Week 6-pelvic mass Flashcards
(45 cards)
Name some non-gynaelogical causes of pelvic mass?
Bowel- constipation, caecal carcinoma, appendix abscess, diverticular abscess
Bladder-Urinary retention, pelvic kidney
Other- retroperitoneal tumour.
What are some causes of uterine masses?
Pregnancy Fibroids (commonest)
Endometrial cancer- usually presents early PMB therefore pelvic mass is unusual.
Cervical cancer- only in late presentation +/- renal failure, bleeding and pain.
What is the other name for uterine fibroids?
Leiomyomas- benign smooth muscle tumours.
Who gets uterine fibroids?
They are very common, especially in the over 40’s.
This is how uterine fibroids are classified.
How do uterine fibroids present?
May be asymptomatic/incidental finding
or
Menorrhagia
Pelvic mass
Pain and tenderness- not usually disproportionate. This usually only happens if something compromises the blood supply e.g. in pregnancy or menopause- called red degeneration.
Pressure symptoms e.g. press on the bladder. Present with nocturia, frequency and pressure.
How would you investigate suspected fibroids?
Hb if heavy bleeding
Ultrasound is usually diagnostic- seeing a smooth echogenic mass-often multiple.
MRI to precisely locate.
Fibroid on MRI
Multiple fibroids on MRI
How would you treat fibroids?
Expectant if they are asymptomatic.
Otherwise traditionally do hysterectomy if the family is complete.
Alternatively-
- myomectomy (remove the fibroid)
- Uterine artery embolisation (disrupt their blood supply)
- Hysteroscopic resection
What are some causes of tubal swellings?
Ectopic pregnancy
Hydrosalpinx
Pyosalpinx
Paratubal cysts.
What symptoms/signs would be present in an ectopic pregnancy?
Empty uterus
Pain
Bleeding
May detect adenexal mass on USS.
What is hydrosalpinx?
A distally blocked fallopian tube with serous or clear fluid. The blocked tube may become substantially distended giving it a sausage like appearence.
It can be longstanding or acute. Usually due to pelvic infection- mucous secreted in the lining of the tube builds up due to infection blocking.
What is pyosalpinx?
The fallopian tube is filled/blocked with pus. Its generally acute or inflammatory.
This is usually when the hydrosalpinx becomes infected.
What are paratubal cysts?
Fluid filled sac (cyst) growing beside the ovaries. They are usually small and incidental (can be due to embryological remnants).
What are the broad categories of causes of ovarian masses?
Tumours- benign or malignant
Non tumours- Functional cysts (cysts related to ovulation), endometriotic cysts.
What are functional cysts related too?
Ovulation- follicular cysts or luteal cysts.
How do you manage functional cysts? Do they present with symptoms?
Usually they are asymptomatic/incidental findings. However they bleed or rupture which can cause pain.
They usually resolve spontaneously but expectant management is appropriate.
What are endometriotic cysts also known as?
Endometriosis.
What are blood filled ovarian endometriotic cysts known as?
Chocolate cysts.
What symptoms are associated with endometriosis?
Typically associated with dyssmenorrhoea, premenstrual pain and dyspareunia.
Typically a tender mass with nodularity and tenderness behind the uterus.
(NOTE- they are occasionally asymptomatic until a large chocolate cyst rupture).
NOTE- think about which layer these tumours arise from. All in previous lecture but this is for revision.
What may malignant germ cell tumours secrete?
May secrete HCG or AFP. Will give a false positive pregnancy test.
What may a dermoid cyst rarely present with?
Thyrotoxicosis (if it has thyroid tissue).
