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Adnexal Mass (Postmeno (51y) (Repro (Premenarchal (11y) (cysts usually bad…

- - - - cysts usually bad
        :crab:
        Ovarian
        
        Germ Cell
        
        Sertoli/Leydig
        
        Granulosa/Theca
    - - Dx: (Best :stars:) Transvag. US
        
        simple v. complex
        
        ~~MRI~~ is better
        
        dont get, expensive :moneybag:
        
        Simple
        
        unilocular
        
        no septations
        
        no loculations
        
        anechoic
        
        1 color
        
        homogeneous
        
        no floaties
        
        small
        
        TV-US
        
        < 3 cm = ignore
        
        < 10 cm = probably simple
        
        repeat imaging
        
        resolves in a few months
        
        Complex
        
        Big
        
        weird edges
        
        septations
        
        not continuous
        
        not the same color
        
        Loculated (multilocular)
        
        Multiechoic
        
        stuff floating in fluid
        
        heterogeneous
        
        multiple colors/structures
        
        TV-US
        
        > 10cm = large
        
        remove
        
        :crab: risk
        
        growing/ fails to resolve
        
        remove
        
        Tx: Laparoscopy (MIS) :camera_with_flash:>> Laparotomy (Ex. Lap :hocho:)
        ~~Aspiration~~: doesnt help simple cyst
        ~~OCP~~: no association w/ simple cysts
        ~~MRI~~: don't need to use on shelf
        
        Teratoma
        
        Path: Benign tumor
        
        teens-20s :woman::skin-tone-2:
        
        Asx
        
        weight gain
        
        abn fullness
        
        Dx: US
        
        enormous cyst!
        
        Tx: not malignant
        
        remove cyst only
        
        preserves fertility
        
        removal of 1 ovary can precede recurrence in another ovary = infertility
        
        likely to recur
        
        Salpingooophorectomy for older women, nonfertile
        
        Endometrioma (endometriosis)
        Path:
        
        retrograde menses :shrug::skin-tone-3:???
        
        menses flows to the fallopian tube
        
        seeding into peritoneum
        
        Estrogen responsive
        
        cyclic pain
        
        Pt: anything
        
        dysmenorrhea
        
        px menses
        
        dysparunia
        
        px sex
        
        infertility
        
        :pencil2: endometrioma = chocolate cyst :chocolate_bar:; not nec. = to endometriosis. ( :chocolate_bar: may be absent)
        Dx: Endometrioma
        
        US
        
        ( :stars: Best) Dx Laparoscope w/ Laser ablation
        
        look around, burn cyst w/ laser…
        
        Endometriosis
        
        OCP trial = improvement
        
        confirmation :+1::skin-tone-2:
        
        Tx: same as for Pelvic px
        
        NSAIDs :pill:
        
        OCP = IUD
        
        or Leuprolide or ~~Danazole~~
        
        gain control of axis
        
        Danazole has androgen SE's
        
        Ectopic
        Path: Stricture or PID
        
        something has scarred or narrowed fallopian tube
        
        ampulla
        
        Pt: Pregnancy ( v. early on)
        
        amenorrhea
        
        or absent spotting
        
        Abd px
        
        (+) UPT
        
        Dx: UPT (+)
        
        make sure its ectopic and not IUP
        
        ß-quant > 2000 = US should show IUP
        
        discriminatory zone
        
        if no US finding, its ectopic
        
        Tx:
        
        Salpingostomy
        
        suck out zygote
        
        w/o rupture of fallopian tube
        
        use for fertility sparing
        
        Salpingectomy
        
        remove the tube
        
        more severe, use w/ a rupture
        
        MTX
        
        w/ leukavorin rescue
        
        most fertility sparing
        
        early pregnancies only!
        
        ßquant < 5000
        
        Gestational size < 3cm
        
        and no fetal heart tones :forbidden::<3:
        
        Torsion
        Path: Pedicle contains suspensory ligament of the ovary, twists due to cyst.
        
        leads to ichemia
        
        Pt: completely spontaneous Abd px
        
        Toxic! :biohazard_sign:
        
        sitting at computer before hand
        
        Dx:
        
        will feel cyst on PEx
        
        Needs; Doppeler US
        
        see decreased flow
        
        Tx: Sx :hocho:: restore the flow
        
        untwist and assess if its viable
        
        1 more item...
        
        Cancer: other lecture