Name
ADNEXAL MASS ( TUMOR )
DESCRIPTION
DETAIL
D.D. : - APPENDICULAR LUMP - PARACECAL ABSCESS - PYOSALPINX - SUPPURATING RT. ILIAC NODES - PSOAS ABSCESS - CARCINOMA OF CAECUM - OVARIAN CYST - PEDUNCULATED FIBROID UTERUS - PARACOLIC ABSCESS - DIVERTICULITIS* STOOL FOR OCCULT BLOOD IS DONE TO RULE OUT COLONIC PATHOLOGY. * URINE ROUTINE - TO RULE OUTANY URINARY BLADDER PATHOLOGY * DIAGNOSTIC LAPAROSCOPY
TYPENOTES
* GIRLS < 9 YRS OF AGE - 80% OF OVARIAN MASSES ARE MALIGNANT & ARE GENERALLY GERM CELL TUMORS. * ADOLESCENTS - 50% OF MASSES ARE ADULT CYSTIC TERATOMAS. * WOMEN WITH GONADS WHICH CONTAIN A Y CHROMOSOME HAVE 25% CHANCE OF DEVELOPING A MALIGNANT NEOPLASM * ENDOMETRIOSIS IS UNCOMMON IN ADOLESCENTS BUT MAY BE PRESENT IN 50% OF THOSE PRESENTING WITH PAINFUL MASS. MEDICAL THERAPY : Asymptomatic, small, well-characterized adnexal masses can be observed with regular pelvic examinations and radiologic evaluations. A surgical approach should be used if any growth occurs in these masses. Masses known to be leiomyomas can be approached with gonadotropin-releasing hormone agonists, with the expectation that 50% will decrease in size. Radiologic ablation of these masses can be used in certain cases. It has been suggested that women with adnexal masses be treated with low-dose birth control pills in an effort to reduce tumor size. Little data seem to be available to support this approach. Its major value seems to be the additional time it takes, which allows for spontaneous regression of many of the functional adnexal masses. The information obtained from ultrasonographic testing should allow the identification of the functional cysts that do not require active treatment. Symptomatic treatment is often all that these women need. Surgical therapy: All adnexal masses that are symptomatic or have characteristics of a malignancy must be addressed with surgical removal. Rarely will a functional cyst have either of these features; therefore, few unnecessary surgeries result from this approach. The nature of this approach must be discussed prior to the surgery. One must consider all possibilities during this discussion. Obvious benign masses can be treated with resection of the mass alone or removal of the adnexal structure. In those cases in which the presence of malignancy is questionable, one should limit the resection to the structures involved unless a preoperative decision has been made that a more aggressive approach should be taken. When an obvious malignancy is encountered, a complete staging protocol must be performed. This generally includes complete exploration of the abdomen, total abdominal hysterectomy, bilateral salpingo-oophorectomy, omentectomy, pelvic and para-aortic lymph node dissections, biopsies of the undersurface of the right and left diaphragms, and biopsies of the colic gutters followed by a maximal resection of the intra-abdominal tumor. In some cases, resecting portions of the small bowel or colon may be necessary; therefore, preoperative bowel preparation is necessary, as is a discussion about possible colostomy or other bowel changes.
RELATED DISEASE
Not Available Disease
DISEASE
INVESTIGATION
STOOL FOR OCCULT BLOOD, URINE ROUTINE, PAP"S SMEAR, ULTRA SOUND WHOLE ABDOMEN - FEMALE, COMPLETE BLOOD COUNT, ULTRA SOUND TVS, CT SCAN ABDOMEN, MRI