Pelvic Masses

Pelvic Masses
Preentation by:Anna Mae Smith, MPAS, PA-C
Lock Haven University

Central Pelvic Masses
* Pregnancy
* Leiomyomata - uterine fibroids
* Endometrial malignancy or uterine sarcoma
* Ovarian or other laterally located masses may present centrally
* Bladder

Leiomyomas
* benign smooth muscle tumors of the uterus
* commonly called “fibroids”
* estrogen dependent
* rarely occur before menarche or after menopause
* grow larger during pregnancy
* rarely malignant
* most common indication for pelvic surgery in women

Leiomyomas in Pregnancy
* interfere with fetal growth and nutrition
* increase the risk of
o spontaneous abortion during the first and second trimesters
o preterm labor

Epidemiology of Leiomyomas
* develop from smooth muscle cells by means of metaplasia
* cause for growth is unknown
* occurs in 20% of women of reproductive age
o most often occurs among African American women
o nulliparous women
o women older than 35
o nonsmokers
o oral contraceptive or IUD users


Classification of Leiomyomas
* submucous - protrude into the uterine cavity
* intramural - within the myometrial wall
* subserous - growing toward the serous surface of the uterus
* intraligamentous - located in the cervix or in between the folds of the broad ligament

Leiomyomas: Symptoms
* usually asymptomatic
* symptoms increase as tumors grow
* common symptoms
o pelvic pressure
o bloating
o pelvic congestion
o feeling of “heaviness”
o urinary frequency
o dysmenorrhea
o dyspareunia
o menorrhagia
o pain - less common
* may report infertility
* pregnant women complain more of pain

Leiomyomas: Physical Exam
* absence of ascites
* normal bowel sounds
* enlarged uterus that is firm and irregular but not tender
* may be mistaken for adnexal mass if situated laterally
* if mass moves with the uterus, likely to be a leiomyoma

Leiomyomas: Diagnostic Tests
* CBC to determine if anemic
* UA to r/o urinary tract infection
* Pregnancy test
* Hemoccult
* Ultrasound
* Barium enema
* IVP
* Endometrial biopsy

Leiomyomas: Differential Diagnoses
* ovarian neoplasm
* tubo-ovarian inflammatory mass
* diverticular inflammatory mass
* pregnancy
* ectopic pregnancy
* adenomyosis
* pelvic kidney
* malignancy

Leiomyomas: Treatment
Leiomyomas: Conservative Surgery
* myomectomy
* Leiomyomas: Hysterectomy
* GI Tract

Lateral Pelvic Masses
* Ovary
* Normal premenopausal ovary - 3x2x1.5cms
* Early Menopausal ovary - 2x1.5x0.5cms
* Postmenopausal ovary - 1.5x0.75x0.5cms
* GI causes
* Pelvic kidney
* PID with tubo-ovarian abscess
* Ectopic pregnancy

Ectopic Pregnancy
* Potentially life-threatening condition in which the embryo implants outside the uterine endometrial cavity.
* Leading cause of pregnancy-related death during the first trimester
* Must be considered in all sexually active women of reproductive age who have abdominal pain or abnormal vaginal bleeding

Risk Factors for Ectopic
* current IUD use
* previous tubal surgery
* history of pelvic inflammatory disease
* history of infertility
* In-utero DES exposure
* H/o STD’s
* Smoking
* Progesterone only contraception
* Use of fertility drugs

Classic Triad of Symptoms
* Amenorrhea
* Irregular vaginal bleeding
* Pelvic pain

Physical Findings of Ectopic Pregnancy
* Prior to rupture may feel nothing…usually some form of abnormal bleeding present
* Ruptured:
o Hypovolemic/orthostatic hypotension
o Peritoneal signs
o Positive CMT & adnexal tenderness
o Bulging cul-de-sac of Douglas

Ectopic Testing
Fallopian Tube
Dermoid Cyst/Teratoma
Ovary
Laparoscopy

Pelvic Masses.ppt