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In young girls the pelvic masses may be palpable in the abdomen as the pelvis is small to accommodate large masses.ExamsIn women of childbearing potential, a pregnancy test should be performed regardless of history. If the pregnancy test is positive, ultrasound or other imaging techniques are not always necessary; imaging is needed when ectopic pregnancy is suspected.

If the presence or origin (gynecological or non-gynecological) of a mass cannot be clinically determined, an imaging examination may be ordered. Pelvic ultrasound is usually the first diagnostic test performed.

In women of childbearing age, the presence of simple, thin-walled ovarian cysts with a diameter of 5-8 cm (usually Graafian cystic follicles) does not require further investigation unless they persist for> 3 menstrual cycles or are accompanied moderate to severe pain.

The International Ovarian Tumor Analysis (IOTA) group has developed the simple rules for preoperatively assessing the risk of cancer in women who have ovarian or other adnexal tissue cancers that may require surgery.

The classification is based on the presence or absence of 10 ultrasound scans and has a higher sensitivity and specificity than other classification scores. In 2016, the simple rules of the International Ovarian Tumor Analysis (IOTA) were updated to include a risk calculation tool (SRrisk), which can be used on IPHone or Android devices (1).

If ultrasonography does not clearly define the size, location, and density of the mass, additional diagnostic work should be done (eg, CT, MRI).Ultrasound of a benign ovarian massUltrasound of a benign ovarian mass

With the permission of the publisher. From Hricak H, Coakley F, Bergman A. In Atlas of Cancer. Edited by M Markman, RR Barakat, and WJ Hoskins. Philadelphia, Current Medicine, 2002.

Ovarian masses with x-ray features of cancer such as a solid component, superficial growths and irregular shape (which also suggests cancer), require fine needle aspiration or a biopsy. Tumor markers can be useful for diagnosing specific tumors.Ultrasound of a malignant ovarian massUltrasound of a malignant ovarian mass

With the permission of the publisher. From Hricak H, Coakley F, Bergman A. In Atlas of Cancer. Edited by M Markman, RR Barakat, and WJ Hoskins. Philadelphia, Current Medicine, 2002.Evaluation references1. International Ovarian Tumor Analysis: IOTA Simple Rules and SRrisk calculator to diagnose ovarian cancer. Accessed 2/16/20.Key points

The type of pelvic mass tends to vary between age groups.In women of childbearing age, the most frequent cause of uniform increase in the volume of the uterus is pregnancy; other common causes of pelvic masses are fibroids and functional ovarian cysts.

In postmenopausal women, pelvic masses are more frequently neoplastic in nature.In women of childbearing age, carry out a pregnancy test.If clinical evaluation is inconclusive, perform an imaging test; pelvic ultrasound is usually the first diagnostic test performed.

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