Benign conditions of ovary and pelvis Flashcards by Laura Lazzari

What categories differentials for a pelvic mass

Gynae
GI
Urological
Other (lymph issue, cyst)

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What are gynaecologist differentials for a pelvic mass?

Ovarian

cyst / para ovarian cyst
torsion
malignancy

ectopic preg
abscess
malignancy
Hydrosalpinx/pyosalpinx

Uterus

fibroid
pregnancy
malignancy

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What is a para ovarian cyst?

Abdominal cyst near ovary

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What is a Hydrosalpinx?

blocked fallopian tube filled with fluid

Due to PID

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What is Pyosalpinx?

blocked fallopian tube filled with pus

Due to PID

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What are types of benign ovarian cysts?

Functional /simple
Inflammatory
Germ cell 
Epithelial 
Sex cord

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Who do functional ovarian cysts occur in?

Young girls

Women in reproductive years

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What are types of functional ovarian cysts?

Follicular
Corpus luteal
Theca luteal

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What medication reduces risk of functional ovarian cysts?

COCP

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What is a cyst minumum diameter? (less than that is normal follicle?

Cyst: >3cm

Normal follicle <2.5cm

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What is management of a SIMPLE FOLLICULAR cyst?

asymptomatic: reassure, repeat USS
symptomatic: laparoscopic cystectomy

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What are investigations for suspected ovarian cyst?

TVUSS (TAUSS if never sexually active)
CT, MRI
Pregnancy scan
Inflamm markers

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What is ovarian torsion?

Rotation of the vascular pedicle supplying the ovary, cutting off the blood supply and risking necrosis

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What is the cause for ovarian torsion?

A large heavy cyst

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What are presenting symptoms for ovarian torsion?

Acute onset lower abdominal pain

Nausea and vomiting

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What is investigations for ovarian torsion

Pregnancy test !
TVUSS + Doppler (looking for blood flow)
CT/MRI if in doubt
DIAGNOSTIC LAPAROSCOPY**

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How do you manage ovarian torsion=?

IMMEDIATE diagnostic laparoscopy + treat
Untwist ovary, reattach pedicle
Remove cyst

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What condition are inflammatory ovarian cysts associate with?

PID

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How do you treat a tube ovarian abscess ( inflammatory ovarian cysts )

Antibiotics
Surgical drainage
Surgical excision

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What are the two types of inflammatory ovarian cysts

Tubo ovarian abscess n

Endometrioma

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What does an endometrioma look like on USS

ground glass appearance

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Who are germ cell tumours common in?

Young women

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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