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3 Reproduction and Sexual Health > Pelvic Mass > Flashcards

Pelvic Mass Flashcards

1
Q

bowel causes of a pelvic mass?

A

constipation
caecal carcinoma
appendiceal abscess
diverticular abscess

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2
Q

urological causes of a pelvic mass?

A

urinary retention

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3
Q

commonest non-physiological cause of a uterine mass?

A

fibroids

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4
Q

why is cancer most likely to not present with a pelvic mass?

A

usually get other symptoms eg abnormal bleeding first then a mass is a late sign

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5
Q

fibroids are benign tumour of what?

A

smooth muscle (leimyoma)

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6
Q

what age group are fibroids most common in?

A

> 40s

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7
Q

how big on average are fibroids?

A

a few cm

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8
Q

name the 3 types of intramural fibroid; where do they lie?

A

intramural - completely in the wall
submucous - projects out into the cavity
subserous - projects to the outside

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9
Q

a fibroid in the uterine cavity is called?

A

intracavitary fibroid

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10
Q

a fibroid found hanging off the outside of the uterus by a stalk is called…

A

pedunculated

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11
Q

presentation of uterine fibroids?

A 
asymptomatic
menorrhagia
pelvic mass
pain/tenderness
pressure symptoms
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12
Q

Ix fibroids?

A

Hb if heavy bleeding
USS first line
MRI for precise localisation

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13
Q

what does USS show if a fibroid is present?

A

smooth echogenic mass

sometimes multiple

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14
Q

Tx fibroids

A 
watchful waiting if asymptomatic
hysterectomy if family complete
consider:
myomectomy
uterine artery embolisation
hysteroscopic resection
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15
Q

hydrosalpinx/pyosalpinx is often longstanding

A

hydrosalpinx

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16
Q

pyosalpinx has an acute inflammatory presentation T or F

A

T

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17
Q

what are paratubal cysts? what do they look like?

A

embryological remnants

small and incidental

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18
Q

if an ovarian mass is not a tumour, what is it?

A

a cyst

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19
Q

name the 2 main categories of cyst that cause pelvic masses

A

functional cysts

endometriotic cysts

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20
Q

cause of functional cysts

A

ovulation-related

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21
Q

how big are functional cysts?

A

small, dont usually get >5cm

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22
Q

presentation of functional cysts

A

asymptomatic mostly

can be menstrual disturbance/pain

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23
Q

Tx functional cysts

A

watchful waiting

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24
Q

what happens if a fibroid undergoes red degeneration? when does it happen?

A

usually in pregnancy and menopause

caused by fibroid outgrowing its blood supply/blood supply cut off

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25
Q

what are endometriotic cysts?

A

blood filled “chocolate cysts” on ovaries associated with endometriosis

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26
Q

presentation of endometriotic cysts

A 
asymptomatic
severe dysmenorrhoea
premenstrual pain
dyspareunia
subfertility
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27
Q

signs of endometriotic cysts on exam?

A

tender mass with nodularity and tenderness behind uterus

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28
Q

a BENIGN ovarian tumour arising from surface epithelium is called…

A

a cystadenoMa

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29
Q

a MALIGNANT ovarian tumour arising from surface epithelium is called…

A

a cystadenoCa

30
Q

name the 5 types of ovarian tumour from surface epithelium?

A 
serous
mucinous
endometrioid
clear cell
brenner
31
Q

most common germ cell ovarian tumour? is it benign or malignant?

A

benign cystic teratoma

32
Q

what kind of ovarian tumour can cause oversecretion of oestrogens? where can it arise from?

A

granulosa cell tumour from the stroma

33
Q

what kind of ovarian tumour can secrete androgens?

A

theca/leydig cell

34
Q

triad of benign ovarian fibroma with ascites and pleural effusion….

A

meig’s syndrome

35
Q

what can a malignant germ cell ovarian tumour produce?

A

HCG (false positive pregnancy test)

AFP

36
Q

oestrogens produced by a tumour may cause what symptoms?

