Re: Gyn: Residual ovary/ovarian remnant?
From: Garry E. Siegel, M.D. (garrys@mindspring.com)
Wed Sep 20 11:32:10 2006
Even if she has an ovarian remnant, she is 61 and I would expect an
elevated FSH, and thus I don't see the reason to order it.
Similarly, I have heard of using Clomid to stimulate folliculogensis, so
that another ultrasound could be done to look for same.
Since she's 61 and menopausal, I've not considered either.
I also don't exactly see why a Ca 125 is warranted, though I don't mind
doing one.
Am I missing something?
Garry
At Tue, 19 Sep 2006, Gordon Goldman wrote:
>
>Hi Kirsten,
>
>Good to hear from you. Hope things are going well for you.
>
>I too have a patient who has had pathology confirmed RSO about two years ago
>and now has a tender 4cm complex right cystic mass causing significant
>dyspareunia. Did do a CA125 which was normal and MRI looks like it may be
>either ovarian remnant or possible peritoneal cyst. FSH of no value with
>left ovary intact.
>
>--
>Gordon M. Goldman, M.D., FACOG
>Private Practice, St. Louis, Missouri
>
>-----Original Message-----
>From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Kirsten
>McDaniel
>Sent: Tuesday, September 19, 2006 7:55 PM
>To: Multiple recipients of list OB-GYN-L
>Subject: Re: Gyn: Residual ovary/ovarian remnant?
>
>What is her FSH level. Does she have any sign of ovarian function. I
>had a similar case in someone in her 40s. Her FSH was quite low. I
>operated her and she had an ovarian remnant in the pelvic sidewall. She
>had also had recent surgery with a general surgeon who reported uterus
>and ovaries absent.
>
>At Mon, 18 Sep 2006, R. Daniel Braun wrote:
>>
>>give her some GnRH and see if her estrogen level goes up.
>>
>>Dan
>>
>>On 9/18/06, Garry E. Siegel, M.D. <garrys@mindspring.com> 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
>>>
>>--
>>R. Daniel Braun
>>
>> "The way to health is an aromatic bath and scented massage
>everyday".
>> Hippocrates
>>
--
Garry E. Siegel, M.D.
Private Practice
Roswell, GA
