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Week 6-pelvic mass Flashcards

1
Q

Name some non-gynaelogical causes of pelvic mass?

A

Bowel- constipation, caecal carcinoma, appendix abscess, diverticular abscess

Bladder-Urinary retention, pelvic kidney

Other- retroperitoneal tumour.

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2
Q

What are some causes of uterine masses?

A

Pregnancy Fibroids (commonest)

Endometrial cancer- usually presents early PMB therefore pelvic mass is unusual.

Cervical cancer- only in late presentation +/- renal failure, bleeding and pain.

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3
Q

What is the other name for uterine fibroids?

A

Leiomyomas- benign smooth muscle tumours.

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4
Q

Who gets uterine fibroids?

A

They are very common, especially in the over 40’s.

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5
Q

This is how uterine fibroids are classified.

A
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6
Q

How do uterine fibroids present?

A

May be asymptomatic/incidental finding

or

Menorrhagia

Pelvic mass

Pain and tenderness- not usually disproportionate. This usually only happens if something compromises the blood supply e.g. in pregnancy or menopause- called red degeneration.

Pressure symptoms e.g. press on the bladder. Present with nocturia, frequency and pressure.

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7
Q

How would you investigate suspected fibroids?

A

Hb if heavy bleeding

Ultrasound is usually diagnostic- seeing a smooth echogenic mass-often multiple.

MRI to precisely locate.

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8
Q

Fibroid on MRI

A

Multiple fibroids on MRI

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9
Q

How would you treat fibroids?

A

Expectant if they are asymptomatic.

Otherwise traditionally do hysterectomy if the family is complete.

Alternatively-

  • myomectomy (remove the fibroid)
  • Uterine artery embolisation (disrupt their blood supply)
  • Hysteroscopic resection
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10
Q

What are some causes of tubal swellings?

A

Ectopic pregnancy

Hydrosalpinx

Pyosalpinx

Paratubal cysts.

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11
Q

What symptoms/signs would be present in an ectopic pregnancy?

A

Empty uterus

Pain

Bleeding

May detect adenexal mass on USS.

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12
Q

What is hydrosalpinx?

A

A distally blocked fallopian tube with serous or clear fluid. The blocked tube may become substantially distended giving it a sausage like appearence.

It can be longstanding or acute. Usually due to pelvic infection- mucous secreted in the lining of the tube builds up due to infection blocking.

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13
Q

What is pyosalpinx?

A

The fallopian tube is filled/blocked with pus. Its generally acute or inflammatory.

This is usually when the hydrosalpinx becomes infected.

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14
Q

What are paratubal cysts?

A

Fluid filled sac (cyst) growing beside the ovaries. They are usually small and incidental (can be due to embryological remnants).

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15
Q

What are the broad categories of causes of ovarian masses?

A

Tumours- benign or malignant

Non tumours- Functional cysts (cysts related to ovulation), endometriotic cysts.

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16
Q

What are functional cysts related too?

A

Ovulation- follicular cysts or luteal cysts.

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17
Q

How do you manage functional cysts? Do they present with symptoms?

A

Usually they are asymptomatic/incidental findings. However they bleed or rupture which can cause pain.

They usually resolve spontaneously but expectant management is appropriate.

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18
Q

What are endometriotic cysts also known as?

A

Endometriosis.

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19
Q

What are blood filled ovarian endometriotic cysts known as?

A

Chocolate cysts.

20
Q

What symptoms are associated with endometriosis?

A

Typically associated with dyssmenorrhoea, premenstrual pain and dyspareunia.

Typically a tender mass with nodularity and tenderness behind the uterus.

(NOTE- they are occasionally asymptomatic until a large chocolate cyst rupture).

21
Q

NOTE- think about which layer these tumours arise from. All in previous lecture but this is for revision.

A
22
Q

What may malignant germ cell tumours secrete?

A

May secrete HCG or AFP. Will give a false positive pregnancy test.

23
Q
A
24
Q

What may a dermoid cyst rarely present with?

A

Thyrotoxicosis (if it has thyroid tissue).

25
Q

What may granulosa cell tumours secrete? What can this cause?

A

May secrete oestrogen leading to precocious puberty (early puberty), PMD.

26
Q

What might thecal/leydig tumours produce?

A

May secrete androgens. Leading to hiurtism and virilisation.

27
Q

What is Meigs syndrome?

A

Pleural effusion and ascites caused by benign ovarian tumour (fibroma)

28
Q

Which types of tumours commonly metastasise to the ovary?

A

Breast

Pancreas

Stomach
GI primaries

29
Q

This is what was explained in the last few cards from the lecture.

A
30
Q

This shows a dermoid cyst on Xray. YOu can see the calcified rim, with fat density inside and a small area of calcification (a tooth).

A
31
Q

How does ovarian cancer present?

A

May be a mass, swelling or pressure

Early transperitoneal spread-deposits on peritoneal surfaces, omental disease, malignant ascites.

Insidious symptoms

In the image are some varied presentations of ovarian cancer.

32
Q

What percentage of ovarian cancer cases have a genetic cause?

A

Only 5%.

33
Q

BRCA 1 and 2 cause which types of cancer?

A

Breast and ovarian.

34
Q

Lynch syndrome causes which type of cancers?

A

Bowel

Endometrial

Ovarian

and more.

35
Q

What is protective against ovarian cancer?

A

The oral contraceptive pill.

36
Q

What are risk factors for ovarian cancer?

A

Nulliparous

Family Hx

Increasing age.

37
Q

How would you investigate ovarian cancer?

A

Hx and exam

Tumour markers-CA125, carcino-embryonic antigen (CEA)

Imaging-USS better for imaging nature of the cyst

CT better for assessing disease outwit the ovary e.g. omental, peritoneal, lymph nodes.

38
Q

When is CA 125 raised?

Does a normal level exclude cancer?

A

Raised in 80% of ovarian cancers. However a normal level does not exclude cancer.

39
Q

When is CA 125 moderately elevated?

A

Endometriosis

Peritonitis/infection

Pregnancy

Pancreatitis

Ascites from any cause e.g. liver disease

Other malignancies- gynae/non gynae

40
Q

Which ovarian cancer doesnt secrete CA 125?

A

Mucinous doesnt.

NOTE- upper level of CA 125 is about 30. If someone has a level of over 1000 they are likely to have cancer. However things like endometriosis can put it up to about 150.

41
Q

When is CEA elevated?

What is its main function?

A

May be moderately elevated in ovarian tumours esp mucinous tumours.

Main function is to exclude metastasis from the GI system.

42
Q

What is the risk of malignancy index (RMI)?

What do you do if RMI is elevated?

A

Menopausal status x serum Ca125 x USS score.

If RMI is elevated, refer to gynae.

43
Q

This shows a simple ovarian cyst.

A

This shows a multi-loculated ovarian cyst.

44
Q

How do you treat ovarian cysts/masses?

A

Removal or drainage if its likely to be benign

Otherwise- removal of ovaries and uterus with removal/biopsy of omentum, debulking of tumour and complete examination/inspection of all peritoneal surfaces.

Chemotherapy may be given pre or post surgery

Cure is unlikely unless confined to ovary at presentation.

45
Q

What are the likely causes of acute presentation with pelvic mass?

A

Cyst accident- rupture or haemorrhage or torsion

Fibroid- usually red degeneration due to compromised blood supply, seen in pregnancy and peri-menopause.

Reproduction (34 decks)

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