Benign and Malignant Disorders of the Breast and Pelvis
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?
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.
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?
a. Excision of the omental metastasis and ovarian cystectomy
b. Omentectomy and ovarian cystectomy
c. Excision of the omental metastasis and unilateral oophorectomy
d. Omentectomy and bilateral salpingo-oophorectomy
e. Omentectomy, total abdominal hysterectomy, and bilateral salpingo-oophorectomy
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.
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, ...