EXAM #1: PELVIC MASSES Flashcards
What is the definition of adnexa?
“Parts attached to the uterus” i.e.
1) Ovaries
2) Fallopian tubes
3) Uterine ligaments
You find an adenxal mass on US. What is the next step?
- Rexamine in 1x month OR
- Laproscopy
How are folliular and CL cysts managed?
- Typically the cyst will regress in a month or two
- Hormone suppression may prevent future cysts
When is operative management indicated for a pelvic cyst?
1) Child with pelvic mass
2) Persistent cyst greater than 6cm or symptomatic
3) Menopausal woman with persistent or complex mass
What are the major risks associated with a persistent ovarian cyst?
1) Rupture
2) Ovarian torsion (adnexal torsion)
How can a ruptured ovarian cyst be managed?
1) Culdocentesis
2) Surgery
What is the most common etiology of ovarian torsion?
Benign cystic teratoma
How is ovarian torsion diagnosed?
Ultrasound w/ doppler flow
How is ovarian torsion managed?
Immediate surgical intervention
What is the most common malignant ovarian tumor?
Serous Cystadenocarcinoma
What is the histologic marker for a serous cystadenocarcinoma?
Psammoma bodies
What is the most common malignant tumor among children and adolescents?
Dysgerminoma
What are the tumor markers associated with Dysgerminomas?
LDH
B-hCG
Clinically, what are the concerning features indicating that an adnexal mass is malignant?
- Post-menopausal female
- Bilateral
- Solid
- Irregular
- Thick-walled
- Fixed
- Rapid growth
- Associated ascites
If a post-menopausal female on estrogen replacement therapy presents to your office asymptomatic. On exam her right ovary is enlarged. What is the next best step in her work-up?
TVUS
TVUS on the post-menopausal female in your office shows a cyst that is less than 1cm, what should you do?
No follow-up necessary
TVUS on the post-menopausal female in your office shows a cyst that is 2-7cm, what should you do?
Repeat TVUS in 1 year
TVUS on the post-menopausal female in your office shows a cyst that is greater than 7cm, what should you do?
Further imaging and surgical evaluation
TVUS on the post-menopausal female in your office shows a cyst that is hemorrhagic; she is early-menopause. What next?
Repeat US in 6-12 weeks
TVUS on the post-menopausal female in your office shows a cyst with a nodule that is without flow; she is late-menopause. What next?
Surgical evaluation/ MRI
What is a uterine leiomyoma?
Uterine fibroid i.e. proliferation of smooth muscle with a pseudocapsule of muscle fibers
What age are uterine leiomyomas more common?
5th decade
What race shows a perdominance for uterine leiomyomas?
African American
What are the different classes of uterine leiomyomas? Where are these different classes of leiomyomas located?
1) Intramural= in the uterine wall
2) Subserosal= beneath the uterine serosa
3) Submucosal= beneath the endometrium
How do leiomyomas change with estrogen?
Get bigger with estrogen
What is the malignant form of a leiomyoma?
Leiomyosarcoma
What are the red flags for a leiomyosarcoma?
1) Post-menopausal bleeding
2) Rapidly enlarging uterine mass
3) Unusual vaginal bleeding
4) Pelvic pain
How will a leiomyoma feel on exam?
“Lumpy”
What is one of the major complications of a very large uterine fibroid?
Pressure on the ureter creating:
1) Hydroureter
2) Hydronephrosis
How are leiomyomas diagnosed?
1) Physical exam
2) US
3) CT/MRI
How will a leiomyoma feel on exam?
- Midline
- Irregular
- Mobile
- Hard
What are the medical treatment options for leiomyomas?
1) Progestin supplementation to minimize bleeding
2) High dose NSAID or Tranexamic acid to treat menorrhagia
3) GnRH agonists to reduce size (esp. pre-op)
What surgical procedure can be done for a leiomyoma to preserve fertility?
Myomectomy i.e. simply removing the fibroid
*25% of women will end up getting a hysterectomy
What is the definitive treatment for leiomyomas?
Hysterectomy
What surgical procedure can be done to treat the bleeding abnormalities of a leiomyoma?
Endometrial ablation
What is myolysis?
Laproscopic thermal, radiofrequency or cryoablation of leiomyoma tissue
What is the IR procedure to treat a leiomyoma? What is a major contraindication for this procedure?
Uterine Artery Embolization
*Do NOT do if patient desires future pregnancy
