Professional Documents
Culture Documents
masses
Prof (M) Dr Mohd Hashim Omar
Jabatan Obstetrik & Ginekologi
Fakulti Perubatan, UKM
Introduction
adenomyosis
Diagnosis and management of
pelvic masses
Premenarchal Female
No Physiologic ovarian lesion or pregnancy-related
masses
Mainly related to congenital anomalies involving
Complete or partial duplication of Mullerian system
Benign or malignant ovarian cyst (germ cell)
Congenital cyst of mesonephric system
Pelvic kidney
A careful history and examination including EUA, IVP
and serum tumour markers (AFP and Beta HCG) as
well as karyotyping should always be done.
Cont.
The sexual abuse also should be role out
Pelvic inflammatory disease and pelvic abscess
Chronic haematomas secondary to forced sex
Diagnosis and management of
pelvic masses
Menstruating Female
Intrauterine and ectopic pregnancy are always a
diagnostic consideration
Careful menstrual history, sexual activity and
pregnancy symptoms
Pattern of menstrual cycle, amounts and any pain
should be asked
Association factors eg. Fever, pain, dyspareunia
and progression
Constitutional symptoms
Diagnosis and management of
pelvic masses
Postmenopausal Female
Pelvic mass is consider omnious
Consider malignant
Functional cyst do not enter into the
differential diagnosis
Fibroid and endometriosis get smaller or
better during menopause
Silent PID lead to pelvic abscess should be
considered
Benign Uterine lesions
Leiomyomas of Uterus
The most common tumour of uterus
20-40% in women over 35 years old
Frequently cause no symptoms
It is the commonest indication for
hysterectomy
Growth of fibroid is faster and incidence of
fibroid in black women
Cont (fibroid)
Pathology
Is discrete and may be single or more
Cut surface has a glistening, white colour with a
characteristic whole-like trabeculation
Pseudocapsul comprised of compressed cell on the
outer layer
Occur in several location, cervix, uterus, broad
ligaments.
Symptoms may related to the size and site of the
fibroid
Cont (fibroid)
Pathogenesis
Aetiology is not established
Hormonal influence on the growth of
leiomyomas is obvious
Growth rapidly during pregnancy , OCP,
PCOS, granulosa cell tumour
Rarely before menarrche and regress after
menopause
Cont (fibroid)
Secondary Changes of Fibroid
Because of sparce in blood supply, fibroid are
subjected to severe degenerative changes
Hyaline degeneration is the most common and not clinically
significant and lead to Calcification
Cystic degeneration is an extreme form of hyaline
degeneration
Red degeneration occur in pregnancy and menopause
The main symptom is pain due to congestion and swelling
Sarcomatous degeneration is rare.
Cont (fibroid)
Sign and Symptoms
Compression symptoms eg. Discomfort, urinary
retention, constipation
Menstrual problems: Submucosa and intramural
fibroid.
Hydronephrosis and hydroureter
Polycytemia in Right broad ligament fibroid
Pain in red and sarcomatous degeneration
Cont (fibroid)
Treatment
Conservative
Asymptomatic
Pregnancy
Surgical
Symptomatic
Completed family : Hysterectomy
Surgical treatment
Hysterectomy
Benign Ovarian Mass
Functional Cyst
Most commonly found during reproductive age
Rarely cause symptoms or require treatment
Follicular cyst
Normally only one follicle will goes to full development and
ovulation
Others degenerated and the follicular fluid is absorbed
Replaced by fibrous and hyaline
If fluid not absorbed: Follicular cyst.
Rarely beyond 7 cm diameter
Decrease in size and disappear within 6-8 weeks
Functional Cyst (cont)
Corpus luteum cysts
During pregnancy, CL may become cystic and
enlarged
No clinical significant; however if ruptured may
granulosa cells
Not require treatment unless it undergone torsion,
rupture or haemorrhage
Cause by excessive HCG stimulation