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Flashcards in Pelvic Masses Deck (56):
1

Define adnexa.

Ovaries, fallopian tubes, and associated ligaments

2

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

3

What is the role of placing mesh in the ovaries following excision of a cystic ovary?

Prevent scar tissue and the development of adhesions

4

True or false: most function cysts (follicular or corpus luteum) regress in 1-2 months

True

5

What is the role of hormonal suppression for ovarian cysts?

-Adds nothing to waiting, but might prevent new cyst formation

6

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

7

What size of cyst indicates the need for surgical excision?

6 cm

8

What are the risks of ovarian cysts? (2)

Pain/leakage of blood/prostaglandins leading to hemoperitoneum

-Torsion

9

What is a culdocentesis?

Drainage of the cul-de-sac if there is hemoperitoneum

10

What are the risks of ovarian torsion?

Compromised vascular supply leads to ischemia

11

What are the s/sx of ovarian torsion?

Sudden onset of constant or intermittent pain with TTP on exam

12

What is the most common cause of an ovarian torsion?

Ovarian cystic teratoma

13

What imaging modality is helpful in diagnosing an ovarian torsion?

US with color doppler sonography

14

What is the treatment for ovarian torsion?

Surgical untwisting vs removal

15

Why are teratomas more likely to result in ovarian torsion?

Heavier mass

16

What are the two main cell lineages that give rise to ovarian neoplasms?

Epithelial cells
Germ cells

17

What are the 5 ovarian tumor that arise from epithelial tissue?

-Serous
-Mucinous
-Endometrioid
-Clear cell
-Brenner

18

What is the most common malignant ovarian tumor? What are the histological characteristics of this?

-Serous cystadenocarcinoma

-Psammoma bodies

19

What is the most common malignant ovarian tumor among children and adolescents? What are the chemical markers of this?

Dysgerminomas and hCG/LDH

20

What is more characteristics of a malignant ovarian tumor: unilateral or bilateral?

Bilateral

21

What is more characteristics of a malignant ovarian tumor: thin walled

Benign
Thick walled = malignant

22

Do ascites occur more often with malignant or benign ovarian tumors?

Malignant

23

What is more characteristics of a malignant ovarian tumor: complex

Malignant

24

What is more characteristics of a malignant ovarian tumor: mobile

Benign

25

What are the three major non-ovarian neoplastic masses?

-Leiomyoma
-Endometrial carcinoma
-Tubal carcinoma

26

What are the non-non-gynecologic, non-neoplastic causes of ovarian masses?

-Appendiceal abscesses
-Diverticulosis
-Adhesions

27

What is the urachus?

Remnant of the umbilical artery

28

What are the carcinomas that commonly met to the ovaries?

Appendix
Large intestines
Bladder

29

What are the four major factors that determine the management of new adnexal masses?

-Urgency (s/sx)
-Size
-Complexity of mass
-Age

30

True or false: any ovarian cyst in a premenopausal woman should have a surgical evaluation

True

31

Under what size of an adnexal mass is no f/u needed for a reproductive aged woman?

Less than 5 cm

32

What is the next step of finding a small, hemorrhagic ovarian mass?

None

33

What is the next step in management for a nodule without flow or multiple thin septations?

Surgical eval or MRI

34

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

35

Woman in early menopause with a hemorrhagic cyst = what to do next?

Repeat US in 6-12 weeks

36

What are Leiomyomas (fibroids)?

Proliferation of smooth muscle surrounded by a pseudocapsule of compressed muscle fibers

37

When is the highest prevalence of uterine Leiomyomas?

5th decade

38

In whom are leiomyomas more common in: white or black people?

Black

39

What is the most common indication for a hysterectomy?

Uterine leiomyomas

40

What are the three classifications of uterine leiomyomas?

-Intramural
-Subserosal
-Submucosal

41

What is the role of estrogen in the development of leiomyomas?

Increases their growth

42

In whom are uterine malignancies more typical in?

Postmenopausal patients who present with rapidly enlarging uterine masses, bleeding, and/or pelic pain

43

How common are leiomyosarcomas?

Rare

44

What are the s/sx of leiomyomas?

-*Bleeding*
-Pelvic pressure

45

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

46

What hematologic abnormality is a risk factor of untreated leiomyomas?

Anemia from chronic bleeding

47

What is the renal complication that can result from an untreated leiomyoma?

Hydroureter or hydronephrosis

48

How do you diagnose leiomyomas?

PE or imaging findings of a midline irregular mass

49

How do you communicate the size of leiomyomas?

Based on a fetal gestational size (e.g. 20 weeks)

50

What are the medical treatment options for leiomyomas?

Progestin supplementation to minimize bleeding
-OCP
-NSAIDs
-GnRH agonists

51

What is the treatment for menorrhagia associated with leiomyomas?

Tranexamic acid

52

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

53

What is the surgical option for fibroids? (3) What are the downsides of each?

-Myomectomy (recurrence risk)
-Hysterectomy (infertility)
-Endometrial ablation (treats bleeding abnormalities, and only for submucosal fibroids)

54

What is myolysis?

Laparoscopic thermal, radiofrequency, or cryoablation of leiomyoma tissue

55

What is uterine artery embolization?

Injecting Poly vinyl alcohol to cause an infarction of the fibroid

56

What is MRI guided focused US?

US energy delivered to tissue to increase temp to 70 C.