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Re: clinical problemFrom: Natalie Sohn (nsohnob@aol.com)Wed Jan 6 19:58:59 1999
, 6 Jan 1999, Natalie Sohn wrote:Some how vital info was lost in transmission and I apologize.... Both trans abdominal and a transvaginal ultrasounds were performed--they revealed a 14cm partially cystic and solid mass ( very suspicious looking) which probably is displacing the uterus although the uterus could not be clearly delineated. My question is as follows: is a ct or mri necc since this patient clearly needs to have exploratory surgery and removal of the mass be it ovarian, uterine or colon. As long as you have the appropriate surgeon(s) to tackle the problem. My first step in evaluating these types of patients is a sonogram (usually transvaginal).you could not do any endometrial testing at all ( technically impossible). A pap was reported as nml but this was taken 3 months prior ( they must have been able to see the cervix then and no mass was reported in that exam. Any comments now that the correct in is given? >At Tue, 05 Jan 1999, Deborah Richert wrote: >>Thank you for your suggestions-but a transvaginal us was done. as far as a sonohysterogram, it was techically impossible ( as was any endometial testing) >>At 09:06 PM 1/5/99 -0600, you wrote: >>>I would like to hear some expert opinion on the following case: >>>64 year old post menopausal female in good health getsreferred by her >>>primary care doc ( actually the nurse practitioner) for post menopausal >>>spotting. Pap, mammo all normal. My exam reveals a mass which >>>displaces the cervix way upward ( you cant visualize it at all with the >>>speculum--and endo biopsy is impossible. Rectal exam reveals the mass ( >>>and/or uterus?) above the rectum and shes guiac neg. There is no >>>ascities and ca125 is wnl. The radiologist wanted me to order a ct scan >>>but I dont feel this is necessary since this most likely uterine or >>>ovarian neoplasm clearly needs to come out.(Ido these cases with a >>>gyn-onc who can stage these tumors adequately.)I am not sure if this is >>>malignat or benign. r/o colon tumor ?-although this seems highly >>>unlikely. My one reservation about ordering these tests is that the the >>>hmo medical directors might delay my case ruling out distant spread when >>>none exists. ( such a thing happened recently to me and there was a 4 >>>week delay-- that woman had ovarian cancer. Any insights? My point here >>>is how would additional testing in this case alter management? >>> >>>-- >>>nsohn >>> >>Natalie - >> >>How about ordering a transvaginal pelvic ultrasound exam to see if this >>patient has a retropositioned uterus or possibly a uterine fibroid? I've >>done many transvaginal ultrasounds for a possible cul de sac mass that >>turned out to be a retropositioned uterus. Also, with a transvaginal >>ultrasound exam, sonohysterography could be performed as needed to see if >>there may be a polyp or fibroid within the endometrial cavity as a cause for >>the PMP spotting. Just a thought. >> >>Deb Richert, AAS, RDMS, RVT >>La Crosse, WI
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