Repro: Monzo- Lecture 1 "benign Pelvic Masses"; Kek

Front 1

at what ages are most malignant ovarian tumors found?

Back 1

prepubescent or postmenopausal - <15 and after menopause (most are in post-menopausal)

Front 2

___% of ovarian masses in a woman >50 are malignant.

Back 2

30%

Front 3

Why are intra-abdominal neoplasias difficult to diagnose and treat?

Back 3

no precursors, no high risk population, no real screening tools, no great improvements on survival rates even with better XRT and chemo, DIFFICULT TO DIAGNOSE

Front 4

You should or should not be able to palpate a post menopausal ovaries?

Back 4

should NOT - lack of stimulation causes them to atrophy

Front 5

an ovarian mass in a postmenopausal woman should be considered _____ until proven otherwise.

Back 5

malignant

Front 6

____ cancer is a leading cause of death in women.

Back 6

ovarian

Front 7

What is a woman's lifetime % risk of getting ovarian cancer?

Back 7

1.4%

Front 8

When eliciting a good history, the patient tells you she has missed a period, what do you think of?

Back 8

ectopic or intrauterine pregnancy

Front 9

When eliciting a good history, the patient tells you she has menorrhagia/dysmenorrhea, what do you think of?

Back 9

fibroids

Front 10

When eliciting a good history, the patient tells you she has pain immediately after intercourse, what do you think of?

Back 10

ruptured cyst

Front 11

When eliciting a good history, the patient tells you she has mid-cycle pain?

Back 11

physiologic cyst: follicular or corpus luteum

Front 12

When eliciting a good history, the patient tells you she has dysmenorrhea/dyspareunia, what do you think of?

Back 12

endometriosis

Front 13

When eliciting a good history, the patient tells you she has abrupt pain with nausea and vomitting, think of?

Back 13

torsion, perforation, infarction, hemorrhage, degenerating fibroid

Front 14

When eliciting a good history, the patient tells you she has pain with fever, what do you think of?

Back 14

PID, tubo-ovarian abscess, appendicitis, diverticulitis, degenerating fibroid

Front 15

When eliciting a good history, the patient tells you she has chronic abdominal bloating, what do you think of?

Back 15

ovarian cancer

Front 16

When eliciting a good history, the 64 yo patient tells you she is having periods again, what do you think of?

Back 16

endometrial or fallopian tube cancer

Front 17

When eliciting a good history, the patient tells you she has abnormal uterine bleeding, breast tenderness, hirsutism, sexual precocity, what do you think of?

Back 17

sex cord or germ cell tumor

Front 18

when doing a PE you palpate the adnexa and the patient flinches with pain, what do you think of?

Back 18

inflammatory tubo-ovarian abscess

Front 19

when doing a PE you palpate the adnexa feel enlarged mobile irregular uterus, what do think of?

Back 19

fibroids

Front 20

when doing a PE you palpate the adnexa and feel cul-de-sac nodularity, think of?

Back 20

endometriosis

Front 21

Name the different laboratory test you can do on a female.

Back 21

Serum, Urine, Micro cultures, PAP/HPV, Tumor markers, Wet Mount, Schiller Test, One Swab for most all STDs, HCG pregnancy test.

Front 22

Name the tumor marker that indicates a surface-derived epithelial ovarian tumor.

Back 22

CA-125 -> account for 60-70% of ovarian tumors

Front 23

what would be considered an elevated Ca-125 and what else, besides ovarian cancer does it pick up?

Back 23

>35U/ml is elevated; CA-125 is also elevated in endometriosis, PID, fibroids, etc

Front 24

Name the tumor marker that indicates the germ cell tumor, dysgerminoma.

Back 24

LDH

Front 25

If a female isn't pregnant but has high HCG, what type of tumor do you suspect?

Back 25

choriocarcinoma

Front 26

what is the difference in sensitivity and specificity?

Back 26

sensitivity = the probability that if the person has the disease, the test will be positive; a 100% sensitive test means that the test recognizes all sick people as having the disease; SPECIFICITY = tests the negatives, the proportions of true negatives really test negative (low false-positive rate).

Front 27

Of all the diagnostic modalities, which is the most valuable in evaluating adnexal masses?

