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Re: Tumor questionFrom: ainsron (ainsron@sbcglobal.net)Tue Mar 6 17:26:05 2007
Tumor seeding is a concern with germ cell tumors, wouldn't recommend laparoscope for this presentation, needs to be open. I would prefer midline. I would send to gyn oncologist. Ronald E. Ainsworth, MD, FACOG -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Raymond Stephen Sent: Tuesday, March 06, 2007 4:09 PM To: Multiple recipients of list OB-GYN-L Subject: Re: Tumor question Haven't any great experience to draw on except the one patient I had long ago who had a similar presentation aged 25. These tumours are very sensitive to chemo and conservative management is not unreasonable. Biopsy of the mass is obviously first, and could easily be achieved laparoscopically. Steve _____ From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Dr. 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 CONFIDENTIALITY NOTICE AND DISCLAIMER The information in this transmission may be confidential and/or protected by legal professional privilege, and is intended only for the person or persons to whom it is addressed. If you are not such a person, you are warned that any disclosure, copying or dissemination of the information is unauthorised. If you have received the transmission in error, please immediately contact this office by telephone, fax or email, to inform us of the error and to enable arrangements to be made for the destruction of the transmission, or its return at our cost. No liability is accepted for any unauthorised use of the information contained in this transmission. If the transmission contains advice, the advice is based on instructions in relation to, and is provided to the addressee in connection with, the matter mentioned above. Responsibility is not accepted for reliance upon it by any other person or for any other purpose.
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