Pelvic Masses

Question 1

List non-gynae causes of pelvic mass

Answer 1

Bowel (constipation, caecal carcinoma, appendix abscess, diverticular abscess)
Bladder/urological (urinary retention, pelvic kidney)
Other e.g. retroperitoneal tumour

Question 2

List gynae causes of pelvic mass

Answer 2

Uterine body
Cervix
Tubal and paratubal
Ovary

Question 3

List causes of uterine pelvic mass

Answer 3

Fibroids
Endometrial cancer (usually PMB)
Cervical cancer (usually renal failure, bleeding, pain)

Question 4

What is the commonest pelvic mass in females?

Answer 4

Fibroids (leiomyomas)

Benign smooth muscle tumours

Question 5

List clinical features of uterine fibroids

Answer 5

Asymptomatic
Menorrhagia
Pelvic mass
Pain/tenderness
Pressure symptoms

Question 6

Which investigations are appropriate if uterine fibroids are suspected?

Answer 6

Hb levels if heavy bleeding
Ultrasound usually diagnostic (smooth mass)
MRI for further localisation

Question 7

What is the treatment for uterine fibroids?

Answer 7

Nothing if asymptomatic
Hysterectomy if family complete
Myomectomy
Uterine artery embolisation
Hysteroscopic resection

Question 8

List some causes of fallopian tube swellings

Answer 8

Ectopic pregnancy
Hydrosalpinx: dilated fallopian tube due to obstruction
Pyosalpinx: dilated fallopian tube due to pus
Paratubal cysts

Question 9

What finding on USS would suggest ectopic pregnancy?

Answer 9

Adnexal mass on USS

Question 10

List types of ovarian mass

Answer 10

Benign tumours
Malignant tumours
Functional cysts
Endometriotic cysts

Question 11

List clinical features of functional cysts

Answer 11

Related to ovulation (follicular, luteal)
Asymptomatic
Menstrual disturbance
Bleeding and pain if rupture

Question 12

What is endometriosis?

Answer 12

Endometrial tissue in the wrong place (outwith uterus)

Question 13

What is the typical appearance of endometriosis on the ovary on ultrasound? (buzzword)

Answer 13

Endometriomas/”chocolate cysts” filled with blood

Question 14

List clinical features of endometriosis

Answer 14

Severe dysmenorrhoea
Premenstrual pain
Dyspareunia
Tender mass with nodularity
Tenderness behind uterus

Question 15

List the main primary ovarian tumours that arise from surface epithelium

Answer 15

Serous
Mucinous
Endometrioid
Clear cell
Brenner

Question 16

List the main primary ovarian tumours that arise from germ cells

Answer 16

Teratoma
Yolk sac tumour
Malignant germ cell tumour

Question 17

What is the commonest benign ovarian tumour?

Answer 17

Dermoid cyst (teratoma)

Question 18

How does a teratoma appear on XRAY?

Answer 18

Rim calcification
Fat inside
Tooth-like calcification

Question 19

What markers may be produced by malignant germ cell tumours?

Answer 19

HCG

AFP

Question 20

What can be some weird features of teratoma and why?

Answer 20

Teeth or hair growing where it shouldn’t

These are germ cell tumours derived from pleuripotent cells that can differentiate into anything

Question 21

List clinical features of ovarian cancer

Answer 21

Ascites/bloating
Pelvic mass
Bladder or bowel dysfunction
Pleural effusion
Breathlessness
Weight loss
Leg oedema or DVT

Question 22

Which genetic mutations increase the risk of ovarian cancer?

Answer 22

BRCA mutations (1 and 2)
Lynch mutations (HNPCC)

Question 23

List risk factors for ovarian cancer

Answer 23

Increasing age
Nulliparity
Family history

Question 24

Which investigations are appropriate if ovarian cancer is suspected?

Answer 24

Tumour markers
USS to determine nature of cyst
CT for identifying mets outwith the ovary

Question 25

What tumour markers should be investigated for if there is suspected ovarian cancer?

Answer 25

Ca 125

Carinoembryonic antigen

Question 26

Normal levels of Ca 125 exclude ovarian cancer. True/False?

Answer 26

False

Question 27

Measuring CEA is used to exclude what kind of ovarian cancer?

Answer 27

Exclude secondary metastasis from GI system

Question 28

What is the “risk of malignancy index” calculation for diagnosing ovarian cancer?

Answer 28

Menopausal status x serum Ca 125 x ultrasound score

If elevated, refer to gynae team

Question 29

How are ovarian cysts treated?

Answer 29

Removal or drainage if benign
Removal of ovaries +/- uterus +/- omentum
Chemotherapy prior to surgery
Cure unlikely unless confined to ovary