A

post menopausal bleeding

precocious puberty

37
Q

what primary cancers can metastasise to the ovary?

A

breast
pancreas
stomach
GI

38
Q

what is a dermoid cyst? is it benign?

A

a benign teratoma containing embryological hair, teeth and sebaceous cells

39
Q

presentation of ovarian cancer?

A 
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
40
Q

genetic causes of ovarian cancer?

A

BRCA 1 and 2

lynch syndrome

41
Q

risk factors for ovarian cancer?

A

age
nulliparity
FH

42
Q

Ix ovarian cancer

A

serum CA125
carcino-embryonic antigen (CEA)
USS - for cyst
CT - for mets/LNs

43
Q

if CA125 is negative cancer is excluded T or F

A

F

44
Q

main function of the CEA test?

A

exclude mets from GI primary cancer

45
Q

presentation of ovarian cancer on USS?

A

complex mass- solid + cystic lesions
multi-loculated
thick septations
assoc ascites

46
Q

name the 3 aspects of the “risk of malignancy” index used to determine referral to gynae cancer team

A

menopausal status
serum CA125
USS score

47
Q

Tx ovarian cyst

A

removal/drainage

48
Q

Tx maligant ovarian cancer

A

ovariectomy
hysterecomy
removal of omentum
chemo before or after surgery

49
Q

what should be established in the menstrual history when screening for ovarian cancer

A

heaviness
cycle
unscheduled periods

50
Q

causes of an acute pelvic mass?

A 
cyst accident eg rupture/bleed/torsion
fibroid degeneration (red)
51
Q

what should be checked on examination of an acute pelvic mass?

A

check for anaemia
cachexic?
chest/breast/node/abdo/V exam
check legs for peripheral oedema

52
Q

how will ascites from a pelvic mass present?

A

symmetrical
in flanks
shifting dullness
fluid thrill

53
Q

how should you describe a pelvic mass (7 things)?

A 
size in cm
consistency - soft/firm/craggy
surface - smooth/irregular
tenderness
mobility
relation to uterus
PoD
54
Q

Ix acute pelvic mass

A 
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
55
Q

Tx acute pelvic mass

A

surgery
laparotomy if cancer
laparoscopic if benign mostly

56
Q

risk factors for ovarian cysts

A

pre-menopausal age group
early menarche
first trimester of pregnancy
personal history of infertility or polycystic ovarian syndrome

57
Q

what controls the growth of fibroids?

A

hormones

58
Q

most common distribution of fibroids

A

intramural

submucosal

59
Q

DDx well circumscribed mass

A

METS

60
Q

describe what “spindle shaped” means

A

elongated
sausage-like
stretched nucleus

61
Q

describe what connective tissue looks like histologically

A

spindle cell-like -> elongated sausage cells

62
Q

describe the transformation zone of the cervix?

A

columnar epithelium of the uterus becomes squamous to the external os and vagina
- squamous epithelium is more heavy duty so better for the vagina

63
Q

difference between a dermoid cyst and a benign teratoma?

A

dermoid cysts have cystic component - got fluid inside

64
Q

where does endometriosis tend to spread to?

A

peritoneum

65
Q

describe what happens in a complete mole

A

sperm fertilising an egg with no sex chromosome

egg has no viable DNA

66
Q

describe what happens in a partial mole

A

2 sperm fertilising an egg

some development of fetal tissue but wont be normal

67
Q

describe the karyotype of a partial mole

A

69 XYY (3 sets of DNA from 2 sperm and 1 egg)

68
Q

describe the karyotype of a complete mole

A

46 YY (sperm gives 2 sex chromosomes because egg has none)

69
Q

a molar pregnancy can become what cancer?

A

choriocarcinoma

70
Q

what level is monitored in molar pregnancies

A

bHCG

71
Q

Tx molar pregnancy

A

surgical removal

wait 3 months before another conception while bHCG falls

72
Q

“sack of grapes” appearance..

A

molar pregnancy

3 Reproduction and Sexual Health (51 decks)

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