Re: GYN: Ovarian Mass at TVH**the answer
From: art fougner, md (evsono@pipeline.com)
Wed Jun 23 11:36:56 2004
Risk of malignancy is low ( obviously not zero) so before surgery, an
alternative would be to repeat the ultrasound in 4 - 6 wks to look for
persistence, interval change and/or pelvic fluid. If surgery is
contemplated, since malignancy is highly unlikely, laparoscopy would be
fine.
Just my opinion ... i could be wrong.
art
At Wed, 23 Jun 2004, Efrain Ramirez wrote:
>
>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)
>
--
art fougner, md
ich bin ein New Yorker
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