Pelvic mass Flashcards
give the non-gynae causes for pelvic masses?
- GI (4)
- bladder (2)
- other (1)
-constipation
caecal carcinoma
Appendix abscess
Diverticular abscess
-urinary retention
pelvic kidney
-retroperitoneal tumour
What organs can cause pelvic mass? (3)
uterus (body, cervix)
Tubal (para-tubal)
Ovarian
-
Causes for a uterine mass? (4)
pregnancy!!
fibroids
endometrial cancer
cervical cancer
Uterine fibroids
- causative tumours?
- common in what age groups?
- locations? (5)
- presentation? (5)
- investigations? (3)
- treatment?
- Leiomyomas- benign smooth muscle tumour
- over 40s
-pedunculated intramural intracavitary sub mucous subserous
- may be incidental Menhorrhagia pelvic mass Pain/tenderness pressure symptoms
-Hb if heavy bleeding
US equally diagnostic
MRI for more precise localisation
-expectant if asymptomatic hysterectomy if family complete alternatives: myomectomy uterine artery embolisation hysteroscopic resection
Tubal swellings
give causes? (4)
-ectopic pregnancy (Emergency + IPT/empty uterus/pain/bleeding) Hydrosalpinx (longstanding) Pyosalpinx (Acute/inflammatory) Paratubal Cysts (usually small and incidental)
Ovarian mass
-give causes?
Tumours/noeplastic
- benign
- malignant
Not tumours
- Functional cysts
- Endometriotic cysts
Functional cysts
- related to what?
- size?
- features?
- complication?
- ovulation- follicular/luteal cysts
- Rarely >5cm diameter
-Usually resolve spontaneously
asymptomatic, might get menstrual disturbance
-May bleed or rupture and cause pain
Endometriotic cysts
- appearance?
- symptoms? (4)
- examination findings?
-blood filled chocolate cyst on ovaries
-severe dysmenhorrhoea and premenstrual pain
typically associated with dyspareunia
sub fertility
-tender mass with nodularity & tenderness behind uterus
Name the ovarian tumours arising from: -epithelium? (5) -germ cells? (2) -stroma? (3) Presenation of: -malig germ cell tumour -Dermoid cyst -Granulosa cell tumour -Thecal tumours -fibromas -ovary is a site of metastasis for which tumours?
-serous Mucinous Endometrioid Clear cell Brenner
-benign cystic teratoma (dermoid cyst- common)
malignancy germ cell tumour (rare)
-Granulosa- secretes eostrogens
Theca/leydig- secretes androgens
Fibroma
- may produce HCG/AFP
- totipotential, can have teeth, sebaceous material, hair, thyroid tissue
- may produce eastorgens and cause precocious puberty
- androgens cause hirsutism and virilisation
- Meig’s syndrome benign but why pleural effusion
- breast, pancreas, stomach, GI
Ovarian cancer
- presentation?
- issue with presentation?
- genetic component?
- risk factors?
- investigations?
- how do you calculate the risk of malignancy index (RMI)?
-mass, swelling, pressure symptoms: heartburn early satiety weight loss/anorexia bloating pressure symptoms change of bowel habit SOB/pleural effusion Leg oedema or DVT -early transperitoneal spread & late presentation
-BRCA1/2
HNPCC (lynch syndrome)
(bowel, endometrial, ovarian ca)
-inc age
nulliparity
Fam hx
(OCP protective)
-hx & exam
CA125 and CEA (carcino-embryonic antigen)
USS then CT to asses disease outwit ovary
-should know dis
CA 125
-raised in what?
80% of ovarian ca so normal doesn't exclude endometriosis peritonitis/infection pregnancy Pancreatitis Ascites from any cause Other malignancies
CEA
-elevated in what?
moderate elevation in ovarian Ca, esp mucinous tumours
excludes Gi mets
What would count as suspicious findings on an USS?
complex mass with solid & cystic area Multi loculated Thick septations Associated ascitis Bilateral disease
treatment of an ovarian cyst/mass?
benign
removal and drainage
malignant
removal of ovaries/uterus and biopsy of omentum and tumour debulking
chemo
why might a pelvic mass present acutely? (2)
cyst accident (rupture, haemorrhage, torsion) Fibroid degeneration (red degeneration, compromised blood supply, seen in pregnancy/peri-menopause)
