Re: GYN: Ovarian Mass at TVH**the answer
From: Efrain Ramirez (eramirezt@coqui.net)
Wed Jun 23 08:55:34 2004
My first advice was to scope - but the spillage factor is real .....-
maybe the old fashion way is better.. I'll keep you posted.. thanks.
>At Tue, 22 Jun 2004, Braun, R. Daniel wrote:
>
>Send it to the Pathologist.
>
>Dan
>
>"Sound is like water. If you drill one hole in the wall the sound will
>leak right through."
>
>- JAY BRAUN, a band member by love, a soundproofer by necessity.
>
>-----Original Message-----
>From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Efrain
>Ramirez
>Sent: Tuesday, June 22, 2004 7:07 PM
>To: Multiple recipients of list OB-GYN-L
>Subject: Re: GYN: Ovarian Mass at TVH**the answer
>
>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)
>
--
"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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