Pelvic Mass

Question 1

Give some non-gynaecological causes of a pelvic mass

Answer 1

Constipation
Caecal carcinoma
Appendix/diverticular abscess
Urinary retention

Question 2

Where do gynaecological causes of a pelvic mass arise from?

Answer 2

Uterus (body/cervix)
Tubal
Ovarian

Question 3

What is the most common cause of a uterine mass?

Answer 3

Fibroids

Question 4

What type of tumour are uterine fibroids?

Answer 4

Leiomyomas

Question 5

How can uterine fibroid location be classified?

Answer 5

Pedunculated
Intracavitary
Intramural
Subserous
Submucous

Question 6

How do uterine fibroids commonly present?

Answer 6

Pelvic mass
Menorrhagia
Pressure symptoms (frequency/retention)
Pain/tenderness

Question 7

What is the first-line imaging for suspected fibroids?

Answer 7

USS

Question 8

What imaging can be used to precisely localise suspected fibroids?

Answer 8

MRI

Question 9

How are fibroids treated?

Answer 9

Hysterectomy (if family complete)
Myomectomy
Uterine artery embolisation
Hysteroscopic resection

Question 10

Give some causes of tubal swellings

Answer 10

Ectopic pregnancy
Hydrosalpinx
Pyosalpinx
Paratubal cysts

Question 11

What is the cause of endometriotic cysts?

Answer 11

Growth of endometrium outside the endometrial cavity

Question 12

How do endometriotic cysts on the ovaries classically present?

Answer 12

Chocolate cysts

Question 13

Give some clinical features of endometriotic cysts

Answer 13

Severe dysmenorrhoea
Premenstrual pain
Dyspareunia
Subfertility

Question 14

The most common ovarian tumours arise from what?

Answer 14

Surface epithelium

Question 15

What are the types of primary ovarian tumours that arise from surface epithelium?

Answer 15

Serous
Mucinous
Endometrioid
Clear cell
Brenner

Question 16

A benign ovarian tumour arising from the surface epithelium is known as what?

Answer 16

Cystadenoma

Question 17

A malignant ovarian tumour arising from the surface epithelium is known as what?

Answer 17

Cystadenocarcinoma

Question 18

What is the main primary ovarian tumour arising from germ cells?

Answer 18

Benign cystic teratoma

Question 19

Give examples of primary ovarian tumours arising from the stroma

Answer 19

Granulosa cell tumour

Fibroma

Question 20

Malignant germ cell tumours may produce what?

Answer 20

HCG

AFP

Question 21

Give some clinical features of ovarian cancer

Answer 21

Pelvic mass (not always)
Heartburn
Weight loss
Bloating
Change of bowel habit

Question 22

Mutations in which genes are highly associated with ovarian cancer?

Answer 22

BRCA 1 & 2

Question 23

The oral contraceptive pill leads to increased/decreased risk of ovarian cancer

Answer 23

Decreased

Question 24

Give some important tumour markers of ovarian cancer?

Answer 24

CA-125

CEA

Question 25

Which imaging modality is better for the ovarian cyst itself?

Answer 25

USS

Question 26

Which imaging modality is better for assessing disease outwith the ovary?

Answer 26

CT

Question 27

What is CA-125 a marker of?

Answer 27

Peritoneal inflammation

Question 28

Give some other conditions where CA-125 could be raised

Answer 28

``` Endometriosis Peritonitis Pregnancy Pancreatitis Ascites ```

Question 29

What is the function of CEA as a marker?

Answer 29

To exclude metastases from GI cancer

Question 30

How are benign ovarian cysts treated?

Answer 30

Removal/drainage

Question 31

How are early stage malignant ovarian tumours treated?

Answer 31

Removal of the ovaries