Pelvic Mass Flashcards
bowel causes of a pelvic mass?
constipation
caecal carcinoma
appendiceal abscess
diverticular abscess
urological causes of a pelvic mass?
urinary retention
commonest non-physiological cause of a uterine mass?
fibroids
why is cancer most likely to not present with a pelvic mass?
usually get other symptoms eg abnormal bleeding first then a mass is a late sign
fibroids are benign tumour of what?
smooth muscle (leimyoma)
what age group are fibroids most common in?
> 40s
how big on average are fibroids?
a few cm
name the 3 types of intramural fibroid; where do they lie?
intramural - completely in the wall
submucous - projects out into the cavity
subserous - projects to the outside
a fibroid in the uterine cavity is called?
intracavitary fibroid
a fibroid found hanging off the outside of the uterus by a stalk is called…
pedunculated
presentation of uterine fibroids?
asymptomatic menorrhagia pelvic mass pain/tenderness pressure symptoms
Ix fibroids?
Hb if heavy bleeding
USS first line
MRI for precise localisation
what does USS show if a fibroid is present?
smooth echogenic mass
sometimes multiple
Tx fibroids
watchful waiting if asymptomatic hysterectomy if family complete consider: myomectomy uterine artery embolisation hysteroscopic resection
hydrosalpinx/pyosalpinx is often longstanding
hydrosalpinx
pyosalpinx has an acute inflammatory presentation T or F
T
what are paratubal cysts? what do they look like?
embryological remnants
small and incidental
if an ovarian mass is not a tumour, what is it?
a cyst
name the 2 main categories of cyst that cause pelvic masses
functional cysts
endometriotic cysts
cause of functional cysts
ovulation-related
how big are functional cysts?
small, dont usually get >5cm
presentation of functional cysts
asymptomatic mostly
can be menstrual disturbance/pain
Tx functional cysts
watchful waiting
what happens if a fibroid undergoes red degeneration? when does it happen?
usually in pregnancy and menopause
caused by fibroid outgrowing its blood supply/blood supply cut off
what are endometriotic cysts?
blood filled “chocolate cysts” on ovaries associated with endometriosis
presentation of endometriotic cysts
asymptomatic severe dysmenorrhoea premenstrual pain dyspareunia subfertility
signs of endometriotic cysts on exam?
tender mass with nodularity and tenderness behind uterus
a BENIGN ovarian tumour arising from surface epithelium is called…
a cystadenoMa
a MALIGNANT ovarian tumour arising from surface epithelium is called…
a cystadenoCa
name the 5 types of ovarian tumour from surface epithelium?
serous mucinous endometrioid clear cell brenner
most common germ cell ovarian tumour? is it benign or malignant?
benign cystic teratoma
what kind of ovarian tumour can cause oversecretion of oestrogens? where can it arise from?
granulosa cell tumour from the stroma
what kind of ovarian tumour can secrete androgens?
theca/leydig cell
triad of benign ovarian fibroma with ascites and pleural effusion….
meig’s syndrome
what can a malignant germ cell ovarian tumour produce?
HCG (false positive pregnancy test)
AFP
oestrogens produced by a tumour may cause what symptoms?
post menopausal bleeding
precocious puberty
what primary cancers can metastasise to the ovary?
breast
pancreas
stomach
GI
what is a dermoid cyst? is it benign?
a benign teratoma containing embryological hair, teeth and sebaceous cells
presentation of ovarian cancer?
heartburn/indigestion early satiety weight loss/anorexia bloating pressure symptoms eg on bladder change in bowel habit SOB/pleural effusion leg oedema/DVT SOMETIMES pelvic mass
genetic causes of ovarian cancer?
BRCA 1 and 2
lynch syndrome
risk factors for ovarian cancer?
age
nulliparity
FH
Ix ovarian cancer
serum CA125
carcino-embryonic antigen (CEA)
USS - for cyst
CT - for mets/LNs
if CA125 is negative cancer is excluded T or F
F
main function of the CEA test?
exclude mets from GI primary cancer
presentation of ovarian cancer on USS?
complex mass- solid + cystic lesions
multi-loculated
thick septations
assoc ascites
name the 3 aspects of the “risk of malignancy” index used to determine referral to gynae cancer team
menopausal status
serum CA125
USS score
Tx ovarian cyst
removal/drainage
Tx maligant ovarian cancer
ovariectomy
hysterecomy
removal of omentum
chemo before or after surgery
what should be established in the menstrual history when screening for ovarian cancer
heaviness
cycle
unscheduled periods
causes of an acute pelvic mass?
cyst accident eg rupture/bleed/torsion fibroid degeneration (red)
what should be checked on examination of an acute pelvic mass?
check for anaemia
cachexic?
chest/breast/node/abdo/V exam
check legs for peripheral oedema
how will ascites from a pelvic mass present?
symmetrical
in flanks
shifting dullness
fluid thrill
how should you describe a pelvic mass (7 things)?
size in cm consistency - soft/firm/craggy surface - smooth/irregular tenderness mobility relation to uterus PoD
Ix acute pelvic mass
Hb WCC/CRP if inflammatory cause suspected biochem esp albumin tumour markers eg CA125, CEA CXR USS TA/TV \+/- MRI for fibroids/uterine mass \+/- CT for suspected ovarian cancer \+/- CT/USS guided biopsy
Tx acute pelvic mass
surgery
laparotomy if cancer
laparoscopic if benign mostly
risk factors for ovarian cysts
pre-menopausal age group
early menarche
first trimester of pregnancy
personal history of infertility or polycystic ovarian syndrome
what controls the growth of fibroids?
hormones
most common distribution of fibroids
intramural
submucosal
DDx well circumscribed mass
METS
describe what “spindle shaped” means
elongated
sausage-like
stretched nucleus
describe what connective tissue looks like histologically
spindle cell-like -> elongated sausage cells
describe the transformation zone of the cervix?
columnar epithelium of the uterus becomes squamous to the external os and vagina
- squamous epithelium is more heavy duty so better for the vagina
difference between a dermoid cyst and a benign teratoma?
dermoid cysts have cystic component - got fluid inside
where does endometriosis tend to spread to?
peritoneum
describe what happens in a complete mole
sperm fertilising an egg with no sex chromosome
egg has no viable DNA
describe what happens in a partial mole
2 sperm fertilising an egg
some development of fetal tissue but wont be normal
describe the karyotype of a partial mole
69 XYY (3 sets of DNA from 2 sperm and 1 egg)
describe the karyotype of a complete mole
46 YY (sperm gives 2 sex chromosomes because egg has none)
a molar pregnancy can become what cancer?
choriocarcinoma
what level is monitored in molar pregnancies
bHCG
Tx molar pregnancy
surgical removal
wait 3 months before another conception while bHCG falls
“sack of grapes” appearance..
molar pregnancy
