Exxcellence pearls: management of adnexal mass

Question 0

What physical exam components should be emphasized for patients with an adnexal mass?

Answer 0

Breast, abdominal, pelvic and rectal exam.

Mammography and colonoscopy should also be considered.

Question 1

What are the most common ovarian masses in postmenopausal women?

What is the lifetime risk of developing ovarian cancer?

Answer 1

Cystadenoma.

1 in 70.

Question 2

What is the most important risk factor for ovarian cancer?

Answer 2

Age

Question 3

What is the risk of ovarian and breast cancer with BRCA2 mutations?

Answer 3

10-27% and 50-85%

Breast cancer risk is same with both BRCA mutations but ovarian cancer risk is greater with BRCA1.

Question 4

What is the risk of ovarian and breast cancer with BRCA1 mutation?

Answer 4

15-45% and 50-85%

Question 5

What percentage of patients with epithelial ovarian cancer will have elevated CA 125?

What percentage will be elevated at stage one?

Answer 5

80%

50%

Question 6

What is the risk of ovarian cancer with Lynch syndrome (hereditary non-polyposis colorectal cancer)?

Answer 6

Approximately 10-20%

Question 8

What tumor markers are ordered for germ cell tumors?

Answer 8

Beta-hCG, LDH, AFP, inhibin A and B

Question 9

Which germ cell tumors have elevated AFP?

Answer 9

Immature teratoma, endodermal sinus tumors, embryonal carcinoma.

Question 10

Which germ cell tumors have elevated beta-hCG?

Answer 10

Choriocarcinoma of the uterus and embryonal carcinomas

Question 11

Which germ cell tumors have elevated inhibin?

Answer 11

Granulosa cell tumors

Question 12

Which germ cell tumors have elevated LDH?

Answer 12

Dysgerminomas.