PELVIC MASS

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PELVIC MASS

• Wasin Benjamaparinyakool
• 423 51512 30

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????????????????????? 38 ?? ????????????????????
???????????????? ???. (???????????????????????????
?)

• CC?????????????????????4?????PTA
• PI4?????PTA ?????????????????????
  ????????????????? ?????????? ???????? ??????????
  ?????????????????? ????????????? ????????????
  ??????????????

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CASE CONFERANCE

• PH????????????????? ????????
• Ob-Gyn HPARA 2-0-0-2 last 15yrs ???????
  ?????????
• mens.history Duration 3 days
  Interval 30 days Amount ????????? 2
  pads/day??????????????????????????????????????????
  ?? LMP 23/5/45
• ????????????-???????????????????????2

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CASE CONFERANCE

• Personal H???????????? ????????????
• FH?????-??????????????????????????????
  
  
  
  
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  ???????- ???????????????
  ???????????????????
  
  
  
  ????-????????
  ?????????
  
  
  
  ???-
  ???????????????

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Physical Examination

• Vital sign BP 110/70mmH BT 37C PR 80/min RR
  20/min
• General AppearanceMiddle age female good
  conscious,look over weight,pleasant and
  co-operative
• HEENTnot pale, no jaundice
• HeartS1S2 normal, no murmur
• LungNormal breath sounds no adventitious sounds

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Physical Examination

• AbdomenTense cystic consistency no tender smooth
  surface , movable

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Physical Examination

• PVNIUB-normal
• Vg-normal mucosa, normal discharge
• Cx-deviated to right side,os closed and
  clean
• Ut-deviated to left side,uterine about 14
  wks size and nodula
• Adnexa-Rt adnexae mass, smooth surface,
  fixed

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PROLEM LISTPelvic mass

• Subjective4?????PTA ?????????????????????
  ????????????????? ?????????? ???????? ??????????
  ?????????????????? ????????????? ????????????
  ??????????????
• Objectivemass 20 wks size above uterus deviated
  to right side Tense cystic consistency no tender
  smooth surface , movable

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PROLEM LISTPelvic mass

• PV PVNIUB-normal
• Vg-normal mucosa, normal discharge
• Cx-deviated to right side,os closed and
  clean
• Ut-deviated to left side,uterine about 14
  wks size and nodula
• Adnexa-Rt adnexae mass, smooth surface,
  fixed

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Differential Diagnosis

• 1.???????????????????????????????
• 2.??????????????????
• 3.?????????????????????????????
• 4.??????????????????????????????????????? ??????
  tubo-oarian complex, appendiceal
  abscess,diverticular abscess, hydrosalpinx, ????
  pyosalpinx
• 5. ??????????????????? subserous myoma obstructed
  uterine horn???????????????????????????????????

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Differential Diagnosis

• 6.???????????????????????? peritoneal,
  paraovarian,paratubal cyst,???????????????????
• 7.????????????? pelvic kidney,??????????????????,?
  ?????????????? ???????????????????????????????
  ???????

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Plan for Investigation

• 1.CBC
• 2.UA
• 3.SEROLOGY and IMMUNOLOGY
• 4.PREGNANCY TEST
• 5.CHEST X-RAY
• 6.ULTRASONOGRAPHY

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Investigation Result

• UA???????????????? ????? pH 8(???????????)
• CBC??????????????????????????????????????????????
  
• Serology and ImmunologyVDRL -non reactive
• 
  HBsAg-negative
• Anti
  HIV-negative
• Chest x-ray????????????????
• EKG ????????????????

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Investigation Result

• UltrasoundUterus-anteverted position size
  10.4x4.1cm.
• Endometrium-thickness mass
  10mm.
• Huge pelvic mass(gt15cm.Out of
  ultrasonographic range)
• Questionable free fluid

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PROVISIONAL DIAGNOSIS

• OVARIAN TUMOR

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Plan for Treatment

• Surgery1.Ovarian cystectomy/Ovarian enucleation
• 2.Unilateral salpingo-oophorectomy
• 3.TAH with BSO

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Indication for surgery

• 1.Solid ovarian tumor
• 2.???????????????????????????????????? USG ??????
  multiseptated cyst,????????????????? solid
  area,????????????????2????,????????? ovary
  ??????? ascites
• 3.ovarian cyst ????? diameter gt8cm.
• 4.Ovarian cyst ?????diameter lt8cm.????????????????
  ?? ????????????????????????????????? 2-3?????

