Pelvic masses Flashcards
Go over this pic of the main structures of the pelvis
What are some of the non-gynaecological causes of pelvic masses ?
Bowel:
- Constipation!
- Caecal carcinoma - colon cancer at the caecum area
- Appendix abscess
- Diverticular abscess
Bladder/Urological.
- Urinary retention
- (pelvic kidney)
Other:
e.g. retroperitoneal tumour.
What are some of the gynaecological origins of pelvic masses ?
- Uterine - body, cervix
- Uterine Tubes
- Ovarian
What are the uterine causes of pelvic masses ?
- Pregnancy!
- Uterine fibroids.
- Endometrial cancer
- Cervical cancer
What is the commonest cause of uterine pelvic masses ?
Uterine fibroids (remember that uterine fibroids are very common)
Endometrial and cervical cancers are common causes of pelvic masses - T or F?
False
- Endometrial cancer usually presents with postmenopausal bleeding and therefore is picked up then so unusual to be at the stage where it is large enough to produce a mass
- Cervical cancer - this would also be a late presentation of cervical cancer so unlikely as usually picked up in screening or vaginal bleeding etc would have resulted in it being picked up
What are uterine fibroids ?
They are benign smooth muscle tumours of the uterus also known as leiomyomas
Who do uterine fibroids typically occur in ?
Women >40
How big can uterine fibroids become ?
Usually few cm, but may be much bigger & multiple - A very large uterine fibroid can cause the uterus to expand to the size of a 6 or 7 month pregnancy
Pic shows large uterine fibroids
What are the typical presenting features of uterine fibroids ?
Many are asymptomatic
Others may have the following symptoms:
- Menorrhagia - they often produce heavy and prolonged periods (dont generally cause intermenstrual or postmenopausal bleeding)
- Pelvic mass
- Pain/tenderness
- Pelvic Pressure
- Urinary and bowel symptoms - freq urination, difficulty emptying bladder, constipation
- May cause fertility problems
What is red degeneration of fibroid ?
It is a rare complication where thrombosis of fibroid vessels occurs followed by venous engorgement an inflammation, causing severe abdo pain +/- vomiting and low grade fever, and localised peritoneal tenderness usually occuring in the last half of pregnancy or 6 months following childbirth (puerperium)
What is the typical presentation of a uterine fibroid felt on pelvic exammination?
- A firm, enlarged, and irregularly shaped non-tender uterus is characteristic of uterine fibroids.
- The mass can be moved slightly from side-to-side.
How are uterine fibroids diagnosed ?
- 1st line = Transvaginal ultrasound - showing a smooth echogenic (lighter colour) mass which is often multiple
- 2nd line = hysteroscopy
Firboid in pic is indicated
What is the pharmacological treatment symptoms of uterine fibroids in terms of:
- Red degeneration
- Menorrhagia + fibroid < 3cm
Red degernation requires painkiller and usually settles down
Menorrhagia:
- 1st line = mierena IUS
- 2nd line = tranexamic acid (not mefenamic acid as shown to be ineffective) think good for pain
- 3rd line = Combined pill or other homronals (progestogens also shown to be ineffective)
Need to try at least 2 medical ones before surgery
What is the treatment required for most people with uterine fibroids ?
None - usually asymptomatic
What is the surgical options for uterine fibroids that could be considered if pharmacological management doesnt work or for those with menhorragia + fibroids > 3cm?
- Hysterectomy — complete removal of the uterus. This is the most successful treatment - if completed family
- 1st Myomectomy,2nd uterine artery embolization — these are both uterine sparing surgeries. - if not completed family
What are the causes of tubual swellings resulting in a pelvic mass ?
Ectopic pregnancy: (covered in another lecture)
- Emergeny +IPT/empty uterus/pain/bleeding
- May detect adnexal mass on USS - need to do the 2 pregnancy tests 48hrs apart to diagnose
Hydrosalpinx:
- Often longstanding/incidental
Pyosalpinx:
- Acute/inflammatory
Paratubal Cysts:
- Usually small & incidental (embryological remnants)
What are some of the causes of ovarian masses resulting in pelvic masses ?
Tumours/Neoplastic:
- Benign
- Malignant
or
Not tumours:
- ‘Functional’ cysts
- Endometriotic cysts.
What is the treatment of benign ovarian cysts/masses ?
Removal or drainage if likely benign
Malignant treatment covered in ovarian cancer lecture
What is pyosalpnix and what is it caused by?
A condition in which the fallopian tube fills up and swells with pus.
Due to untreated PID which in turn is caused commonly by chlamydia and gonorrhoea
What are the symptoms potentially caused by pyosalpinx ?
- pain in the lower belly that is constant, or that comes and goes
- painful lump in the lower belly
- pain before your periods
- fever
- pain during sex
