2011 62 Premenopausal Ovarian Masses Flashcards
What proportion of women have some form of surgery for an ovarian mass?
10%
What is the incidence of a symptomatic ovarian cyst being malignant, a) premenopausally, b) > age 50
a) 1:1000
b) 3:1000
What tumour markers are useful in the identification of germ cell tumours?
AFP
HCG
LDH
What proportion of suspected ovarian masses are found to be non-ovarian in origin?
10%
How long do dimple ovarian cysts <50mm typically take to resolve?
2-3 menstrual cycles
What are the differentials for benign ovarian masses?
- Functional cysts
- Endometriomas
- Serous cystadenoma
- Mucinous cystadenoma
- Mature teratoma
What are the differentials for benign non-ovarian adnexal masses?
- Paratubal cyst
- Hydrosalpinges
- Tubo-ovarian abscess
- Peritoneal pseudocyst
- Appendiceal abscess
- Diverticular abscess
- Pelvic kidney
What are the differentials for primary malignant ovarian masses?
- Germ cell tumour
- Epithelial carcinoma
- Sex cord tumour
Where do secondary malignant tumours typically originate from?
- Breast
- Gastrointestinal
What history is important in assessing ovarian masses?
- Risk/protective factors
- Family hx ovarian or breast Ca
- Endometriosis Sx
- Persistent abdo distension
- Appetite change esp satiety
- Pelvic or abdo pain
- Increased uirinary urgency or frequency
What ovarian cyst accidents should be considered in acute pelvic pain?
- Torsion
- Rupture
- Haemorrhage
What examination features are important in adnexal masses?
- Mass tenderness
- Mobility
- Nodularity
- Ascites
What conditions can raise Ca-125?
- Fibroids
- Endometriosis
- Adenomyosis
- Pelvic infection
What premenopausal Ca-125 level should be referred to gynae-onc?
> 200
What imaging should be used for suspected ovarian masses?
Transvaginal ultrasound
Refer complex lesions to gynae inc MDT, rather than CT or MRI
How is RMI I calculated?
RMI = U x M x Ca-125
U= 0, 1 for 1, 3 for 2-5
M= 1 pre, 3 post
What is the sensitivity & specificity of RMI I scores of > 200?
Sensitivity 78%
Specificity 87%
How is RMI 2 calculated?
RMI = U x M x Ca-125
U= 1 for 0-1, 2 for 2+
M= 1 pre, 4 post
What is the sensitivity & specificity of RMI 2?
Sensitivity 80%
Specificity 92%
What are the IOTA B-rules?
- Unilocular cysts
- Largest solid component <7mm
- Acoustic shadowing
- Smooth multilocular tumour, largest diameter < 100mm
- No blood flow
What are the IOTA M-rules?
- Irregular solid tumour
- Ascites
- ≥ 4 papillary structures
- Irregular multilocular tumour ≥ 100mm
- Strong blood flow
What are the sensitivity & specificity of IOTA rules?
Sensitivity 95%
Specificity 91%
How should premenopausal cysts of different sizes be managed?
a) < 50mm: no follow-up
b) 50-70mm: yearly ultrasound
c) > 70mm: MRI or surgery
How should ovarian cysts that persist or increase in size be managed?
Surgically
More likely to be dermoid
How does COCP impact on functional ovarian cysts?
No evidence of benefit
Why is aspiration of ovarian cysts not recommended?
No better than expectant management
Recurrence rates 53-77%
Which type of cyst can cause chemical peritonitis if spilled?
Dermoid cysts
