Pelvic mass

武功密笈

小黃藏書

OBS
GYN
Gyn Oncology
Infertility
Urogynecology

向上 Abnormal Bleeding Endometriosis PID Cervical Pregnancy Amenorrhea Chronic Pelvic Pain Ectopic Pregnancy interstitial pregnancy Periop management Pelvic mass Acute Pelvic Pain Endoscopic Myomectomy Nutritional Support ectopic pregnancy LAVH HRT candidiasis PMS Amenorrhea

~ Pelvic Mass ~

　

Pelvic Mass by Approximate Frequency and Age Group

Infancy
  • Functional ovarian cyst
  • Germ cell tumor

Prepubertal
  • Germ cell tumor

Adolescent
  • Functional ovarian cyst
  • Pregnancy
  • Dermoid / other germ cell tumors
  • Obstructing vaginal / uterine anomalies
  • Epithelial ovarian tumors

Reproductive
  • Functional ovarian cyst
  • Pregnancy
  • Uterine fibroids
  • Ovarian epithelial tumors

Perimenopausal
  • Fibroids
  • Ovarian epithelial tumors
  • Functional cysts

Postmenopausal
  • Ovarian tumor (malignant or benign)
  • Bowel, malignant tumors or inflammation
  • Metastases

　

Prepubertal Age Group

  1. Clinical Presentation:

    2. ¬ Abdominal mass

    ­ Acute abdominal pain: often associated with torsion

    v In girls younger than 9 y/o, approximately 80% of the ovarian neoplams were found to be

    malignant. Germ cell tumors account for approximately 60% of ovarian neoplasms in children

    and adolescents.
  2. Differential Diagnosis: Wilms’ tumor, neuroblastoma, etc.
  3. Diagnosis and Management: (Figure 13.11, p355)

　

Adolescent Age Group

  1. Differential Diagnosis:
  1. Ovarian Masses:

    2. V Functional ovarian cysts: an incidental findings, or presented with pain caused by torsion,

    leakage or rupture.

    V Endometriorsis: less common in adolescence than in adults.
  2. Uterine Masses: (rare)

    3. V Obstructive uterovaginal anomalies: imperforate hymen, transverse vaginal septa, vaginal

    agenesis with a normal uterus and functional endometrium, vaginal duplications with

    obstructing longitudinal septa, and obstructed uterine horns.

    ä hematocolpos, hematometra

    V Myomas are not commonly seen in this age group.
  3. Inflammatory Masses:

    4. V Adolescents have the highest rates of PID of any age group, if one considers only individuals

    at risk for STDs.

    V Eg. tubo-ovarian complex (a mass consisting of matted bowel, tube, and ovary),

    tubo-ovarian abscess (a mass consisting primarily of an abscess cavity within an anatomically

    defined stucture such as the ovary), pyosalpinx, or, chronically, hydrosalpinx.
  4. Pregnancy-Related Causes: eg. ectopic pregnancy
  1. Diagnosis: history, PV, lab. studies (including EIA), ultrasonography, etc.
  2. Management: (Figure 13.11, p355)

　

Reproductive Age Group

  1. Conditions Diagnosed as A “Pelvic Mass” in Women of Reproductive Age:

    2. 　

    Full urinary bladder

    Urachal cyst

    Sharply anteflexed or retroflexed uterus

    Pregnancy (with or without concomitant myomas):

    Intrauterine

    Tubal

    Abdominal

    Ovarian or adnexal masses:

    Functional cysts

    Inflammatory masses:

    Tubo-ovarian complex

    Diverticular abscess

    Appendiceal abscess

    Matted bowel and omentum

    Peritoneal cyst

    Stool in sigmoid

    Neoplastic tumors:

    Benign

    Malignant

    Paraovarian or paratubal cysts

    Intraligamentous myomas

    Less common conditions that must be excluded:

    Pelvic kidney

    Carcinoma of the colon, rectum, appendix

    Carcinoma of the fallopian tube

    Retroperitoneal tumors (anterior sacral meningocele)

    Uterine sarcoma or other malignant tumors

  2. Diagnosis: history, PV, lab. studies (including EIA), ultrasonography, etc.
  3. Management:

1). Myoma Uteri:

  1. Non-surgical: first line

    2. À follow-up of symtoms and signs, and uterine size

    Á GnRH analog

    Â low-dose hormonal therapy

  2. Surgical:

G Indications:

À Abnormal uterine bleeding with anemia, unresponsive to hormonal management

Á Severe dysmenorrhea, dyspareunia, or lower abdominal pain, etc.

 Acute pain, as in torsion of a pedunculated myoma or

prolapsing submucous myoma

à Urinary S/S, such as hydronephrosis.

Ä Rapid enlargement of the uterus during the premenopausal years, or any increase

in uterine size in postmenopaused females

Å Infertility, with myoma as the only finding

Æ Enlarged uterus with compression symptoms or discomfort

G OP methods:

À Myomectomy: abdominal, vaginal, laparoscopic, hysteroscopic, etc.

Á Hysterectomy

2). Ovarian Masses:

- Functional tumors: expectant therapy

- Symptomatic cysts:

À Analgesia: first-line

Á Surgery:

v Indications: significant pain, or suspicion of malignancy

v OP methods:

a). laparotomy: when R/O malignancy

b). laparoscopy only used in

c). aspiration low risk of malignancy

　

Postmenopausal Age Group

  1. Diagnosis: PV, ultrasonography, CA-125 ð to rule out malignancy
  2. Management:
  1. Non-surgical:

    2. When the cyst is asymptomatic, small (< 5 cm in diameter), unilocular, and thin-walled.

  2. Surgical: R/O malignancy

　

　

Ultrasound Scoring system for Adnexal Masses

Clear cyst and smooth border

1

Clear cyst with slightly irregular border; Cyst with smooth walls but low-level echoes (i.e. Endometrioma)

2

Cyst with low-level echoes with slightly irregular border but no nodularity (i.e. Endometrioma); clear cyst in postmenopausal patient

3

Equivocal, nonspecific ultrasound appearance: solid ovarian enlargement or small cyst with irregular borders and internal echoes (hemorrhagic cyst or benign ovarian tumor)

4-6

Multiseptated or irregular cystic mass consistent in appearance with ovarian tumor (7 = less nodularity; 8-9 = more nodularity)

7-9

Pelvic mass as above, with ascites

10

· 1 = benign; 10 = malignant

　

Filename: Pelvic Mass