Pelvic Masses & Fibroids Flashcards
Diagnostic features of pelvic masses
Size Shape
Consistency Mobility
Position Tenderness
The Five ‘F’s of pelvic masses
Fat Flatus
Fluid Fetus
Fibroids
Fibroids
40% in south london - much higher incidence in African populations
Can present in a variety of ways - treatments depends on symptoms
Can be Subserosal, submucosal or intramural
Fetus
Pregnancy is No. 1 cause of secondary amenorrhoea
Always check the urine hCG
Fluid
Can be gynae (ovarian hyperstimulation) or non-gynae (ascities)
Ovarian Hyperstimulation
A serious complication of stimulation of ovulation characterised by acute inflammation and raised CRP - up to 20 follicles grow and there is massive estrogen release - can be critical or fatal
Occurs to some extent in 1/3 of IVF cycles
Vaginal masses (3)
Mucocolpos (mucus in the vagina)
Gartner’s Duct cyst
Neoplasm
Uterine Masses (7)
Pregnancy Round ligament tumours
Fibroids Neoplasm
Adenomyosis Congenital abnormalities
Haematometra/pyometra
Tubal Masses (6)
Para-ovarian cyst Tubo-ovarian abscess
Ectopic Hydrosaplinx
Torsion Tubal carcinoma
Ovarian Masses (5)
Follicular cysts PCOS
Corpus Luteum Cysts Endometrioma
Ovarian Abscesses
Definition of Fibroids
Most common benign tumours of myometrium (AKA myomas or leiomyomas)
Composed of whorls of smooth muscle and fibrous tissue
Rarely malignant (leiomyosarcoma)
Incidence of Fibroids
20-40% of women of reproductive age
Highest in black populations
strong Family tendency
Aetiology of Fibroids
Growth is Estrogen and progesterone dependent
Regress and degenerate after the menopause
Increase in size during pregnancy
Classification of fibroids
Intramural –> in the myometrium
Pedunculated –> on a mobile stalk which can tort
Submucous –> project into the uterine cavity
Subserous –> outside the contours of the uterus
Clinical signs of fibroids
50% are incidental, asymptomatic findings
Can have heavy menstral bleeding with submucosal or intramural fibroids (or dysmenorrhoea rarely)
Anaemia or Dyspareunia with cervical fibroids
Pressure symptoms , impair implanation –>subfertility
Fibroids in pregnancy
usually increase in size
Can outgrow their blood supply leading to red degeneration which can cause pain and a raised WCC/CRP
Management of fibroids
Similar to management of HMB
If asymptomatic do nothing
Medical, surgical or interventional
Medical Management of fibroids
Non-hormonal –> treat anaemia or NSAIDs if painful or tranexamic acid (50% reduction in menorrhagia)
Hormonal –> COC, progestogens day 5-26 for symptomatic relief, GnRH analogues induce amenorrhoea but can only be used for 3mths due to bone thinning
Mirena coil
Surgical management of fibroids
Laproscopic or open myomectomy but this can cause intrauterine adhesions and fibroids can reoccur
Operative hysteroscopy –> useful for 3-5cm submucosal fibroids, 70-85% relief of symptoms for 15 yrs.
hysterectomy is curative
Uterine artery embolisation
Can cause fibroid regression but there is a risk of inferility and recurrence.
Avoids GA and faster recovery, good for JW
What is a pyrometra?
Collection of pus in uterine cavity
Principally in stenosed os or malignancy of internal gynae organs/ radiotherapy
