Re: Gyn: Residual ovary/ovarian remnant?
From: art fougner, md (evsono@pipeline.com)
Wed Sep 20 13:02:49 2006
Garry
a CA 125 in this case is unnecessary ...
Just my opinion, I could be wrong.
Art
At Wed, 20 Sep 2006, Garry E. Siegel, M.D. wrote:
>
>Even if she has an ovarian remnant, she is 61 and I would expect an
>elevated FSH, and thus I don't see the reason to order it.
>
>Similarly, I have heard of using Clomid to stimulate folliculogensis, so
>that another ultrasound could be done to look for same.
>
>Since she's 61 and menopausal, I've not considered either.
>
>I also don't exactly see why a Ca 125 is warranted, though I don't mind
>doing one.
>
>Am I missing something?
>
>Garry
>
>At Tue, 19 Sep 2006, Gordon Goldman wrote:
>>
>>Hi Kirsten,
>>
>>Good to hear from you. Hope things are going well for you.
>>
>>I too have a patient who has had pathology confirmed RSO about two years ago
>>and now has a tender 4cm complex right cystic mass causing significant
>>dyspareunia. Did do a CA125 which was normal and MRI looks like it may be
>>either ovarian remnant or possible peritoneal cyst. FSH of no value with
>>left ovary intact.
>>
>>--
>>Gordon M. Goldman, M.D., FACOG
>>Private Practice, St. Louis, Missouri
>>
>>-----Original Message-----
>>From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Kirsten
>>McDaniel
>>Sent: Tuesday, September 19, 2006 7:55 PM
>>To: Multiple recipients of list OB-GYN-L
>>Subject: Re: Gyn: Residual ovary/ovarian remnant?
>>
>>What is her FSH level. Does she have any sign of ovarian function. I
>>had a similar case in someone in her 40s. Her FSH was quite low. I
>>operated her and she had an ovarian remnant in the pelvic sidewall. She
>>had also had recent surgery with a general surgeon who reported uterus
>>and ovaries absent.
>>
>>At Mon, 18 Sep 2006, R. Daniel Braun wrote:
>>>
>>>give her some GnRH and see if her estrogen level goes up.
>>>
>>>Dan
>>>
>>>On 9/18/06, Garry E. Siegel, M.D. <garrys@mindspring.com> wrote:
>>>>
>>>> 62 YO P2002 with a year or more of LLQ pain, including trouble raising
>>>> her left leg. Records including op notes and pahtology available.
>>>>
>>>> She was sent to the orthopedist to check out her left hip, and the MRI
>>>> showed a bilobed structure around 3 cm. in the left adnexal
>>>> reason--such as a lyphatic cyst or an adnexal one if the ovary was
>>>> present. An ultrasound done showed a 2.4 by 1.7 by 2.7 cm. cyst
>>>> similar to a simple ovarian one on the left side.
>>>>
>>>> Records:
>>>>
>>>> 1975 TVH, post. repair no significant pathology noted
>>>> 1978 lapscope, Right S and O by laparotomy with LOA. Pathology confirms
>>>> ovary/tube removed--hemorrhagic corpus luteum.
>>>> 1983 lapscope, Left S and O by laparotomy with LOA. ditto on the
>>>> pathology.
>>>> 1992 lapscope with LOA--extensive between omentum and sigmoid/left
>>>> pelvic wall. "Uterus, tubes and ovaries noted to be absent."
>>>>
>>>> My suspicion is that the imaging abnormality is a cystic peritoneal
>>>> structure and/or adhesive disease, and she probably has recurrent
>>>> adhesive disease. I can't help but think of residual ovarian syndrome,
>>>> and don't exactly know how to proceed at this point. A recent article
>>>> (Am Journal Ob/Gyn, Magtibay, in 2005) was in our ABOG Annual Board
>>>> Certification packet (2 of 3).
>>>>
>>>> For now, she's seeing a general surgeon, and we'll go from there. I may
>>>> want to have her see a gyn oncologist, too, if surgery is contemplated.
>>>>
>>>> Garry
>>>>
>>>--
>>>R. Daniel Braun
>>>
>>> "The way to health is an aromatic bath and scented massage
>>everyday".
>>> Hippocrates
>>>
>--
>Garry E. Siegel, M.D.
>Private Practice
>Roswell, GA
>
--
art fougner, md
"May The Wings of Liberty Never Lose a Feather." - Jack Burton
