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
