Re: GYN: Ovarian Mass at TVH**the answer
From: Efrain Ramirez (eramirezt@coqui.net)
Tue Jun 22 19:05:21 2004
Along those lines - patient not mine so forgive if no more details are
given but essentially -- 53 y/o post menopausal - no ERT - incidental
finding on an US - simple cyst without excrescences --6 cms - previous
U/S no cyst -- doppler flow WNL - Ca 125 = 27 - next step?
>At Tue, 22 Jun 2004, art fougner, md wrote:
>
>Garry
>
>you MADE the diagnosis and the patient will receive appropriate therapy
>...
>
>art
>
>At Mon, 21 Jun 2004, Garry E. Siegel, M.D. wrote:
>>
>>Sorry to a bit slow in replying.
>>
>>Hindsight is always 20-20, and I wish that i had thought of a couple of
>>the options that you fine colleagues suggested. I especially liked
>>putting it in a bag, as I do think that I could have passed an endopouch
>>and it would have fit. I then could have punctured and drained it and
>>kept the contents under control. I didn't think of simply needling it,
>>as that would spill. I also thought of a laparotomy, as I didn't need a
>>laparoscopy to disconnect it (I did that OK vaginally), and I would need
>>an incision to have removed it intact.
>>
>>So, I easily ligated the blood supply, and while bringing it out through
>>the vagina (no bag, etc.), it did have a pinpoint leak, spilling
>>material that looked like pus. I contained it as best that I could, and
>>the frozen showed a borderline endometriod tumor. The final pathology
>>showed a moderately well differentiated endometriod adenocarcinoma, with
>>minimal stromal invasion.
>>
>>The Gyn Onc suggested a CT of the chest and abdomen, and the likely a
>>staging laparoscopy. The Ca 125 postop was 8.
>>
>>Garry
>>
>>At Tue, 15 Jun 2004, Garry E. Siegel, M.D. wrote:
>>>
>>>62 YO P3003 with symptomatic procidentia, otherwise normal exam.
>>>
>>>At planned TVH/BSO/repairs and sacrospinous ligament fixation, after the
>>>uterus was out, the left ovary was, lo and behold, 6-8 cm., white,
>>>smooth, no excresances, etc. The other ovary/tube/pelvic structures
>>>were all pristine, there was no ascites when opening the peritoneal
>>>cavity, and the enlarged ovary was not evident to me during examination
>>>under anesthesia.
>>>
>>>At this point, both infundibulopelvic ligaments are accessible, meaning
>>>that transvaginal removal is possible. However, I'm not so sure that I
>>>can get the ovary out without rupture.
>>>
>>>What would you do? I've already done it and know the results!
>>>
>>>Garry
>>>
>>>--
>>>Garry E. Siegel, M.D.
>>>Private Practice
>>>Roswell, GA
>>>
>>--
>>Garry E. Siegel, M.D.
>>Private Practice
>>Roswell, GA
>>
>--
>art fougner, md
>ich bin ein New Yorker
>
--
"The opposite of a correct statement is a false statement.
But the opposite of a profound truth may well be another profound truth."
Niels Bohr (1885 - 1962)
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