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Montgomery
Sent: Wednesday, 7 March 2007 10:59 AM
To: Multiple recipients of list OB-GYN-L
Subject: Tumor question
Could use y'all's opinion on this one.
38 y.o. presents for exam - new to the area. History is that of having
a "mixed malignant germ cell tumor" with "foci of embryonal carcinoma"
in '89, at the age of 19. She had the involved ovary, as well as the
tube removed and no signs of mets. Had three rounds of VP 16, Bleomycin
and cisplatinum. Following that, she had three ectopics, ultimately
resulting in the removal of the remaining tube. In 2004, had successful
IVF resulting in term twins, and also has frozen embryos from that and
strongly desires more babies.
At the time of presentation, she states that she is having symptoms
similar to those she had in '89. Ultrasound shows a complex appearing
mass on the remaining ovary measuring 3.7 x 4.7 cm - consistent with a
similar neoplasm. Tumor markers of HCG, AFP and CA-125 pending.
Certainly needs to be explored to determine the nature of the mass,
given the history.
Questions that come to mind:
1. Previous horizontal incision - now do a vertical?
2. If positive for tumor and it can be "shelled out", would
anybody be conservative to retain the ovary - given the pregnancy
considerations?
3. If positive for similar tumor and no signs of mets,
salpingooopherectomy and leave the uterus for future pregnancy -
"staging" won't be back until post-op?
4. Risk of recurrence with pregnancy?
Lynn
Lynn D. Montgomery, M.D.
Obstetrics & Gynecology, Maternal-Fetal Medicine
The Birth Center/Rocky Mountain Women's Health
1211 S. Reserve St.
Missoula, Montana, 59801
406-549-0978
fax 406-549-0987
e-mail: apgar10@qwest.net
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