Pelvic Masses & Fibroids

Question 1

Diagnostic features of pelvic masses

Answer 1

Size Shape
Consistency Mobility
Position Tenderness

Question 2

The Five ‘F’s of pelvic masses

Answer 2

Fat Flatus
Fluid Fetus
Fibroids

Question 3

Fibroids

Answer 3

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

Question 4

Fetus

Answer 4

Pregnancy is No. 1 cause of secondary amenorrhoea

Always check the urine hCG

Question 5

Fluid

Answer 5

Can be gynae (ovarian hyperstimulation) or non-gynae (ascities)

Question 6

Ovarian Hyperstimulation

Answer 6

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

Question 7

Vaginal masses (3)

Answer 7

Mucocolpos (mucus in the vagina)
Gartner’s Duct cyst
Neoplasm

Question 8

Uterine Masses (7)

Answer 8

Pregnancy Round ligament tumours
Fibroids Neoplasm
Adenomyosis Congenital abnormalities
Haematometra/pyometra

Question 9

Tubal Masses (6)

Answer 9

Para-ovarian cyst Tubo-ovarian abscess
Ectopic Hydrosaplinx
Torsion Tubal carcinoma

Question 10

Ovarian Masses (5)

Answer 10

Follicular cysts PCOS
Corpus Luteum Cysts Endometrioma
Ovarian Abscesses

Question 11

Definition of Fibroids

Answer 11

Most common benign tumours of myometrium (AKA myomas or leiomyomas)
Composed of whorls of smooth muscle and fibrous tissue
Rarely malignant (leiomyosarcoma)

Question 12

Incidence of Fibroids

Answer 12

20-40% of women of reproductive age
Highest in black populations
strong Family tendency

Question 13

Aetiology of Fibroids

Answer 13

Growth is Estrogen and progesterone dependent
Regress and degenerate after the menopause
Increase in size during pregnancy

Question 14

Classification of fibroids

Answer 14

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

Question 15

Clinical signs of fibroids

Answer 15

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

Question 16

Fibroids in pregnancy

Answer 16

usually increase in size

Can outgrow their blood supply leading to red degeneration which can cause pain and a raised WCC/CRP

Question 17

Management of fibroids

Answer 17

Similar to management of HMB
If asymptomatic do nothing
Medical, surgical or interventional

Question 18

Medical Management of fibroids

Answer 18

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

Question 19

Surgical management of fibroids

Answer 19

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

Question 20

Uterine artery embolisation

Answer 20

Can cause fibroid regression but there is a risk of inferility and recurrence.
Avoids GA and faster recovery, good for JW

Question 21

What is a pyrometra?

Answer 21

Collection of pus in uterine cavity

Principally in stenosed os or malignancy of internal gynae organs/ radiotherapy