Pelvic masses

Question 1

adnexal is in reference to which structures?

Answer 1

ovaries
oviducts
ligaments

Question 2

most functional ovarian cysts regress over what period of time?

Answer 2

1-2 months

Question 3

what is the role of hormonal suppression for ovarian cysts?

Answer 3

not better than waiting, but might prevent new cyst formation

Question 4

when is operative management indicated for an ovarian cyst?

Answer 4

• child with pelvic mass
• reproductive woman with persistent cyst over 6 cm, complex, or symptomatic
• any menopausal woman with persistent or complex mass

Question 5

what are the risks of an ovarian cysts / pelvic masses?

Answer 5

rupture

torsion

Question 6

what are the sequelae of an ovarian rupture?

Answer 6

• pain due to leakage of blood / PGs
• midcycle pain
• hemoperitoneum from ruptured hemorrhagic corpus luteum cyst

Question 7

what is the pathogenesis of an ovarian torsion?

Answer 7

compromised vascular supply - ischemia

Question 8

what is the most common cause of an ovarian torsion?

Answer 8

benign cystic teratoma

Question 9

what is the treatment for an ovarian torsion?

Answer 9

surgical - untwisting vs removal

Question 10

what are the main cell types of origin of ovarian tumors?

Answer 10

epithelial cells

germ cells

Question 11

presentation: sudden onset of extreme pelvic pain

what do you do?

Answer 11

ovarian torsion

color doppler / US

Question 12

what is the most common MALIGNANT ovarian tumor? what is seen on histology?

Answer 12

serous cystadenocarcinoma

psammoma bodies

Question 13

what is the most common malignant tumor among children and adolescents? what are the tumor markers?

Answer 13

dysgerminoma

HCG and LDH

Question 14

what factors (epidemiological, clinical, US) make it more or less likely that a particular ovarian tumor is malignant?

Answer 14

benign:
- unilateral
- cystic
- thin walled
- mobile
- smooth
- no ascites
- slow growth
- younger women

malignant

• bilateral
• solid
• thick walled
• fixed
• irregular
• ascites
• rapid growth
• older women

Question 15

what are the nonovarian gynecologic neoplasms?

Answer 15

• leiomyoma
• endometrial carcinoma
• tubal carcinoma

Question 16

what is a uterine leiomyoma?

Answer 16

proliferation of smooth muscle surrounded by a pseudocapsule of compressed muscle fibers

Question 17

highest prevalence of leiomyoma is in which decade?

Answer 17

5th decade

Question 18

what is the most common indication for hysterectomy?

Answer 18

leiomyoma

Question 19

what are the subcategories of leiomyomas?

Answer 19

• intramural
• subserosal
• submucosal

Question 20

are leiomyomas responsive to hormones? how are they impacted by pregnancy?

Answer 20

yes

pregnancy may induce their growth due to high estrogen

Question 21

what is the most common presenting symptom in a leiomyoma? what is the sensation on exam? what is the cause?

Answer 21

• bleeding
• “lumpy bumpy”
• alteration of normal myometrial contractile function
• inability of overlying endometrium to respond to normal E/P - incomplete sloughing
• pressure necrosis of overlying endometrial bed

Question 22

fibroids are usually diagnosed with which method?

Answer 22

US

sometimes CT / MRI if large enough

Question 23

what are the medical treatments options for fibroids?

Answer 23

• progestins
• high dose NSAIDs or antifibrinolytics
• GnRH agonists

Question 24

what are the surgical treatment options for fibroids?

Answer 24

• myomectomy
• hysterectomy
• endometrial ablation
• myolysis

Question 25

what do progestins do for fibroid treatment?

Answer 25

minimize bleeding

Question 26

what do GnRH agonists do for fibroids?

Answer 26

reduce fibroid size, reduce bleeding, preparation for surgery

Question 27

what is the indication for myomectomy for fibroids?

Answer 27

if patient wants to retain childbearing potential

Question 28

endometrial ablation for fibroids treats what abnormalities?

Answer 28

bleeding abnormalities