Re: complex ovarian cyst
From: dsalama@pipeline.une.edu
Tue Feb 11 13:04:57 2003
Thanks for the info.
Per your questions: negative family history.
Also forgot to mention she has been on birth control this entire time
(pior to even noticing the cyst). Also, the US were read by different
technicians, as you assumed, at Mass General Hosp.
What is the stats for a young 25 y/o nulliparious woman with this kind
of cyst presentation being malignant? Is there any comforting statistic
to inform her to calm her nerves prior to surgery?
-david
At Tue, 11 Feb 2003, Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C.
wrote:
>
>At Tue, 11 Feb 2003, David, Med Student wrote:
>>
>>I have a patient that I am following and wondering how to go about
>>explaining to her what needs to be done without scaring her. She is a
>>25 y/o G-0 P-0 woman with a complex ovarian cyst (60% solid, 40% cystic)
>>that is 4.5 cm in her left ovary which is also enlarged (mostly from the
>>cyst). The cyst originated as a simple cyst a year and half ago,
>>looking at her old records and had measured 3.2 cm then. (A ruptured
>>cyst in the same ovary at that time is what brought her and allowed for
>>discovery of the current problem). Ca-125 was not done, as the utility
>>is not great from what i've read.
>>
>>She obviously needs some kind of surgery, what are the benefits of scope
>>vs. laparotomy in this case? I've been reading a lot, but the size of
>>her cyst fits into a "gray" area in the texts and journals i've been
>>reading. I'm suspecting a dermoid cyst - any other possiblities? How to
>>go about explainign without scaring her too much?
>>
>>thanks,
>>David MSIII
>>UNECOM
>
>David , the family history here is very important any hint of ovarian
>tumors would justify doing a CA 125.
>
>Was the u/s done by the same person, one person's 3.2cm can be another
>persons
>4.5 cm.
>
>Make sure she understands the only way to make a diagnosis is to obtain
>tissue.
>Even if it is cancer if it is confined to one ovary she does not need a
>hyst and
>removal of the opposite ovary, most ovarian malignancies can be treated
>with
>a cystectomy.
>
>Not all dermoids are benign, some require post-op chemotherapy.(mature
>Vs. Immature teratomas.)
>
>There is essentially no difference in treatment between Laparoscope or
>laparotomy
>the amount of post-op pain is related to the size of the skin incision,
>a small
>ovarian cyst can be handled by a very small pfanstiel incision. There
>may be
>a trend to fewer adhesions with a laparotomy in terms of future
>fertility, though
>this has not been proven in a rigorous evidence based fashion.
>
>--
> Take care, John
>
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