Pelvic Masses Flashcards
List some non-gynaecological causes for a pelvic mass.
constipation, caecal carcinoma, appendix abscess, diverticular abscess
urinary retention
retroperitoneal tumour
ascites (non-gynae cause)
List some gynaecological causes for a pelvic mass.
pregnancy
uterine: benign & malignant
adnexal masses: benign & malignant
A patient presents with a adnexal mass and mentions a FH of breast and prostate cancer. What mutation are you thinking of?
BRCA mutation
Tumour markers for germ cell cancers?
LDH, AFP and HCG
Tumour markers for serosal masses?
Ca125
Which cells produce Ca125?
mesothelial cells
What does RMI include?
menopausal status (pre or post) ultrasound features of ovary serum Ca125
If patient’s RMI >200, what are their chances of ovarian cancer?
3/4
Describe the points system for RMI.
menopausal status: 1 for pre and 3 points for postmenopausal
USS: one feature gets 1 pint and >1 feature gets 3.
Serum 125 is taken by its absolute level
What is the formula for RMI?
menopausal status x USS features x Ca125
If you wanted to identify the contents of an abdominal cyst, which imaging modality would you use?
MRI - able to identify if contents of cyst are solid, fluid, endometrioma, PCOS and if cancer, shows invasion to surrounding structures.
Meig’s syndrome
benign ovarian fibroma associated with ascites ± pleural effusion
Functional ovarian cysts - management?
rarely >5cm, usually resolve spontaneously so expectant management is appropriate.
Often asymptomatic but occasionally menstrual disturbance or pain if rupture or bleeds.
Patient presents with what you suspect as endometriosis. You perform bimanual exam - what do you expect to feel?
Tender mass with modularity and tenderness behind the uterus.
Might not be tolerated by patient due to severe pain
30 y/o nulliparous patient presents with severe period pain which begins before she bleeds and continues through menstruation. She has also recently been having pain during sex.
Diagnosis and treatment?
endometriosis/endometrioma
Medical - GnRH analogues, OCP, NSAIDs for pain
Surgical excision/ablation if she wants to have children and doesn’t want to take OCP.
Ovarian tumours of which type arise from surface epithelium? (benign and malignant)
serous mucinous endometrioid brenner clear cell
Name for benign cystic teratoma?
dermoid cyst
Tumours arising from granulosa cell might secrete what?
oestrogen
Tumours arsing from theca/leydig cells may secrete what?
androgens
Ovaries are a common site of metastatic disease. Which primary tumours often metastasises there?
breast, pancreas, stomach, GI
Patient has metastasis of their primary cancer to their ovaries. Histology shows characteristic signet ring cells - where is the primary tumour?
usually stomach
= Kruckenberg tumour
40 y/o woman presents with intermenstrual bleeding, painful periods and backache. Abdomen is slightly tender on palpation in centre but main finding is on bimanual palpation when you feel a small mass in the posterior uterus.
Diagnosis and treatment options?
uterine fibroids - leiomyoma
medical - GnRH analogue, Mirena coil, progestins (ullipristal acetate max 3 months use; norethisterone tablets temporary stop to excessive menstrual bleeding)
surgical - laparoscopic myomectomy
List some of the presentations of ovarian cancer.
heartburn/indigestion early satiety weight loss/anorexia bloating 'pressure' symptoms (esp. bladder) change of bowel habit SOB/pleural effusion leg oedema or DVT
Does a normal level of Ca125 exclude cancer?
No normal level does not exclude cancer
