomas that commonly met to the ovaries?
What are the four major factors that determine the management of new adnexal masses?
-Complexity of mass
True or false: any ovarian cyst in a premenopausal woman should have a surgical evaluation
Under what size of an adnexal mass is no f/u needed for a reproductive aged woman?
Less than 5 cm
What is the next step of finding a small, hemorrhagic ovarian mass?
What is the next step in management for a nodule without flow or multiple thin septations?
Surgical eval or MRI
What size of an ovarian mass in a postmenopausal woman indicates the need for f/u? When is just f/u with US sufficient? When is surgery indicated?
More than 1 cm
Less than 7 cm = US f/u
More than 7 cm take out
Woman in early menopause with a hemorrhagic cyst = what to do next?
Repeat US in 6-12 weeks
What are Leiomyomas (fibroids)?
Proliferation of smooth muscle surrounded by a pseudocapsule of compressed muscle fibers
When is the highest prevalence of uterine Leiomyomas?
In whom are leiomyomas more common in: white or black people?
What is the most common indication for a hysterectomy?
What are the three classifications of uterine leiomyomas?
What is the role of estrogen in the development of leiomyomas?
Increases their growth
In whom are uterine malignancies more typical in?
Postmenopausal patients who present with rapidly enlarging uterine masses, bleeding, and/or pelic pain
How common are leiomyosarcomas?
What are the s/sx of leiomyomas?
What causes the bleeding with leiomyomas?
Alteration of normal myometrial contractile fashion, and an inability of the overlying endometrium to respond to normal e/p
What hematologic abnormality is a risk factor of untreated leiomyomas?
Anemia from chronic bleeding
What is the renal complication that can result from an untreated leiomyoma?
Hydroureter or hydronephrosis
How do you diagnose leiomyomas?
PE or imaging findings of a midline irregular mass
How do you communicate the size of leiomyomas?
Based on a fetal gestational size (e.g. 20 weeks)
What are the medical treatment options for leiomyomas?
Progestin supplementation to minimize bleeding
What is the treatment for menorrhagia associated with leiomyomas?
What is the MOA of tranexamic acid?
It serves as an antifibrinolytic by reversibly binding four to five lysine receptor sites on plasminogen or plasmin. This prevents plasmin from binding to and degrading fibrin and preserves the framework of fibrin's matrix structure
What is the surgical option for fibroids? (3) What are the downsides of each?
-Myomectomy (recurrence risk)
-Endometrial ablation (treats bleeding abnormalities, and only for submucosal fibroids)
What is myolysis?
Laparoscopic thermal, radiofrequency, or cryoablation of leiomyoma tissue
What is uterine artery embolization?
Injecting Poly vinyl alcohol to cause an infarction of the fibroid