Re: GYN: Ovarian Mass at TVH**the answer
From: art fougner, md (evsono@pipeline.com)
Tue Jun 22 07:01:14 2004
Garry
you MADE the diagnosis and the patient will receive appropriate therapy
...
art
At Mon, 21 Jun 2004, Garry E. Siegel, M.D. wrote:
>
>Sorry to a bit slow in replying.
>
>Hindsight is always 20-20, and I wish that i had thought of a couple of
>the options that you fine colleagues suggested. I especially liked
>putting it in a bag, as I do think that I could have passed an endopouch
>and it would have fit. I then could have punctured and drained it and
>kept the contents under control. I didn't think of simply needling it,
>as that would spill. I also thought of a laparotomy, as I didn't need a
>laparoscopy to disconnect it (I did that OK vaginally), and I would need
>an incision to have removed it intact.
>
>So, I easily ligated the blood supply, and while bringing it out through
>the vagina (no bag, etc.), it did have a pinpoint leak, spilling
>material that looked like pus. I contained it as best that I could, and
>the frozen showed a borderline endometriod tumor. The final pathology
>showed a moderately well differentiated endometriod adenocarcinoma, with
>minimal stromal invasion.
>
>The Gyn Onc suggested a CT of the chest and abdomen, and the likely a
>staging laparoscopy. The Ca 125 postop was 8.
>
>Garry
>
>At Tue, 15 Jun 2004, Garry E. Siegel, M.D. wrote:
>>
>>62 YO P3003 with symptomatic procidentia, otherwise normal exam.
>>
>>At planned TVH/BSO/repairs and sacrospinous ligament fixation, after the
>>uterus was out, the left ovary was, lo and behold, 6-8 cm., white,
>>smooth, no excresances, etc. The other ovary/tube/pelvic structures
>>were all pristine, there was no ascites when opening the peritoneal
>>cavity, and the enlarged ovary was not evident to me during examination
>>under anesthesia.
>>
>>At this point, both infundibulopelvic ligaments are accessible, meaning
>>that transvaginal removal is possible. However, I'm not so sure that I
>>can get the ovary out without rupture.
>>
>>What would you do? I've already done it and know the results!
>>
>>Garry
>>
>>--
>>Garry E. Siegel, M.D.
>>Private Practice
>>Roswell, GA
>>
>--
>Garry E. Siegel, M.D.
>Private Practice
>Roswell, GA
>
--
art fougner, md
ich bin ein New Yorker
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