Back 27

ultrasound - great for looking at cystic vs. solid

Front 28

Which is more concerning? Cystic or Solid mass?

Back 28

Solid mass is much worse - do a complete workup very soon

Front 29

List the characteristics of a benign mass.

Back 29

anechoic, fluid filled cyst; thin-walled; homogenous low to medium echoes in a thick-walled cyst suggest endometrioma

Front 30

List the characteristics of a malignant mass.

Back 30

solid, nodular or papillary, thick septations, increased color/doppler flow, presence of ascites, peritoneal mass, enlarged nodes, matted bowel, thick walled with papillary excresenses(abnormal, excessive, or useless outgrowth)

Front 31

name some features that are associated with an increased risk of malignancy in an ovarian neoplasm.

Back 31

1) personal hx of breast or colon CA; 2)strong family hx of ovarian, breast, colonic, or endometrial CA; 3) Positive CA-125; 4) suspcious findings on US; 5) suspicious findings on PE

Front 32

Name the 3 types of Ultrasound.

Back 32

Transabdominal, Transvaginal, Doppler (shows blood flow, which is increased in CA)

Front 33

What imaging modality is good for visualizing the adnexa esp. in an obese female?

Back 33

transvaginal ultrasound - no bladder distention required (vs. transabdominal), less artifact, better visualization of pelvic structures

Front 34

What is the normal size of a premenopausal ovary?

Back 34

3.5x2x1.5cm - size doesn't correlate with malignancy

Front 35

What do multiple small cysts suggest?

Back 35

PCOS

Front 36

Of the following scopes, list what body part they associate with: colposcopy, hysteroscopy, laporoscopy.

Back 36

Colposcopy: cervix; Hysteroscopy: Uterus; Laporscopy: abdominal cavity

Front 37

What are the deciding factors on the plan to intervene or not in an adnexal mass?

Back 37

the decision is based on: age, findings on pelvic/US, Labs, and Symptoms

Front 38

What are the major issues with intervening?

Back 38

risk of: malignancy, rupture, torsion, surgery complications, future fertility, possibly increasing the amount of pain, early-onset menopause

Front 39

If you find a simple cyst that is <10cm what would you do and why?

Back 39

put pt on oral contraceptives and follow since 70% of simple cysts will resolve over several cycles

Front 40

If you find a cyst >10cm, what would you do?

Back 40

surgical exploration and consult a gynecological oncologist

Front 41

If the female is pregnant and you find a cyst, what do you do?

Back 41

don't give OCs! and if needed, surgical exploration in the 2nd trimester is better for the fetus

Front 42

If the female is postmenopausal and you find a small (3-5cm) mass, she is asymptomatic, with a normal CA-125, what do you do?

Back 42

ultrasound q 3months then every 6month- in postmenopausal women, we are more aggressive since this is the age group more ovarian CA

Front 43

You palpate a 7cm mass in a postmenopausal female. She has symptoms, a CA-125 of >35U/mL, ascites, and her mother had breast cancer what do you do?

Back 43

Exploratory surgery by gyn/onc

Front 44

When and how do follicular cysts arise?

Back 44

in the normal process of ovulation, the follicle matures and ruptures to release the ovum - follicular cysts arise when rupture doesn't occur and the follicle continues to grow

Front 45

When and how do corpus lutuem cyst arise?

Back 45

in the normal process of ovulation, the ovum is release and the left over corpus lutuem involutes - corpus lutuem cysts arise when the corpus luteum fails to involute - can become hemorrhagic; these are BOTH physiologic or functional

Front 46

compare the appearance of follicular vs. corpus luteum cysts.

Back 46

Follicular= smooth, thin-walled and unilocular on US; Corpus luteum = complex and grossly yellow

Front 47

A pregnant patient comes in for a visit and is growing newly apparent facial hair, what do you suspect?

Back 47

Luteoma of pregnancy. Its a non-neoplastic ovarian mass that if appears, only occurs during pregnancy. should involute after delivery

Front 48

Name the following mass. Non-malignant/benign epithelial ovarian tumor that is usually unilateral, unilocular, conatins clear yellow fluid and should be removed via laparoscopy or laparotomy.

Back 48

Serous Cystadenoma

Front 49

Name the following mass. This surface epithelial-stromal tumor is almost always benign, 90% unilateral, yellowish-brown in color, affects women in their 40-50s, and treatment is a TAHBSO.

