Pelvic masses

Template:Search infobox Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Epidemiology and demographics[edit | edit source]

Pelvic masses are most commonly found in women, pelvic masses can also occur in men. Cases besides bladder distension and pregnancy need to be ruled out before workup. Consider every case as a malignancy. As age increases, so does the liklihood that malignancy could be a cause.

Differential Diagnosis[edit | edit source]

In alphabetical order: ^{[1] [2]}

• Colorectal Cancer
• Constipation
• Corpus luteum cysts
• Diverticular abscess
• Endometrioma
• Enlarged bladder
• Functional ovarian cysts
• Germ cell tumor
• Hernia
• Hydrosalpinx
• Leiomyoma
• Lymphoma
• Metastatic disease of the uterus, breast or GI tract
• Neoplasms
• Ovarian fibromas
• Ovarian cysts
• Polycystic Ovarian Syndrome
• Pregnancy (uterine, ectopic, molar)
• Primary ovarian carcinoma
• Retroperitoneal tumors
• Tubo-ovarian abscess
• Wilms' Tumor

Diagnosis[edit | edit source]

History and Symptoms[edit | edit source]

• Determine whether the mass is painful

Physical examination[edit | edit source]

Abdomen[edit | edit source]

• Full abdominal exam
• Full pelvic/genital exams (bimanual & rectal)

Other[edit | edit source]

• Full breast exam
• Full lymph node exam

Laboratory Findings[edit | edit source]

• Labs include:

• BUN/creatinine
• CBC w/ differential
• Culture for gonorrhea and chlamydia
• Hemoccult testing
• Liver function tests
• Pap smear
• Urinalysis

Electrolyte and Biomarker Studies[edit | edit source]

• Tumor markers if ultrasound is abnormal

• Beta-hCG
• Serum CA-125
• LDH

MRI and CT[edit | edit source]

• Pelvic CT
• Abdominal CT

Echocardiography or Ultrasound[edit | edit source]

• Pelvic ultrasound for masses in the uterus to determine existence, size & composition.

Other Diagnostic Studies[edit | edit source]

• Colonoscopy to exclude colon cancer
• Bladder catheterization if culprit may be bladder distension

Treatment[edit | edit source]

Acute Pharmacotherapies[edit | edit source]

• Leiomyoma

• Hypoestrogenic medications

Indications for Surgery[edit | edit source]

• Premenopausal ovarian mass

• Ovarian cyst

• observe 4-6 weeks
• suppress with OCP

• Consider laparoscopic procedure
• If ovarian solid mass, complex cyst, ascites are indicated, surgical evaluation is necessary

• Postmenopausal ovarian mass

• <3 and asymptomatic and a normal exam indicates serial ultrasounds

• if persistent, evaluate for surgery

• In the event that the cyst is >3 and is symptomatic, perform laparoscopy

• Leiomyoma

• Consider myomectomy instead of hysterectomy

Referrals[edit | edit source]

• Premenarchal ovarian masses - high malignancy potential; immediate gynecologic referral

References[edit | edit source]

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