5: Pelvic masses Flashcards
Which organs may be involved in a patient with a pelvic mass?
Bladder
GI - large/small bowel, rectum
Gynae - uterus, Fallopian tubes, ovaries
What is a common GI condition which can present with abdominal pain and a pelvic mass?
Constipation
Which renal problem may cause an abdominal mass on examination?
Urine retention
Which female genital tract structures may cause a pelvic mass?
Uterus (including endometrium and cervix)
Fallopian tubes
Ovaries
What is the most common reason for a uterine mass?
Uterine fibroids
Among women, what is the most straightforward reason for a uterine mass?
Pregnancy
What are uterine leiomyomas also known as?
Fibroids
What is the underlying pathology of uterine fibroids?
Leiomyomas
Benign smooth muscle tumours
Which cancers can cause the uterus to enlarge?
Cervical cancer
Endometrial cancer
What is a common presentation of endometrial cancer?
Post-menopausal bleeding
In which age group are uterine fibroids common?
Women aged > 40
Uterine fibroids are often an incidental finding on examination - why?
Asymptomatic
If uterine fibroids are symptomatic, what do women complain of?
Menorrhagia (heavy bleeding)
Pelvic mass
In which situation do uterine fibroids cause pain?
Infarction due to loss of blood supply
called ‘red degeneration’ because the fibroid has a red, ischaemic appearance
How are suspected uterine fibroids investigated?
USS pelvis
Which imaging modalities can be used to look at uterine fibroids?
USS pelvis
MRI scan
What is the most common management of uterine fibroids?
Expectant management if woman is < 40 and wants to start a family
Surgical management i.e hysterectomy otherwise
What are the surgical management options for uterine fibroids?
Hysterectomy (definitive, effective treatment - family planning issue)
Uterine artery embolisation
Myomectomy
What is an obstetric emergency which causes the Fallopian tube to swell?
Ectopic pregnancy
How does ectopic pregnancy present?
Initially: amenorrhoea, light bleeding, mild abdominal (maybe shoulder tip) pain
Ruptured: severe pain, heavy bleeding + signs of shock
In any woman with amenorrhoea and gynae symptoms, what must you exclude using imaging?
Ectopic pregnancy
Which diseases of the ovaries can cause a pelvic mass?
Tumours - benign and malignant
Cysts
Endometriosis
Polycystic ovarian syndrome (note these aren’t actually cysts)
What is a benign disease of the ovaries which affects most women at some point in their lifetimes?
Ovarian cyst
Do most ovarian cysts require treatment?
No
Usually resolves themselves
Which disease causes patches of uterine tissue to grow in the Fallopian tubes, ovaries and peritoneal cavity?
Endometriosis
What are the symptoms of endometriosis?
Pelvic pain
Painful periods
Menorrhagia
Which kind of ovarian cyst is caused by endometriosis?
Ovarian endometrioma
or ‘chocolate cyst’, because it’s reddy/brown in appearance
Which types of tumour are seen on the ovaries?
Epithelial tumours
Germ cell tumours
Stromal tumours
What are epithelial tumours of the ovary called?
Cystadenomas (cystadenocarcinomas)
Which germ cell tumour is commonly found in the ovary and is highly keratinised?
What name does it commonly go by?
Benign cystic teratoma
or Dermoid cyst
What is a dermoid cyst?
Mature cystic teratoma
On histology, mature cystic teratomas have the appearance of ___.
skin, hair
highly keratinised epithelium, giving the name DERMOID CYST
Which conditions make up the triad of Meig’s syndrome?
Ovarian tumour
Ascites
Pleural effusion
The ovarian tumour usually seen in Meig’s syndrome is (benign / malignant).
benign
How is Meig’s syndrome managed?
Surgical removal of ovarian tumour
Ascitic tap
Chest drain
The ovaries are a common location of ___ tumours.
secondary tumours
i.e metastatic disease
