Adnexal Mass Evaluation Guide

Adnexal Masses Todd D. Tillmanns MD Associate Professor Division of Gynecologic Oncology University of Tennessee And West Clinic

Evaluation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Epithelial Ovarian Carcinoma ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Ovarian Serous Cystadenocarcinoma ,[object Object],[object Object],[object Object]

Ovarian Papillary Serous Cystadenocarcinoma ,[object Object]

Ovarian Mucinous Cystadenocarcinoma ,[object Object],[object Object],[object Object]

Endometrioid Adenocarcinoma ,[object Object],[object Object],[object Object],[object Object]

Sex Cord Stromal Tumors ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Granulosa Cell Tumor ,[object Object],[object Object],[object Object]

Germ Cell Tumors ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Sertoli Leydig Tumor ,[object Object],[object Object],[object Object]

Benign Adnexal Masses ,[object Object],[object Object],[object Object],[object Object]

Simple follicular cyst ,[object Object]

Corpus Luteum Cyst ,[object Object],[object Object]

Paratubal Cyst ,[object Object],[object Object],[object Object]

Mature Cystic Teratomas ,[object Object],[object Object],[object Object],[object Object]

Ovarian Fibroma ,[object Object]

Endometrioma ,[object Object],[object Object],[object Object],[object Object],[object Object]

Leiomyomata ,[object Object],[object Object]

Tuboovarian Abscess ,[object Object],[object Object]

Screening Guidelines ,[object Object],[object Object]

Screening Guidelines ,[object Object],[object Object],[object Object],[object Object]

Screening Guidelines ,[object Object],[object Object],[object Object]

Ovarian Cancer Screening Trials ,[object Object],[object Object],[object Object]

GOG-199 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Screening Recomendations ,[object Object]

Who Should be Referred According to ACOG ,[object Object],[object Object],[object Object],[object Object],[object Object]

OVA1 ,[object Object],[object Object]

Hereditary Risk ,[object Object],[object Object],[object Object],[object Object],[object Object]

Conditions found in association with increased CA-125 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Morphology Index for Tumors ,[object Object],De Priest et al. Gynecol Oncol 1993;51:7-11 Predom Solid Solid area > 10 mm Thick Septa 3 mm-10 mm Thin septa < 3mm No Septa Septa Structure Predom solid Papillary Projection > 3 mm Papillary Projections < 3 mm Smooth >3 mm thickness Smooth <3 mm thickness Cyst Wall Structure >500 cm 3 >200-500 cm 3 >50-200 cm 3 10-50 cm 3 <10 cm3 Volume 4 3 2 1 0

Morphology Index in Premenopausal Patients ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],De Priest et al. Gynecol Oncol 1993;51:7-11

U/S Scoring System to Differentiate Benign from Malignant ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Alcazar JL et al. Am J Obstet Gynecol 2003;188:685-692

Multivariate Significant Parameters on U/S ,[object Object],[object Object],[object Object],[object Object],[object Object],Alcazar JL et al. Am J Obstet Gynecol 2003;188:685-692

Prospective U/S Studies with Scoring Systems in use ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Sassone AM et al. Obstet Gynecol 1991;78:70-6 // De Priest et al. Gynecol Oncol 1993;51:7-11 // Ferazzi E et al. Ultrasound Obstet Gynecol 1997;10:192-7 // Alcazar JL et al. Am J Obstet Gynecol 2003;188:685-692

Ultrasound / CT ,[object Object],[object Object],Ultrasound

CT –vs- U/S to diagnose Premenopausal Adnexal Masses ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Mallarini GS.etal. Ultra Obstet Gynecol 1997;9:339

U/S Adnexal Mass > 3 cm ,[object Object],[object Object],[object Object],[object Object],[object Object],Osmers RGW et al. Obstet Gynecol 1996;175:428-434

1072 Consecutive Ovarian tumors in Premenopausal Women ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Functional Tumors ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Osmers RGW et al. Obstet Gynecol 1996;175:428-434

Ovarian Cancer and Pregnancy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Smith LH et al. Obstet Gynecol 2003;189:1128-1135

Adnexal Masses in Pregnancy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Sherard GB et al. Obstet Gynecol 2003;189:358-362

Ovarian Conservation -vs- Oophorectomy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Parker, WH et al. Ovarian Conservation at the time of hysterectomy and long term Health Outcomes in the Nurses’ Health Study. Obstet Gynecol 2009;113:1027-1037

Specific Guide Line Work Up History & Physical CXR, abd/pelvic CT scan or U/S Obtain family cancer history CA 125, CBC, Chem Profile, BE/colonoscopy if symptomatic Adnexal Mass Surgical Candidate? Counsel Patient on Risks of Pregnancy Loss, Preterm Delivery, Fetal Morbidity, Torsion, Possibility of benign disease –vs- LMPT –vs- Malignancy

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Adnexal Mass Evaluation Guide

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Adnexal Mass Evaluation Guide