Re: Gyn: Fibroids/ovarian abnormality
From: Garry E. Siegel, M.D. (garrys@mindspring.com)
Tue Nov 6 11:39:46 2007
Well put and right on the mark.
If she chooses for me to operate, I'll put a scope in, look around, and
go from there. If ovarian cancer, I'll prove it by biopsy and get out.
If negative, I'll proceed.
Garry
At Mon, 5 Nov 2007, Rafael Haciski wrote:
>
>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
>
--
Garry E. Siegel, M.D.
Private Practice
Roswell, GA
|
|