Back 49

Brenner Tumor- associated with Meig's Syndrome (pleural effusion and ascites - "I thought this was only in sex-cord tumors..."?-kiley)

Front 50

Name the following mass. Arises from endometrial tissue and forms a "chocolate cyst"; often adherent to surrounding structures(bowel, etc); Ca-125 may be elevated; difficult to differentiate from benign hemorrhagic cyst and easy to see on ultrasound.

Back 50

Endometrioma

Front 51

How do you diagnose endometriomas?

Back 51

histopathology needed, clinical diagnosis made in women with endometriosis and adnexal mass; 50% of women with endometriosis get these; often bilateral; Use Ultrasound

Front 52

How do endometriomas appear on US?

Back 52

homogeneous low to medium level echoes in a thick-walled cystic mass (unilocular or multilocular); may be confused with hemorrhagic cyst

Front 53

What are the indications for removal of endometriomas?

Back 53

Indications: Relief of Pain, Exclusion of Malignancy, Infertility (may diminsh ovarian fxn)

Front 54

How do you treat endometriomas?

Back 54

removal (esp. if symptomatic); try and preserve the ovary (ovarian cystectomy) or oophorectomy (if done with bearing children and close to menopause anyway)

Front 55

Is removal difficult and why?

Back 55

difficult to excise a pseudocyst and if you spill the contents you may get scarring/adhesions

Front 56

Name this mass. Appears in the first two decades of life, usually unilateral, almost always benign, most common germ cell tumor, consists of all 3 germ layers.

Back 56

teratoma - (vs. in males, almost always malignant)

Front 57

How should you treat a dermoid cyst (aka mature teratoma)?

Back 57

Removal (always try to save the ovary since these are usually young women)

Front 58

Name the teratoma that contains thyroid tissue.

Back 58

Struma ovarii

Front 59

This is a complication seen with PID. It makes a hydrosalpinx/pyosalpinx in the tube and/or ovary.

Back 59

tubo-ovarian abscess - symptoms are consistent with PID (abdominal pelvic pain, fever, purulent vaginal discharge)

Front 60

what is a hydrosalpinx and why does it cause problems?

Back 60

its a fallopian tube filled with fluid (water, blood, pus); blocks the tubes and may cause the fimbria to close leading to infertility - usually a complication of PID

Front 61

How does one diagnose a hydrosalpinx?

Back 61

hysterosalpingogram (no spill); US (see sausage shaped fluid collection); Laparoscopy (direct visuallization)

Front 62

If a woman had bilateral hydrosalpinx, how could she get pregnant?

Back 62

bypass the fallopian tubes and do invitro fertilization (IVF) - directly take eggs out of the ovary, fertilize with sperm in the lab and transfer into the uterus.

Front 63

name the technique that involves surgically opening up the fallopian tubes and what are the disadvantages?

Back 63

neosalpingostomy; disadv: high recurrence rate and takes 6-12 months to heal prior to attempting pregnancy

Front 64

What is the ultimate treatment of a hydrosalpinx?

Back 64

salpinectomy

Front 65

What is the other name for the very common, usually multiple benign fibroids that vary in size and location of the uterus.

Back 65

leiomyoma - mostly affect women in their 30-40s

Front 66

Name the locations of the fibroids.

Back 66

submucosal, intramural, and subserosal

Front 67

List the signs and symptoms of a female with fibroids.

Back 67

enlarging uterus and abdomen, pain/pressure in the abdomen/back; abnormal bleeding, urinary/bowel issues (BUT MOST OFTEN = 75% NO SYMPTOMS!!)

Front 68

What is the connection between estrogen and fibroids?

Back 68

estrogen causes fibroids to grow; this is the reason you won't see them causing problems in prepubescent and postmenopause

Front 69

How do you diagnose fibroids?

Back 69

history, PE, US (with doppler) and MRI

Front 70

name the treatments for problem causing fibroids.

Back 70

Meds (OCP, NSAIDS, Lurpon/Danazol); UAE (uterine artery embolization)- cut off supply; surgical removal; D&C; Hysteroscopic resection; abdominal myomectomy; Laparoscopic myomectomy (preserves fertility); hysterectomy