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Thread: Case Study: Gynecologic and Obstetric Disorders --Lower Abdominal "Heaviness"

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    Default Case Study: Gynecologic and Obstetric Disorders --Lower Abdominal "Heaviness"

    Gynecologic and Obstetric Disorders --Lower Abdominal "Heaviness"


    PATHOLOGY CASE 3: Lower Abdominal "Heaviness"

    A 21-year-old nulliparous woman complains of lower abdominal “heaviness.” She takes an oral contraceptive and is in a monogamous relationship. On examination, she has a normal-sized, nontender uterus, and a 9-cm right adnexal mass is palpated. Her pregnancy test is negative. On sonography, the mass appears cystic and solid.
    Case 3 Questions:

    • Whsat is the most likely diagnosis?
    • What are some of the histologic findings expected in this mass?
    ------------

    Answer / Explanation:


    [HIDE]
    Summary: A 21-year-old nulliparous woman has a 9-cm right adnexal mass that on sonography appears cystic and solid.

    Most likely diagnosis: Benign cystic teratoma of the ovary.

    Expected histologic findings in this mass: Any tissue may be found, but the most common are sebum, skin, hair, teeth, thyroid, and neurologic tissues.

    [/HIDE]

    .

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    CLINICAL CORRELATION

    [HIDE]This young woman has an ovarian mass that on ultrasound has cystic and solid components, a classic presentation of a benign cystic teratoma (dermoid cyst) of the ovary. Although benign cystic teratomas are often asymptomatic, larger dermoids (as in this case) can present with pelvic pain, pressure, fullness, or dyspareunia. The patient’s pregnancy test was reported as negative; however, in rare cases, degenerating ectopic pregnancies can be missed with urine human chorionic gonadotropin (hCG) assays because of the low sensitivity of urine pregnancy tests in the presence of very low (<25 mIU/mL) serum hCG levels.

    The fact that the patient is engaged in a monogamous relationship should decrease the risks of her contracting gonorrhea or Chlamydia, hence decreasing the possibility of pelvic inflammatory disease and tuboovarian abscess (TOA). The patient also gives a history of oral contraceptive (OC) use, which also serves to decrease the risk of pelvic inflammatory disease and/or TOA. Oral contraceptives also greatly decrease the likelihood of the mass being a physiologic ovarian mass (follicular cyst, hemorrhagic corpus luteum cyst, etc.). The ultrasound shows a complex (both cystic and solid) ovarian mass, which also is not consistent with an abscess or a physiologic ovarian or paraovarian cyst.

    Although some disagreement exists over the timing and indications for surgery in complex masses under 6 cm or simple cysts of any size, a 9-cm complex ovarian mass almost always needs to be explored surgically. This is due primarily to the small but not insignificant risk of malignancy. Upon confirmation of benign intraoperative findings, efforts should be directed at salvaging all normal tissue from the affected ovary and removing only that tissue which has undergone neoplastic degeneration.

    .[/HIDE]
    Last edited by trimurtulu; 01-05-2009 at 10:48 PM.

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