Re: GYN: Ovarian Mass at TVH**the answer
From: Garry E. Siegel, M.D. (garrys@mindspring.com)
Tue Jun 22 21:13:34 2004
I just saw an article about masses under 10 cm., and without excresences
and with a normal Ca 125, the likelihood of malignancy was low. It was
from the U. of Kentucky, but I can't remeber the reference.
Garry
At Tue, 22 Jun 2004, Efrain Ramirez wrote:
>
>Along those lines - patient not mine so forgive if no more details are
>given but essentially -- 53 y/o post menopausal - no ERT - incidental
>finding on an US - simple cyst without excrescences --6 cms - previous
>U/S no cyst -- doppler flow WNL - Ca 125 = 27 - next step?
>
>>At Tue, 22 Jun 2004, art fougner, md wrote:
>>
>>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
>>
>--
>"The opposite of a correct statement is a false statement.
>But the opposite of a profound truth may well be another profound truth."
>
>Niels Bohr (1885 - 1962)
>
--
Garry E. Siegel, M.D.
Private Practice
Roswell, GA
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