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2019 | OriginalPaper | Hoofdstuk

24. Benign pelvic mass

Auteurs : Toon van Gorp, Dr Peggy M. A. J. Geomini

Gepubliceerd in: Textbook of Obstetrics and Gynaecology

Uitgeverij: Bohn Stafleu van Loghum

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Summary

Benign pelvic masses can be of uterine or ovarian origin. Benign uterine masses such as uterine fibroids usually cause additional symptoms such as abnormal vaginal bleeding (chap. 22). There are numerous types of benign cysts. Functional cysts include follicular and corpus luteum cysts. Neoplastic cysts include epithelial tumours, sex cord-stromal tumours, or germ cell tumours. The most common types are the mature teratomas, serous and mucinous cystadenomas and the ovarian fibromas. For optimal treatment of ovarian masses, accurate differentiation between a benign and malignant mass with ultrasound is indispensable. Besides subjective assessment, there are many ultrasound models available to aid the clinician with this differentiation. The most promising models are the IOTA models: logistic regression 2 (LR2) model, Simple Rules, and Assessment of Different NEoplasias in the adneXa (ADNEX) model. The decision whether to operate depends on the symptoms, the subtype, the size, the patient’s menopausal status, and whether there is doubt about the nature of the mass. If surgery is indicated, the route of surgery (laparoscopy versus laparotomy) and extent of surgery (cystectomy versus ovariectomy) should be decided.
Bijlagen
Alleen toegankelijk voor geautoriseerde gebruikers
Woordenlijst
IOTA group
The International Ovarian Tumor Analysis (IOTA) group is a worldwide consortium that focusses on the ultrasound diagnosis of ovarian masses. Research has focused on the development of predictive models to estimate the risk of malignancy
Subjective assessment or pattern recognition
The subjective evaluation of ultrasound findings. The sonographer does not use a model but uses his knowledge to estimate whether a cyst is benign or not
Logistic regression
A mathematical model used in statistics to estimate (guess) the probability that the given input belongs to a certain class. In case of an ovarian mass, the model will estimate the probability that the mass is malignant
Granulosa cells
Endocrine cells in the ovary that surround the oocyte and form the internal lining of the follicle. The major function of granulosa cells includes the synthesis of sex steroid from androgens (coming from the theca cells). Depending on the timing during the menstrual cycle, they produce oestrogens or progesterone
Theca cells
Endocrine cells in the ovary that surround the follicle. They have many functions during follicle growth, including the synthesis of androgens
Septum
A thin strand of tissue running across the cyst cavity from one internal surface to the contralateral side
Solid areas
Areas exhibiting high echogenicity suggesting the presence of tissue (e.g. myometrium, the ovarian stroma, myomas, fibromas). In adnexal tumours diffuse wall thickening, normal ovarian stroma, and regular septa are not regarded as solid tissue
Papillary formations
Any solid projections into the cyst cavity from the cyst wall with a height greater than or equal to 3 mm
Acoustic shadows
A loss of acoustic echo behind a sound-absorbing structure
Unilocular cyst
A cyst without septa and without solid parts or papillary structures
Unilocular solid cyst
A cyst with one locule and a measurable solid component or at least one papillary structure
Multilocular cyst
A cyst with at least one septum but no measurable solid components or papillary projections
Multilocular solid cyst
A cyst with at least one septum and a measurable solid component or papillary projection
Solid mass
A tumour where the solid components comprise 80 % or more of the tumour when assessed in a two-dimensional section
Colour score
A subjective and semi-quantitative assessment of blood flow within an ovarian mass. The following terms can be used to describe the amount of blood flow (area and colour scale) within the septa, cyst walls, or solid tumour areas: a score of 1 is given when no blood flow can be found in the lesion; a score of 2 is given when only minimal flow can be detected; a score of 3 is given when moderate flow is present, and a score of 4 is given when the adnexal mass appears highly vascular with marked blood flow