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Indication for surgery

• 5.?????????????????? torsion, rupture,
  infection, hemorrhage, adhesion
• 6.??ovarian mass ????????????

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OPERATIVE NOTE

• Pre-op DxOvarian tumor
• Op DxRight mucinous cystadenoma with
  endometriotic cyst
• OperationTAH with BSO with LN sampling with
  partial omentectomy

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OPERATIVE NOTE

• FindingRight ovarian cyst diameter
  20cm.loculated with spontaneous rupture of
  capsule mixed with endometriotic cyst diameter 6
  cm.(accidental rupture)
• Left ovary diameter 4 cm.with small
  endometriotic cyst 1x2cm.
• Normal both tubes

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OPERATIVE NOTE

• Minimal ascites fluid 50ml.yellowish color
• Appendix was previous surgery
• Bowel adhesion at cul-de-sac with pelvic
  endometriosis
• No residual lesion

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PATHOLOGICAL DIAGNOSIS

• CervixChronic cervicitis
• EndometriumSecretory endometrium
• MyometriumAdenomyosis
• Lt ovaryCorpus luteum
• Rt ovaryMucinous cystadenoma and endometriotic
  cyst
• Both fallopian tubesUnremarkable

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PATHOLOGICAL DIAGNOSIS

• OmentumChronic and acute infalammation with
  focal mesothelial hyperplasia
• LymphnodeLympoid hyperplasia

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BENIGN MUCINOUS TUMOR

• ????????????????????????????20-25???????????????
  ???????????????? ?????.??????????20??????????????
  ?????????????????
• ??????????????????????? 20-60 ??
• ?????????????????????????? 2-3????????
  ?????????????????????????????????? ????????
  multiloculation ???????? ???????????
  ???????????????????????? ?????????????????cyst
  ????????????????

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1.???????????????????????????? adnexal mass
??????????????????????

• A. Dysgerminomas
• B. Ectopic pregnancy
• C. Leiomyomas
• D. Primary ovarian carcinoma

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1.???????????????????????????? adnexal mass
??????????????????????

• A. Dysgerminomas
• B. Ectopic pregnancy
• C. Leiomyomas
• D. Primary ovarian carcinoma

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2.??????????????????????????????????? adnexal mass

• A.Pain
• B. Menstrual disturbances
• C.GI symptom
• D.?????????

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2.??????????????????????????????????? adnexal mass

• A.Pain
• B. Menstrual disturbances
• C.GI symptom
• D.?????????

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3.Investigation ???????????????? ??????? adnexal
mass ?????????????

• A.Ultrasound
• B.CBC
• C.Pregnancy test
• D.CT scan

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3.Investigation ???????????????? ??????? adnexal
mass ?????????????

• A.Ultrasound
• B.CBC
• C.Pregnancy test
• D.CT scan

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4.??????????????? Diagnosis ???

• A.Ectopic pregnancy
• B.Mucinous cystadenoma
• C.Endometriosis
• D.????B ??? C

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4.??????????????? Diagnosis ???

• A.Ectopic pregnancy
• B.Mucinous cystadenoma
• C.Endometriosis
• D.????B ??? C

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5.????????? benign mucinous tumor

• A.????????????????? ????????????
• B.?????????2 ????????????? ?????? cyst ??? solid
  ??????
• C. multiloculation ???????? ???????
• D.????????????????????? papillar pattern
  ???????????? stroma ???????????

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5.????????? benign mucinous tumor

• A.????????????????? ????????????
• B.?????????2 ????????????? ?????? cyst ??? solid
  ??????
• C. multiloculation ???????? ???????
• D.????????????????????? papillar pattern
  ???????????? stroma ???????????