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GYN: Pelvic Mass (long--good case)From: Garry E. Siegel, M.D. (garrys@mindspring.com)Wed Mar 25 11:35:14 1998
Any opinions/help appreciated 41 YO P0010 LMP 10 days ago, no contraception, married, with a negative gyn history, presents to her internist on Monday 3/23 with 4 to 5 days of lower abdominal pain, vaginal bleeding, and feeling poorly. Of note is that she is hypertensive, hypothyroid (surgical--due to thyroid cancer years ago), and a long standing insulin dependent diabetic. He saw her on Monday AM, and did a CBC, ordered a pelvic ultrasound, and put her on a couple of newfangled antibiotics. On Tuesday, 3/24, her pelvic ultrasound showed bilateral septate 6 cm. ovarian masses, and she still felt poorly, and she was admitted. Her temp was 103, and her lab from the previous day returned with a WBC of 2400, a hematocrit of 29%, and a platelet count of 62,000. On her exam, she was mildly tender abdominally, no masses, no peritoneal signs. On pelvic she was menstruating, the uterus sounded to 8 cm., and I did a Pipelle endo biopsy. Her uterus was small, slightly tender, and I did not appreciate her masses due to discomfort. Rectal confirmed but I could not test the stool for occult blood due to vaginal blood. A serum pregnancy test was already negative, and ordered are an HIV, RPR, Genprobes for GC and Chlamydia. A CT of the lower abdomen/pelvis showed the masses without the attendant inflammation (per the radiologist) usually seen with TOAs. She is on parenteral antibiotics per the ID consultant, and the Heme Onc guy is on the case. So. . .Is she pancytopenic from infection, cancer, or who knows? Are these TOAs, primary ovarian tumors (benign or malignant), or metastatic (Krukenbergs, or endometrial) ovarian tumors? Right now, it seems that she'll be on antibiotics a few days, and eventually come to exploration depending on whether she responds or not. Garry
-- Garry E. Siegel, M.D., FACOG Private Practice Roswell, Ga.
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