Pelvic Mass

Question 1

Definition of what issue?
(a) Most common benign neoplasm of the female genital tract.
(b) Discrete, round, firm, often multiple uterine tumor composed of smooth muscle and connective tissue.
(c) May cause miscarriage and pregnancy complications because they interfere with implantation.

Answer 1

Leiomyoma of the uterus (fibroid tumor)

Question 2

Leiomyoma of the uterus (fibroid tumor) is usually asymptomatic what are some symptoms for which females will seek treatment?

Answer 2

1) Pelvic pressure
2) Abnormal uterine bleeding
3) Pain

Question 3

DDx for Fibroids

Answer 3

(a) Pregnancy
(b) Adenomyosis (the endometrium grows into the myometrium)
(c) Ovarian tumor

Question 4

What labs would you run for Fibroids? and what are you looking for?

Answer 4

CBC
Iron deficiency anemia

Question 5

Imaging for fibroid tumor

Answer 5

(a) Transvaginal ultrasound
—1) Confirm presence and monitor for growth
(b) MRI with contrast
—1) Assess location within the muscle and blood flow to the tumor
(c) Hysterography or hysteroscope

Question 6

Fibroids
Surgery may be required for What?

Answer 6

acute torsion of a pedunculated myoma

Question 7

What can help decrease bleeding associated with fibroids?

Answer 7

LNG IUD

Question 8

Specific treatment for fibroids

Answer 8

1) Asymptomatic myomas can be managed expectantly
2) NSAIDs decrease menstrual blood loss
3) Hormonal therapies can reduce volume, size, and menstrual blood loss
4) Surgical therapy is definitive treatment and curative.

Question 9

Follow up/ DISP for Fibroids

Answer 9

(a) Any patient with symptomatic (anemia, pain, AUB) fibroids should be referred to gynecologist.
(b) MEDEVAC for suspected torsion of fibroid and hemorrhage

Question 10

Definition of what issue?
(a) Abnormal uterine bleeding is the presenting sign in 90% of cases
—1) ALL post-menopausal bleeding requires evaluation
(b) Pap smear is frequently negative
(c) Pain is usually a late symptom
(d) After a negative pregnancy test, endometrial tissue is required to confirm diagnosis.
Most often 50-70 years of age

Answer 10

Carcinoma of the endometrium

Question 11

What is the second most common cancer of the female reproductive tract?

Answer 11

Adenocarcinoma of the endometrium

Question 12

True/False
These factors decrease risk for Carcinoma of the endometrium
1) Obesity
2) Nulliparity (unopposed estrogen)
3) Diabetes
4) Polycystic ovaries with prolonged anovulation (unopposed estrogen)
5) Unopposed estrogen therapy
6) Extended use of tamoxifen for the treatment of breast cancer. An estrogen
blocker.
7) Family history of colorectal cancer

Answer 12

False Increase risk

Question 13

What ancillary diagnostic work up would you do?

Answer 13

Lab
–(a) Biopsy of endometrial tissue
–(b) Pap smear
Imaging
–(a) Vaginal ultrasound
–(b) Hysteroscopy

Question 14

Treatment for Carcinoma of the uterus

Answer 14

a) Surgery
–1) Total hysterectomy
–2) Bilateral salpingo-oophorectomy
–3) Peritoneal washings for cytology
–4) Lymph node sampling
(b) Post-operative radiation
(c) Chemotherapy

Question 15

All patients with concern for endometrial carcinoma should be
referred to where?

Answer 15

gynecologic oncologist