Re: complex ovarian cyst
From: Efrain Ramirez (eramirezt@coqui.net)
Tue Feb 11 16:29:35 2003
My bets are on Benign Cystic Teratoma BUT - its has to be looked at -
either by scope or laparotomy ...
>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
>
--
"Not everything that can be counted counts, and not everything
that counts can be counted."
Albert Einstein
