Pelvic Masses Flashcards
List non-gynae causes of pelvic mass
Bowel (constipation, caecal carcinoma, appendix abscess, diverticular abscess)
Bladder/urological (urinary retention, pelvic kidney)
Other e.g. retroperitoneal tumour
List gynae causes of pelvic mass
Uterine body
Cervix
Tubal and paratubal
Ovary
List causes of uterine pelvic mass
Fibroids Endometrial cancer (usually PMB) Cervical cancer (usually renal failure, bleeding, pain)
What is the commonest pelvic mass in females?
Fibroids (leiomyomas)
Benign smooth muscle tumours
List clinical features of uterine fibroids
Asymptomatic Menorrhagia Pelvic mass Pain/tenderness Pressure symptoms
Which investigations are appropriate if uterine fibroids are suspected?
Hb levels if heavy bleeding
Ultrasound usually diagnostic (smooth mass)
MRI for further localisation
What is the treatment for uterine fibroids?
Nothing if asymptomatic Hysterectomy if family complete Myomectomy Uterine artery embolisation Hysteroscopic resection
List some causes of fallopian tube swellings
Ectopic pregnancy
Hydrosalpinx: dilated fallopian tube due to obstruction
Pyosalpinx: dilated fallopian tube due to pus
Paratubal cysts
What finding on USS would suggest ectopic pregnancy?
Adnexal mass on USS
List types of ovarian mass
Benign tumours
Malignant tumours
Functional cysts
Endometriotic cysts
List clinical features of functional cysts
Related to ovulation (follicular, luteal)
Asymptomatic
Menstrual disturbance
Bleeding and pain if rupture
What is endometriosis?
Endometrial tissue in the wrong place (outwith uterus)
What is the typical appearance of endometriosis on the ovary on ultrasound? (buzzword)
Endometriomas/”chocolate cysts” filled with blood
List clinical features of endometriosis
Severe dysmenorrhoea Premenstrual pain Dyspareunia Tender mass with nodularity Tenderness behind uterus
List the main primary ovarian tumours that arise from surface epithelium
Serous Mucinous Endometrioid Clear cell Brenner
List the main primary ovarian tumours that arise from germ cells
Teratoma
Yolk sac tumour
Malignant germ cell tumour
What is the commonest benign ovarian tumour?
Dermoid cyst (teratoma)
How does a teratoma appear on XRAY?
Rim calcification
Fat inside
Tooth-like calcification
What markers may be produced by malignant germ cell tumours?
HCG
AFP
What can be some weird features of teratoma and why?
Teeth or hair growing where it shouldn’t
These are germ cell tumours derived from pleuripotent cells that can differentiate into anything
List clinical features of ovarian cancer
Ascites/bloating Pelvic mass Bladder or bowel dysfunction Pleural effusion Breathlessness Weight loss Leg oedema or DVT
Which genetic mutations increase the risk of ovarian cancer?
BRCA mutations (1 and 2) Lynch mutations (HNPCC)
List risk factors for ovarian cancer
Increasing age
Nulliparity
Family history
Which investigations are appropriate if ovarian cancer is suspected?
Tumour markers
USS to determine nature of cyst
CT for identifying mets outwith the ovary
