Pelvic Mass Case Studies

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Pelvic Mass Case Studies

• Oct. 2, 2001
• -- Jorge Garcia, MD

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Case 1.

• A healthy 36 y.o. advertising executive presents
  for PAP smear, due 2 ½years ago, complaining of
  bloating. Exercises nearly every day,
  deniesweight loss, and no other symptoms. States
  that pants dont fit wellanymore.PMHx
  negativeROS neg. except new constipation.Exam
  thin, comfortable, abdomen normal. Bimanual
  easily palpatednormal uterus, but unable to feel
  adnexa. What would you do now?

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Case 2.

• A healthy 68-year-old presents for exam, worried
  about cancer. She has afriend that was just
  diagnosed with ovarian ca, and a sister that
  hadbreast cancer at age 73. PMHx and FHx
  otherwise normal. Her exam was entirely normal.

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Case 2.

• What do you do next?What is her risk of ovarian
  cancer?How does her family history influence the
  risk?How can you reduce this risk?How can you
  reduce her risk of dying with this cancer?What
  are her biggest health risks, in order?

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Case 3.

• A healthy 72-year-old woman presents for a
  routine complete physicalexam. She has no
  symptoms. PMHx is negative. She is
  G3/P2/SAB1.Exam right ovary is palpable, but
  small and non-tender.What do you want to do
  next?Is a bimanual a good screening test?

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Case 4.

• A 48-year-old over ideal weight but otherwise
  healthy woman presents with3 days of spotting
  and left pelvic pain. History of irregular
  periods forsix months. PMHx G4/P3 s/p tubal
  ligation 6 years ago. Smokes 1 PPD/20
  years.Exam 98/60 98.8 110 22Abd Decreased BT,
  mild lower left side tenderness w/o
  guarding/rebound.Cx. appears healthy. Left
  adnexal tenderness, and mild CMT.What would you
  do next?