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Benign and Malignant Disorders of the Breast and Pelvis

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A 21-year-old woman presents with left lower quadrant pain. An anterior 7-cm firm adnexal mass is palpated. Ultrasound confirms a complex left adnexal mass with solid components that appears to contain a tooth. What percentage of these tumors is bilateral?

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a. Less than 1

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b. 2 to 3

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c. 10

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d. 50

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e. Greater than 75

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The answer is c. Benign cystic teratomas (dermoids) are the most common germ cell tumors, and account for about 20% to 25% of all ovarian neoplasms. They occur primarily during the reproductive years, but may also occur in postmenopausal women and in children. Dermoids are usually unilateral, but 10% are bilateral. Usually the tumors are asymptomatic, but they can cause severe pain if there is torsion or if the sebaceous material perforates, spills, and creates a reactive peritonitis.

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A 54-year-old woman is scheduled for laparotomy due to a pelvic mass. At the time of exploratory laparotomy, a unilateral ovarian neoplasm is discovered that is accompanied by a large omental metastasis. Frozen section diagnosis confirms metastatic serous cystadenocarcinoma. Which of the following is the most appropriate intraoperative course of action?

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a. Excision of the omental metastasis and ovarian cystectomy

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b. Omentectomy and ovarian cystectomy

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c. Excision of the omental metastasis and unilateral oophorectomy

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d. Omentectomy and bilateral salpingo-oophorectomy

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e. Omentectomy, total abdominal hysterectomy, and bilateral salpingo-oophorectomy

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The answer is e. The survival of women who have ovarian carcinoma varies inversely with the amount of residual tumor left after the initial surgery. At the time of laparotomy, a maximum effort should be made to determine the sites of tumor spread and to excise all resectable tumor. Although the uterus and ovaries may appear grossly normal, there is a relatively high incidence of occult metastases to these organs; for this reason, they should be removed during the initial surgery. Ovarian cancer metastasizes outside the peritoneum via the pelvic or para-aortic lymphatics, and from there into the thorax and the remainder of the body. Therefore, a complete staging procedure also includes pelvic washings, pelvic and abdominal exploration for metastatic disease, appendectomy, and lymph node sampling.

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A 68-year-old woman is seen for evaluation of a swelling in the right, posterior aspect of her vaginal opening. She has noted pain in this area when walking and during intercourse. At the time of pelvic examination, ...

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