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Re: Gyn: Fibroids/ovarian abnormality From: Rafael Haciski (haciski@earthlink.net) Mon Nov 5 20:09:25 2007 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: mark decker: "Re: view Finds Routine Amniotomy of No Benefit" Previous message: D. Ashley Hill, M.D.: "Re: Postpartum sexual dysfunction" In reply to: Garry E. Siegel, M.D.: "Gyn: Fibroids/ovarian abnormality" Next in thread: Garry E. Siegel, M.D.: "Re: Gyn: Fibroids/ovarian abnormality" Reply: Garry E. Siegel, M.D.: "Re: Gyn: Fibroids/ovarian abnormality" The problem with ovarian masses as I see it is whether it will be malignant. If it is benign, I have no problem taking out the ovary/mass, and/or the uterus, usually through the laparoscope and the problem is solved. However, if it is malignant on the frozen, then she needs deep LN dissection and para-aortic LN dissection, neither of which i feel comfortable doing on my own. Thus I would have to close and send her to the onc who would need to do a second laparoscopy for the node dissection for proper staging, thus putting her through two surgeries, as opposed to the one surgery if the onc were doing it the first time. However, going to oncologist involves extra effort on her part, difficulties with switching doctors etc, and thus less likable to the pt. The logistics for the oncologist to be on standby to assist in case of positive malignancy are too impossible to arrange. So it boils down to a lot of guess work as to what are the chances of malignancy, and how does the pt feel about the possibility of needing a second laparoscopy. -- Rafael Haciski MD FACOG Anchor Health Centers GYN 800 Goodlette Rd #360 239-643-8780 office 239-571-0292 cell Naples, FL. On Nov 2, 2007, at 7:04 PM, Garry E. Siegel, M.D. wrote: > 48 YO P2002 referred by friendly radiologist. > > 15 years ago, had laparotomy and ovarian cystectomy (unsure which > side) > for a dermoid; no records available. > > A couple of years ago had menomet., but lately has been having regular > but heavy periods until recently, when she has missed one or two here > and there and had some hot flashes. She also is now having some > bleeding in between the periods/spotting. > > She saw another gyn in the community, and was told to see the gyn > oncologist ASAP due to a 7 cm. complex ovarian mass, and by the > way you > have fibroids and your uterus is tilted and the cervix couldn't be > visualized (I have no records except ultrasound snapshots, and the > history is from the patient). > > She somehow then saw the radiologist for embolization > consideration, and > he reviewed her history and recent ultrasound images. She had seen > her > in 2/07 and her MRI then showed a few fibroids, 4 cm. max. His > review > of the current ultrasound images said "no change" on the fibroids, but > the ovary contained a 4 cm. complex cyst. > > In ROS, BTW she has increasing bloating and gas, and has always had > hemorrhoid trouble (colonoscopy 2006 "ok") that is now worsened. > > On exam, she has a scaphoid abdomen that is non-tender and no masses. > > On speculum exam, when the posterior blade of the Pederson speculum > hit > the posterior fornix, she jumped, and I could only partially visualize > the lower 1/2 of the very anterior cervix, and on bimanual exam, her > uterus/pelvic mass is firm, directly retroverted and tender--she jumps > away, and she says this degree of tenderness is not like her normal > exams. A planned endo biopsy was ditched, obviously. > > CBC and Ca 125 are normal. > > I advised lapscope/H-scope at a minimum, with possible unilateral > cystectomy and/or oophorectomy, as she was not at all interested in > hysterectomy at the first meeting. > > Today, when I returned a follow up call, I reiterated same, and she > asked if she needs to see a gyn onc, since gyn #1 suggested it. > > Thoughts? > > Garry > > -- > Garry E. Siegel, M.D. > Private Practice > Roswell, GA Next message: mark decker: "Re: view Finds Routine Amniotomy of No Benefit" Previous message: D. Ashley Hill, M.D.: "Re: Postpartum sexual dysfunction" In reply to: Garry E. Siegel, M.D.: "Gyn: Fibroids/ovarian abnormality" Next in thread: Garry E. Siegel, M.D.: "Re: Gyn: Fibroids/ovarian abnormality" Reply: Garry E. Siegel, M.D.: "Re: Gyn: Fibroids/ovarian abnormality"

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