Benign Ovarian Tumors Flashcards
what do symptoms of unilateral, intermittent, and then acutely worsening pelvic pain indicate?
ovarian torsion
what do symptoms of progressive pelvic pain associated with fevers, chills, vomiting, and vaginal discharge
tubo-ovarian abscess
women who report acute or chronic dysmenorrhea or pain with intercourse may have an _______
endometrioma
persistent bloating, generalized abdominal pain, and early satiety may be signs of _____
malignancy
abnormal uterine bleeding or postmenopausal bleeding may he caused by estrogen produced by sex ___-_____ _____
cord-stromal tumors
what is the most commonly used imaging technique for the evaluation of adnexal masses? 2nd line?
transvaginal ultrasound
abdominal ultrasound
what lab may help to distinguish between benign and malignant masses?
CA-125
the most widely method of screening for ovarian cancer
CA-125
23 yo G1P1 presents to clinic with a new crampy pain in her right pelvic over the last 3 days. last menstrual period was 3 weeks ago and was normal. she uses condoms and her urine pregnancy test is negative. on pelvic exam, a 3-4 cm tender cystic mass is found in the right adnexa. The remainder of exam is negative. next step?
transvaginal US
23 yo G1P1 presents to clinic with a new crampy pain in her right pelvic over the last 3 days. last menstrual period was 3 weeks ago and was normal. she uses condoms and her urine pregnancy test is negative. on pelvic exam, a 3-4 cm tender cystic mass is found in the right adnexa. The remainder of exam is negative. the best management would be to schedule….
return visit to office in 6 weeks
patient will be in diff menstrual cycle so US to be repeated
follicle diameter of at least 3cm that causes pelvic pain, a dull sensation, or heaviness in the pelvis; it is mobile, unilateral and not associated with ascites
functional ovarian cyst
what will be noted on a bimanual exam to indicate a functional ovarian cyst?
5-8 cm cystic adnexal mass
23 yo G1P1 presents to clinic with a new crampy pain in her right pelvic over the last 3 days. last menstrual period was 3 weeks ago and was normal. she uses condoms and her urine pregnancy test is negative. on pelvic exam, a 3-4 cm tender cystic mass is found in the right adnexa. The remainder of exam is negative. During f/u visit, the patient feels better and pelvic exam is unremarkable. transvaginal US shows no ovarian cyst bilaterally. what should you offer her?
OCPs
what agents may be given to suppress gonadotropin levels and prevent development of another cyst?
low-dose contraceptives
when to refer to gynecology for a cyst? (4)
cyst persists over 6 weeks
symptomatic
large cyst (10cm or more)
ovarian torsion cannot be ruled out
32 yo G1P1 comes to ER c/o sudden onset of LLQ pain that started 2 hours ago. The pain is sharp and comes in waves and is associated with nausea and vomiting. PE is remarkable for a left adnexal fullness and rebound and guarding. Transvaginal US shows 5cm ovarian cyst. No blood flow to left ovary. Dx? treatment?
ovarian torsion
left salpingoophorectomy
in adult females, what is the most likely factor to predispose to ovarian torsion?
functional ovarian cyst
25 yo G0 complains of painful full sensation in her right lower quadrant. She has had regular periods since menarche and has no history of STDs. on PE, you find a mobile mass in her right adenxae about 8x8 cm. Her urine pregnancy is negative and you order a transvaginal US, which shows an 8cm right adnexal mass that is composed of mixed and solid components, some which are calcified. No evidence of ascites and the left adnexa is unremarkable. Dx?
dermoid cyst
what is the most common ovarian neoplasm that is a germ cell tumor?
dermoid cyst
what is the treatment for a dermoid cyst if it is symptomatic or large?
cystectomy or oophectomy
what is the treatment for a dermoid cyst if it is small without symptoms?
expectant management (wait and see / observe)
32 yo patient comes for routine annual exam. Does not have any complaints. Gyn history is remarkable for chlamydia infection 2 yrs ago and was treated successfully. on pelvic exam, there is a 4x4 cm left adnexal fullness. Pregnancy test is negative. transvaginal US shows tubular structure adjacent to left ovary without pelvic fluid. Dx?
hydrosalpinx
the 2 most benign tumors of the fallopian tubes are called:
hydrosalpinx
pyosalpinx
how to definitively diagnose a fallopian tube tumor?
salpingectomy
35 yo G2P1001 c/o pelvic pain and pressure, she is currently 10 weeks pregnant. serum quantitative pregnancy hormone is 250,000 IU. transvaginal US shows a uterus with heterogeneous material and bilateral 10cm ovarian cysts. based on US, you suspect the patient has a molar pregnancy. what type of cyst does this patient have?
theca-lutein cyst
what is the treatment for theca-lutein cysts? (3)
discontinuation of medications
IV fluids
correct electrolytes
what is the treatment for a theca-lutein cyst in a patient with a molar pregnancy?
evacuation of uterine contents (dilation + curettage)
what causes theca-lutein cysts to occur?
elevated HCG hormone (pregnancy)
28 yo G0P0 woman presents to ER with sudden onset of RLQ pain that started after sexual intercourse. patient has hx of ovarian cysts and is not using any contraceptives. PE is remarkable for right lower quadrant tenderness to palpation. TVUS shows pelvic fluid and pregnancy test is negative. Dx?
ruptured cyst
what may prevent the development of new ovarian cysts, but cannot prevent rupture of existing ones?
hormonal treatments
which ovary is most commonly associated with a ruptured ovarian cyst?
right ovary
not protected by rectosigmoid colon like left side
what imaging should be ordered if a ruptured ovarian cyst is suspected?
pelvic ultrasound
treatment for uncomplicated ruptured ovarian cyst?
observation
treatment for complicated ruptured ovarian cyst?
inpatient +/- surgery
what 2 signs indicate a complicated ruptured ovarian cyst?
hypotension
tachycardia
