Adnexal Mass

Question 1

Consultation with or referral to a gynecologic oncologist is recommended for women with an adnexal mass who meet one or more of the following 3 criteria:

Answer 1

— Postmenopausal with elevated CA 125 level, ultrasound findings suggestive of malignancy, ascites, a nodular or fixed pelvic mass, or evidence of abdominal or distant metastasis
— Premenopausal with very elevated CA 125 level, ultrasound findings suggestive of malignancy, ascites, a nodular or fixed pelvic mass, or evidence of abdominal or distant metastasis
— Premenopausal or postmenopausal with an elevated score on a formal risk assessment test such as the multivariate index assay, risk of malignancy index, or the Risk of Ovarian Malignancy Algorithm or one of the ultrasound-based scoring systems from the International Ovarian Tumor Analysis group

Question 2

Transabdominal ultrasonography rather than transvaginal ultrasonography is recommended for who?

Answer 2

Young, virginal, or prepubertal adolescents.

Question 3

5 reasons to remove benign ovaries in premenopausal patients?

Answer 3

1- FamHx ovarian CA/BRCA/Lynch
2- TOA that is non-responsive to other Tx
3-Benign neoplasms where cystectomy or partial oophorectomy is not possible
4- Torsion with necrosis
5- Last resort for endometriosis

Question 4

What adnexal masses are sometimes seen bilaterally?

Answer 4

1- Endometriomas
2- Teratomas
3- Krukenberg
4- Theca Lutein
5- Dysgerminomas

Question 5

US features of hemorrhagic cyst?

Answer 5

Reticular pattern of internal echoes

Question 6

What indices should prompt referral to GYN-Onc?

Answer 6

1- Elevated CA-125
2- Ascites
3- Evidence of Metastases
4- First degree relative with Breast/OvarCA
5- Fixed or nodular mass

Question 7

Markers for Germ Cell tumors?

Answer 7

Inhibin [a&b] , LDH, AFP, B-HCG