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Reproduction and Sexual Health > pelvic + ovarian masses > Flashcards

pelvic + ovarian masses Flashcards

1
Q

what is a functional cyst?

A
  • cyst related to ovulation
  • rarely >5cm
  • usually resolve spontaneously
  • often asymptomatic/incidental finding
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2
Q

when is a functional cyst considered a differential?

A
  • in acute abdomen
  • as they can bleed or rupture
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3
Q

how does an endometriotic cyst present?

A
  • severe dysmenorrhea/premenstrual pain
  • dyspareunia
  • assoc w sub-fertility
  • occasionally asympomatic
    -> acute abdomen ddx if it ruptures
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4
Q

endometriotic cyst findings on examination?

A
  • tender mass w modularity
  • tenderness behind uterus
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5
Q

dermoid cyst is described as totipotential what does this mean?

A
  • cells that can give rise to cells of all types
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6
Q

what kind of contents can be in a dermoid cyst?

A
  • teeth
  • sebaceous material
  • hair
  • thyroid tissue -> thyrotoxicosis
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7
Q

what is the treatment of benign ovarian tumours?

A
  • conservative
  • medical - GNRH analogues, OCP
  • surgical - laparoscopic/laparotomy
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8
Q

what are some different surgical options for benign ovarian tumours

A
  • ovarian cystectomy
  • unilateral oophorectomy
  • bilateral oophorectomy
  • pelvic clearance
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9
Q

what is the role of GNRH analogues in the treatment of ovarian tumours?

A
  • GnRH is a hormone produced by hypothalamus that stimulates production of FSH and LH
  • it is also involved in regulation of proliferation and mets of ovarian cancer
  • GnRH acts directly on GnRH receptors on surface of ovarian cancer cells
  • GnRH analogues block release of gonadotrophins - therefore suppressing ovarian growth/proliferation
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10
Q

in borderline ovarian tumours in young women what is typical tx?

A
  • unilateral cystectomy/oopherectomy w close follow up
  • laparoscopic techniques - avoid laparotomy
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11
Q

in borderline ovarian tumours in postmenopausal women what is typical tx?

A
  • pelvic clearance
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12
Q

what is in the anterior compartment of the pelvis?

A
  • bladder
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13
Q

what is in the middle compartment of the pelvis?

A
  • uterus
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14
Q

what is in the posterior compartment of the pelvis?

A
  • bowel
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15
Q

what is in the lateral compartment of the pelvis?

A
  • adnexae
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16
Q

name some types of tubal masses?

A
  • hydrosalpinx, ectopic px, tuboovarian abscess
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17
Q

what is the top DDx for pelvic masses?

A
  • pregnancy
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18
Q

name some other ddx for pelvic masses other than pregnancy?

A
  • bladder tumours
  • bladder distension
  • uterine fibroids
  • adenomyosis
  • carcinosarcoma
  • leiomyosarcoma
  • cervical cancer - hematometra/pyometra
  • ovarian mass - benign or malignant
  • tubal mass
  • bowel tumour
  • appendiceal mass
  • hernia
  • diverticular abscess
  • pelvic kidney
  • ascitis
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19
Q

in a women presenting with bleeding as main symptom where is origin?

A
  • uterine
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20
Q

in a women presenting with pain as main symptom where is origin?

A
  • ovarian
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21
Q

in a women presenting with pressure symptoms as main symptom where is origin?

A
  • uterine or ovarian
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22
Q

long term symptoms (months/years) in a women w a pelvic mass what does this usually mean?

A
  • benign aetiology
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23
Q

short term symptoms (weeks) in a women w pelvic mass what does this usually mean?

A
  • acute aetiology
  • examples inlcude torsion, rupture, haemorrhage
24
Q

women presenting w possible pelvic mass, doubling pain with nausea indicates what kind of scenario?

A
  • acute scenario
  • seek help immediately!
25
Q

a midline, lobulated mass, moves w cervical motion, non-tender is situated where?

A
  • uterine origin
26
Q

lateral, occupying fornices, no movement w cervical motion, can be tender is located where?

A
  • ovarian origin
27
Q

smooth, mobile mass can suggest what?

A
  • benign mass
28
Q

cachexia, ascites, craggy mass, not mobile can suggest what kind of pathology?

