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GYNECOLOGICAL ONCOLOGY . . . CONT.

• treatment • TAH-BSO • no adjuvant therapy given if disease confined to uterus and mitotic index is low • radiation if high mitotic index or tumour spread beyond uterus (not used in Toronto) • chemotherapy generally not useful endometrial stromal sarcoma • clinical presentation • menometrorrhagia • postmenopausal bleeding • pelvic pain • 50% have metastatic disease at time of

• treatmenptresentation, especially liver and/or lung mets • TAH-BSO • hormonal therapy (progestogens) • rarely use radiotherapy mixed Mullerian sarcoma • most common uterine sarcoma • treatment • same as leiomyosarcoma • use of adjuvant radiotherapy for low stage disease

OVARY

Table 10. Characteristics of Benign vs. Malignant Ovarian Tumours

Benign

  • reproductive age group (epithelial cell)

  • very large tumors

  • unilateral

  • freely mobile

  • capsule intact, smooth surface, cystic, unilocular

  • no ascitic fluid

  • smooth peritoneal surfaces

Benign Ovarian Tumours

Malignant

  • very young (germinal cell) or older (epithelial cell) age groups

  • bilateral

  • fixed, adherent to adjacent organs

  • multiloculation, thick septa, disruption of solid areas

  • ascites

  • peritoneal seeding

    • e.

      g. cul-de-sac and bowel serosa

Functional Tumours f o l l i c u l a r c y s t f o l l i c l e f a i l s t o r u p t u r e d u r i n g o v u l a t i o n s e l d o m m e a s u r e s m o r e t h a n 6 - 8 c m u s u a l l y u n i l o c u l a r , l i n e d b y g r a n u l o s a c e l l s c l i n i c a l p r e s e n t a t i o n u s u a l l y a s y m p t o m a t i c m a y r u p t u r e , b l e e d , t w i s t , a n d i n f a r c t c a n r e s e m b l e P I D o r e c t o p i c p r e g n a n c y c l i n i c a l l y t r e a t m e n t i f < 6 c m , w a i t 6 w e e k s t h e n r e - e x a m i n e a s c y s t m a y r e g r e s s w i t h n e x t c y c l e o v a r i a n s u p p r e s s i o n w i t h O C P a s p i r a t i o n v i a l a p a r o s c o p y l u t e i n c y s t c o r p u s l u t e u m f a i l s t o r e g r e s s a f t e r d a y 1 4 , b e c o m i n g c y s t i c o r h e m o r r h a g i c u s u a l l y s l i g h t l y l a r g e r a n d f i r m e r t h a n f o l l i c u l a r c y s t m a y r u p t u r e , b l e e d , t w i s t , a n d i n f a r c t a n d c a u s e m i l d t o s e v e r e p a i n m a y d e l a y o n s e t o f n e x t p e r i o d t r e a t m e n t

theca-lutein cysstame as for follicular cyst • due to atretic follicles stimulated by abnormally high blood levels of ßhCG

MCCQE 2000 Review Notes and Lecture Series

Notes

Gynecology 45

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