Adnexal massses and ovarian tumours
Adnexia reers to the ovaries and the tubes
Adnexal masses are common and most women will have it incidentaly
Localised pain is because of bleeding into the CL and that stretches the capsule a lot?
Ovulation induction drugs stimulates the theca layer
Parsocsrism cysts coming and arising from the mesonephric tubules
Can't investigate everymass for malignancy...only weigh it and then investigate
Must backtrack the history to the causes..take a good history....and examination and also relation to menstrusl cycle is important
Relate history to the cause like in usual cases
Not only to check for typical benig and typical malignant conditions...in the age,history, symptoms and examination and also ultrasounds but also to evkuate size. indications for surgery is 1. Big size 2. Likely malignant
Ultrasound ...liquid will show a dark hypoechoic region with posterior shadowing... shadowing because it's like a traverse section of the reflection and all the rays not reflected are finally getting a chance to reflect
Big size is a problem because the artery runs along the onfundibulo pelvic ligament...so if big can drag down and twist and compromise blood flow.its an emergency like appendicitis because the inflammatory mediators released can cause sepsis
: Increased size is associated with torsion and malignancy. so indicationbfor removal
Can do cystectomy and then the hpe Will give the final diagnosis. whether benign or malignant
And then can decide further treatment then
: Why to operate? 1
Risk of birth labour dystocia and problems..2. risk of ovarian torsion especially when it's between 12bto 20 weeks when there's rapid increase in size and also during purperium when it shrinks
When to operate? Why not first trimester? Because of aneyhesia conolixations and can be worse in first trimester.. but if torsion must operate immediately
Laparoscopic Vs laporomomy...laposcopy is preferred even in pregnancy
: Anesthesia used in each of the above
Ca 125 has problems of sensitivity and specificity. it's not sensitive because it's only raised in epithelial ovarian cancer and not in other types,unless it's late stage and not specific because raised in other diseases as well.. mainly in those diseases found in the repro age group,that is why not used in that age group!!!
I'm ovarian masses there is no ultrasound guided biodpy like you saw in endometrial and cervical cancer.instead if erndrvide surgery we open up and then during surgery we decide whether to do a cystectomy or remove the whole ovaries depending on whether it looks benig or malignant. malignant usually bilateral
There's several things that can form adnexal masses. ovarian tumours are one of them!! (mostly benign)
mostly bilateral because by the time it has been detected it would have spread to the other ovaries
detected late unlike for cervical and endometrial ca because they are picked up by bleeding but this not. Only by non specific GI symptoms.
so because of this it has a poor prognosis and also poor because of the rapid mc route of spread.
it starts by being restricted to the ovaries adn then it spreads by bursting the capsule and micro deposits outwards
tumour marker is different here. because ca 125 only picks up epithelial ovarian cancer of the serous type mainly.
because filled with mucin can grow to large sizes and therefore diagnosed early ⇒ so unilateral and better prognosis
endometroid AKA choclate cysts
clear cell is the most aggresivel and poor prognosis
id detected in the old its most porbbaly epithelial type
if detected in the young then its most commonly a germ cell tumour.
but mostly detected in the old and thats why most common is epithelial
can have thyroid tissue inside as well
most common to undergo torsion because the contents in it makes it havier than the others.
on ultrasound will be able to see the cyst as black appearance and then the strands of hair and then the protuberance which is teeth and bone.
sometimes dot and dash appearance from the hair
so can easily be diagnosed on ultrasound.
malignant change can happen in any of these components but most commonly its the outside layer that gets changed to str sqaurmous cell ca.
its benign so no need to remove!!!
PLAP = placental alkalin phosphatse
dysgermino has good prognosis, the rest doesnt have good prognosis.
the cc seen here is way different from the cc seen in gtn ...this cc is more aggresive.
usually unilateral but dusgerminoma can be bilateral sometimes
dysgerminoma is chemsenstive but not the other form sof germ cell cancers
so contrast the approach to younger women with ovarian cacner with older women. one needs surgery, and another just chemotheraopy and conservattive surgery is possible.
the call exner bodies can also be found in normal ovaries where the oocyte is in the middle surrounded by follicles....
here the nuclear is like bilobed like coffee been.
friboma is seperate from the thecal and sertoli leydic cell tumouts ...its idfferent
meigs vs pseudomeigs syndrome
kkrukenberg most of the time is bilateral but not always!
capsule is intact and shape matiained because its a metstasis and not arising from the ovaies.
signet ring cells is hwere the nuclei has been pushed to the periphery and thats because the cell is filled with mucin
granulosa cll tumour is common in 40 to 50 years of age
radiotherapy is not used for therapy but only chemotherapy is, because radio might kill the ovaries
normal ca 125 is less than 35. in cancers it will be more than 200.
most likely endometriosis above because endometrisois > tb when it comes to this presentation.
Ovarian cancer
Ovarian cancer
Salpingectomy and hysterectomy is thought to be protective for ovarian cancer because 1 it prevents carcinogens from entering from outside 2. One of th epithial type cancer actually could arise from the tubal epitheluem
Ovulation induction drugs stimulates the theca layer
: Parsocsrism cysts coming and arising from the mesonephric tubules
Can't investigate everymass for malignancy...only weigh it and then investigate
Must backtrack the history to the causes..take a good history....and examination and also relation to menstrusl cycle is important
Relate history to the cause like in usual cases
Not only to check for typical benig and typical malignant conditions...in the age,history, symptoms and examination and also ultrasounds but also to evkuate size. indications for surgery is 1. Big size 2. Likely malignant
Ultrasound ...liquid will show a dark hypoechoic region with posterior shadowing... shadowing because it's like a traverse section of the reflection and all the rays not reflected are finally getting a chance to reflect
: Big size is a problem because the artery runs along the onfundibulo pelvic ligament...so if big can drag down and twist and compromise blood flow.its an emergency like appendicitis because the inflammatory mediators released can cause sepsis
Increased size is associated with torsion and malignancy. so indicationbfor removal
Can do cystectomy and then the hpe Will give the final diagnosis. whether benign or malignant
And then can decide further treatment then
Why to operate? 1
Risk of birth labour dystocia and problems..2. risk of ovarian torsion especially when it's between 12bto 20 weeks when there's rapid increase in size and also during purperium when it shrinks
[When to operate? Why not first trimester? Because of aneyhesia conolixations and can be worse in first trimester.. but if torsion must operate immediately
Laparoscopic Vs laporomomy...laposcopy is preferred even in pregnancy
Anesthesia used in each of the above
Ca 125 has problems of sensitivity and specificity. it's not sensitive because it's only raised in epithelial ovarian cancer and not in other types,unless it's late stage and not specific because raised in other diseases as well.. mainly in those diseases found in the repro age group,that is why not used in that age group!!!
: I'm ovarian masses there is no ultrasound guided biodpy like you saw in endometrial and cervical cancer.instead if erndrvide surgery we open up and then during surgery we decide whether to do a cystectomy or remove the whole ovaries depending on whether it looks benig or malignant. malignant usually bilateral
Ovarian cancer
Whenever you suspect a benign surgery and then do a surgical proceure and then the hpe report came as malignant then you should again do a complete surgery for that stage. So sometimes can like doa simple cystectomy and then hpe can come as malignant and for that must do a more extensive complete surgery .
Ovarian neoplasm case