A
  • malignant
29
Q

tender abdomen, rebound tenderness, guarding, exquisite cervical excitation can suggest what?

A
  • acute presentation
30
Q

38 year old women, pelvic mass, long standing menorrhagia

O/E midline mass, 16 weeks size, moves w cervical motion and non-tender on examination?

A
  • uterine fibroids
    -> uterine origin due to description of mass…
31
Q

38 year old women, pelvic mass, pain on RS assoc w dyspareunia and dysmenorrhoea

O/E 6cm mass in right fornix, does not move w cervical motion

A
  • adnexal mass (area next to uterus)
32
Q

what imaging is recommended for suspected ovarian masses?

A
  • USS
33
Q

what imaging is recommended for fibroids?

A
  • MRI
34
Q

what invesitgations is recommended for premenopausal ovarian cysts?

A
  • MRI, tumour markers CA125 and AFP, HCG, LDH
35
Q

what investigations is recommended for postmenopausal ovarian masses?

A
  • CT and CA125
36
Q

38 y/o women, pelvic mass, RS pain, dyspareunia, dysmenorrhoea

2 days - more intermittment, more pain, and nauseus

O/E tender in RIF, rebound tenderness, 6cm mass in R fornix, does not move w cervical motion, cervical exciation present

A
  • adnexal mass - acute mass
37
Q

what benign conditions can CA125 be raised?

A
  • endometriosis
  • benign ovarian cysts
  • uterine leiomyomata (fibroids)
38
Q

why is CA125 tumour marker important

A
  • can indicate ovarian cancer
  • if >35 IU/ml or above usually recommended US of pelvis
39
Q

what other tumour markers are important in women <40 when Ix a pelvic mass?

A
  • AFP - raised in embryonal carcinoma
  • HCG - raised in choriocarcinoma
  • LDH - raised in dysgerminoma
40
Q

what can a raised AFP indicate?

A
  • embryonal carcinoma
41
Q

what can a raised HCG indicate?

A
  • choriocarcinoma
42
Q

what can a raised LDH indicate?

A
  • dysgerminoma
43
Q

name some malignant features present on USS?

A
  • irregular solid tumour M1
  • presence of ascites M2
  • at least 4 papillary structures M3
  • irregular multilocular-solid tumour w largest tumour > 100mm M4
  • very strong blood flow M5
44
Q

what is RMI?

A
  • risk of malignancy index
  • useful to estimate risk of malignancy
  • based on CA125, menopausal status, US score

1 point for:
- multi-locular cysts
- solid areas
- metastases
- ascites
- bilateral lesions

45
Q

how do you calculate RMI?

A

RMI = U x M x CA-125

46
Q

what is some benign features on USS?

A
  • unilocular cysts
  • presence of solid components where largest solid component < 7mm
  • presence of acoustic shadowing
  • smooth multi-locular tumour w largest diameter - <100mm
  • no blood flow
47
Q

what is mx for pre-menopausal simple cyst 30-50mm?

A
  • likely physiological, do not require follow up
  • almost always resolve within 3 cycles
48
Q

what is mx for pre-menopausal women w simple ovarian cyst 50-70mm?

A
  • yearly US follow up
49
Q

what is the mx for pre-menopausal wojmen w larger simple cyst?

A
  • consider MRI or surgical intervention
50
Q

mx for endometrioma?

A
  • laparoscopic cystecomty
51
Q

what are the 3 types of fibroids/leiomyomas?

A
  • subserosal
  • intramural
  • submucosal -> smooth muscle tumours, usually benign
52
Q

where are intramural fibroids located?

A
  • are located within uterine wall
  • become transmural fibroids - when they span from outer serosal surface through uterine wall all the way to endometrium
  • assoc w reduced fertility outcomes
53
Q

where are submucosal fibroids located?

A
  • intramural fibroid where part of fibroid projects into uterine cavity and another part in myometrium
  • grow just underneath uterine lining (endometrium) can reduce embryo implantation
54
Q

where are subserosal fibroids located?

A
  • grow on outside of uterus
  • fewer reproductive consequences because of this
  • however some can put pressure on abdomen, bladder, or rectum (fullness ie pregnancy symptoms, bloating, pelvic pressure, urinary urgency, or constipation)
55
Q

suspect metastatic ovarian masses if CA125/CEA is below?

A

<25

Reproduction and Sexual Health (29 decks)

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