Re: Gyn: Residual ovary/ovarian remnant?
From: Rafael Haciski (haciski@earthlink.net)
Tue Sep 19 13:17:49 2006
My assumption was that all of that was already done and pain
persists, hence then need for further intervention.
While I would order the CA125 as well, that is more of a CYA test as
many ovarian tumors do not secrete it, and many situations where
there is elevated CA125 do not have an ovarian tumor.
--
Rafael Haciski MD FACOG
Palmetto, FL
On Sep 19, 2006, at 12:55 PM, Andrew Folley wrote:
> I would not be so quick to operate. If she had no pain what would
> you do???
> Make sure pain is not orthopedic or GI. Check CA 125. Observe the
> cystic structure.
> Her pain may very well be adhesive in nature and then perhaps a
> laparsocopy would be in order. ie if the pain persists. andy
>
>> From: Rafael Haciski <haciski@earthlink.net>
>> Reply-To: ob-gyn-l@obgyn.net
>> To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>
>> Subject: Re: Gyn: Residual ovary/ovarian remnant?
>> Date: Mon, 18 Sep 2006 20:00:10 -0500
>>
>> Bowel prep, catheterize the ureters, pelviscopy and whatever
>> necessary: LOA, remnant resection etc.
>>
>> Rafael Haciski MD FACOG
>> Palmetto, FL
>>
>> On Sep 18, 2006, at 6:02 PM, Garry E. Siegel, M.D. wrote:
>>
>>> 62 YO P2002 with a year or more of LLQ pain, including trouble
>>> raising
>>> her left leg. Records including op notes and pahtology available.
>>>
>>> She was sent to the orthopedist to check out her left hip, and
>>> the MRI
>>> showed a bilobed structure around 3 cm. in the left adnexal
>>> reason--such as a lyphatic cyst or an adnexal one if the ovary was
>>> present. An ultrasound done showed a 2.4 by 1.7 by 2.7 cm. cyst
>>> similar to a simple ovarian one on the left side.
>>>
>>> Records:
>>>
>>> 1975 TVH, post. repair no significant pathology noted
>>> 1978 lapscope, Right S and O by laparotomy with LOA. Pathology
>>> confirms
>>> ovary/tube removed--hemorrhagic corpus luteum.
>>> 1983 lapscope, Left S and O by laparotomy with LOA. ditto on the
>>> pathology.
>>> 1992 lapscope with LOA--extensive between omentum and sigmoid/left
>>> pelvic wall. "Uterus, tubes and ovaries noted to be absent."
>>>
>>> My suspicion is that the imaging abnormality is a cystic peritoneal
>>> structure and/or adhesive disease, and she probably has recurrent
>>> adhesive disease. I can't help but think of residual ovarian
>>> syndrome,
>>> and don't exactly know how to proceed at this point. A recent
>>> article
>>> (Am Journal Ob/Gyn, Magtibay, in 2005) was in our ABOG Annual Board
>>> Certification packet (2 of 3).
>>>
>>> For now, she's seeing a general surgeon, and we'll go from
>>> there. I may
>>> want to have her see a gyn oncologist, too, if surgery is
>>> contemplated.
>>>
>>> Garry
>>>
>>
>
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