Benign conditions of ovary and pelvis Flashcards
What categories differentials for a pelvic mass
Gynae
GI
Urological
Other (lymph issue, cyst)
What are gynaecologist differentials for a pelvic mass?
Ovarian
- cyst / para ovarian cyst
- torsion
- malignancy
FT
- ectopic preg
- abscess
- malignancy
- Hydrosalpinx/pyosalpinx
Uterus
- fibroid
- pregnancy
- malignancy
What is a para ovarian cyst?
Abdominal cyst near ovary
What is a Hydrosalpinx?
blocked fallopian tube filled with fluid
Due to PID
What is Pyosalpinx?
blocked fallopian tube filled with pus
Due to PID
What are types of benign ovarian cysts?
Functional /simple Inflammatory Germ cell Epithelial Sex cord
Who do functional ovarian cysts occur in?
Young girls
Women in reproductive years
What are types of functional ovarian cysts?
Follicular
Corpus luteal
Theca luteal
What medication reduces risk of functional ovarian cysts?
COCP
What is a cyst minumum diameter? (less than that is normal follicle?
Cyst: >3cm
Normal follicle <2.5cm
What is management of a SIMPLE FOLLICULAR cyst?
asymptomatic: reassure, repeat USS
symptomatic: laparoscopic cystectomy
What are investigations for suspected ovarian cyst?
TVUSS (TAUSS if never sexually active)
CT, MRI
Pregnancy scan
Inflamm markers
What is ovarian torsion?
Rotation of the vascular pedicle supplying the ovary, cutting off the blood supply and risking necrosis
What is the cause for ovarian torsion?
A large heavy cyst
What are presenting symptoms for ovarian torsion?
Acute onset lower abdominal pain
Nausea and vomiting
What is investigations for ovarian torsion
Pregnancy test !
TVUSS + Doppler (looking for blood flow)
CT/MRI if in doubt
DIAGNOSTIC LAPAROSCOPY**
How do you manage ovarian torsion=?
IMMEDIATE diagnostic laparoscopy + treat
Untwist ovary, reattach pedicle
Remove cyst
What condition are inflammatory ovarian cysts associate with?
PID
How do you treat a tube ovarian abscess ( inflammatory ovarian cysts )
Antibiotics
Surgical drainage
Surgical excision
What are the two types of inflammatory ovarian cysts
Tubo ovarian abscess n
Endometrioma
What does an endometrioma look like on USS
ground glass appearance
Who are germ cell tumours common in?
Young women
How do you diagnose germ cell tumours?
Pelvic USS
Who are epithelial tumours more common in?
Perimenopausal
Who are sex cord stromal tumours more common in=?
Elderly
What is the most common type of sex cord stromal tumour’
Ovarian fibroma
What is Ca 125 a marker for?
Epithelial ovarian cancer (serous)
What is Ca 19-9 a marker for=
Epithelial ovarian cancer (mucinous)
What is inhibin a marker for?
Sex cord stromal tumour (granulose cell)
What is beta HCG a marker for ?
Germ cell tumour
- choriocarcinoma, dysgerminoma
What is AFP a marker for?
Germ cell tumour
- endodermal yolk sac
- Immature teratoma
What is endometriosis?
Endometrial tissue lying outside the uterine cavity
What are possible locations for endometriosis?
Peritoneum ( pelvic side walls, pouch of Douglas, uterosacral ligament, bladder)
Ovary (endometrioma)
FT
Umbilicus, abdo scar, pleural cavity
What is a poor consequence of endometriosis?
INFERTILITY (due to fibrosis and adhesion formation each month, as the endometrial tissue responds to hormonal changed)
What is adenomyositis?
Endometrial tissue penetrating through into myometrium
What are clinical features of endometriosis?
Severe cyclclical pelvic pain
HMB , dysmenorrhoea
dyspareunia
low back pain severe fatigue
What are clinical exam factors suggestive of endometriosis?
Tenderness in pouch of Douglas
Adnexal mass
Fixed retroverted uterus
thick uterosacral ligament
How do you dx endometriosis?
TVUSS
MRI
Laparoscopy
How do you manage endometriosis ?
Medical
- analgesics (NSAIDS, avoid opiates)
- COCP (tricycle)
- progestogens
- GnRH agonist
Surgical
- Excision of endometrial tissue
- oophorectomy / FT removal / hysterectomy
Why should you tricycle COCP
Better at alleviating symptoms (induces amenorrhoea)
How long max can you give GnRH agonist, and why?
6 months max
risk of osteoporosis
What is surgical tx for endometriosis?
Fertility sparing
- ablate/excise endometriosis
Hysterectomy, oophorectomy + immediate oestrogen only HRT
What is chronic pelvic pain=
Intermittent /constant pain in lower abdo of a woman of min 6 month duration, that is NOT dysmenorrhoea or dyspareunia or due to pregnancy
What are gynaecological causes of chronic pelvic pain?
Endometriosis Adenomyosis Adhesions - chronic PID uterine fibroids ovarian cyst
When do corpus luteal cysts occur?
Following ovulation
How do you manage corpus luteal cysts?
Expectant (with analgesia)
They usually self resolve in 2-3 months (like all simple cysts) if they are not excessively big
Who do theca luteal cysts occur in?
Pregnant women
What is the outcome of theca luteal cysts?
They usually self resolve
What is Meig Syndrome?
TRIAD:
- Ovarian fibroma
- Ascites
- Pleural effusion
Who does Meig Syndrome usually occur in?
Women over 40
How do you manage Meig Syndrome?
Drain ascites and pleural effusion
THEN
Surgically remove the fibroma
What is a thecoma?
A benign oestrogen secreting tumour
Presents after menopause
What symptoms can a thecoma cause?
Symptoms of excess oestrogen
e.g. PMB
What are the two theories for endometriosis?
Samson’s Theory - retrograde menstruation along FT and subsequent implantation on pelvic peritoneum
Meyer’s Coelomic Metaplasia Theory - De-differentiation of peritoneal cells to primitive origin, then into endometrial cells
What are endometriosis findings on examination?
Thickening/nodularity of uterosacral ligaments
Tenderness in Pouch of Douglas
Adnexal mass
Fixed retroverted uterus
What is the gold standard diagnostic method for endometriosis?
LAPAROSCOPY
