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)
what should you look for on examination of pelvic mass:
- general? (6)
- abdo? (4)
- vaginal?
-Anaemia Cachexia Chest examination Breast examination Nodes Peripheral/leg oedema
-scars
Distention
ascites
Mass (can you get below it?)
-speculum and bimanual examination?
How should the mass be described? (6)
Size cms or ‘weeks gestation’ Consistency e.g. soft, firm, hard, craggy, indurated, boggy, fluctuant Surface Smooth, irregular, ‘bosselated’ Tenderness Mobility Relation to uterus/Pouch of douglas.
Investigation overview just for the fun
Hb WCC/CRP if suspect inflammatory mass Biochemistry esp serum albumin Tumour markers (CA125, CEA, HCG,AFP) (CXR) Ultrasound TA/TV \+/- MRI (for fibroids/uterine mass) \+/-CT (for suspected ovarian Ca) \+/- CT/US guided tissue biopsy. but n.b. aspiration for cytology not helpful