Haemoperitoneum
The presence of blood in the peritoneal cavity
Literatuur
1.
go back to reference Condous G, Khalid A, Okaro E, Bourne T. Should we be examining the ovaries in pregnancy? Prevalence and natural history of adnexal pathology detected at first-trimester sonography. Ultrasound Obstet Gynecol. 2004;24(1):62–6. CrossRef Condous G, Khalid A, Okaro E, Bourne T. Should we be examining the ovaries in pregnancy? Prevalence and natural history of adnexal pathology detected at first-trimester sonography. Ultrasound Obstet Gynecol. 2004;24(1):62–6. CrossRef
2.
go back to reference Kaijser J. Towards an evidence-based approach for diagnosis and management of adnexal masses: findings of the International Ovarian Tumour Analysis (IOTA) studies. Facts Views Vis Obgyn. 2015;7(1):42–59. PubMedPubMedCentral Kaijser J. Towards an evidence-based approach for diagnosis and management of adnexal masses: findings of the International Ovarian Tumour Analysis (IOTA) studies. Facts Views Vis Obgyn. 2015;7(1):42–59. PubMedPubMedCentral
3.
go back to reference Kaijser J, Sayasneh A, Hoorde K van, Ghaem-Maghami S, Bourne T, Timmerman D, Calster B van. Presurgical diagnosis of adnexal tumours using mathematical models and scoring systems: a systematic review and meta-analysis. Hum Reprod Update 2014;20(3):449–62. CrossRef Kaijser J, Sayasneh A, Hoorde K van, Ghaem-Maghami S, Bourne T, Timmerman D, Calster B van. Presurgical diagnosis of adnexal tumours using mathematical models and scoring systems: a systematic review and meta-analysis. Hum Reprod Update 2014;20(3):449–62. CrossRef
4.
go back to reference Kurman RJ, Carcangiu ML, Herrington CS, Young RH. WHO classification of tumours, volume 6: WHO classification of tumours of female reproductive organs. 4th ed. Lyon: IARC press; 2014. Kurman RJ, Carcangiu ML, Herrington CS, Young RH. WHO classification of tumours, volume 6: WHO classification of tumours of female reproductive organs. 4th ed. Lyon: IARC press; 2014.
5.
go back to reference Leiserowitz GS, Xing G, Cress R, Brahmbhatt B, Dalrymple JL, Smith LH. Adnexal masses in pregnancy: how often are they malignant? Gynecol Oncol. 2006;101(2):315–21. CrossRef Leiserowitz GS, Xing G, Cress R, Brahmbhatt B, Dalrymple JL, Smith LH. Adnexal masses in pregnancy: how often are they malignant? Gynecol Oncol. 2006;101(2):315–21. CrossRef
6.
go back to reference Medeiros LR, Rosa DD, Bozzetti MC, Fachel JM, Furness S, Garry R, Rosa MI, Stein AT. Laparoscopy versus laparotomy for benign ovarian tumour. Cochrane Database Syst Rev. 2009;(2):CD004751. Medeiros LR, Rosa DD, Bozzetti MC, Fachel JM, Furness S, Garry R, Rosa MI, Stein AT. Laparoscopy versus laparotomy for benign ovarian tumour. Cochrane Database Syst Rev. 2009;(2):CD004751.
7.
go back to reference Meys EM, Kaijser J, Kruitwagen RF, Slangen BF, Calster B van, Aertgeerts B, Verbakel JY, Timmerman D, Gorp T van. Subjective assessment versus ultrasound models to diagnose ovarian cancer: a systematic review and meta-analysis. Eur J Cancer 2016;58:17–29. CrossRef Meys EM, Kaijser J, Kruitwagen RF, Slangen BF, Calster B van, Aertgeerts B, Verbakel JY, Timmerman D, Gorp T van. Subjective assessment versus ultrasound models to diagnose ovarian cancer: a systematic review and meta-analysis. Eur J Cancer 2016;58:17–29. CrossRef
8.
go back to reference Parker WH, Feskanich D, Broder MS, Chang E, Shoupe D, Farquhar CM, Berek JS, Manson JE. Long-term mortality associated with oophorectomy compared with ovarian conservation in the nurses’ health study. Obstet Gynecol. 2013;121(4):709–16. CrossRef Parker WH, Feskanich D, Broder MS, Chang E, Shoupe D, Farquhar CM, Berek JS, Manson JE. Long-term mortality associated with oophorectomy compared with ovarian conservation in the nurses’ health study. Obstet Gynecol. 2013;121(4):709–16. CrossRef
9.
go back to reference Satasneh A, Ekechi C, Ferrara L, Kaijser J, Stalder C, Sur S, Timmerman D, Bourne T. The characteristic ultrasound features of specific types of ovarian pathology. Int J Oncol. 2015;46(2):445–58. CrossRef Satasneh A, Ekechi C, Ferrara L, Kaijser J, Stalder C, Sur S, Timmerman D, Bourne T. The characteristic ultrasound features of specific types of ovarian pathology. Int J Oncol. 2015;46(2):445–58. CrossRef
10.
go back to reference Timmerman D, Valentin L, Bourne TH, Collins WP, Verrelst H, Vergote I; International Ovarian Tumor Analysis (IOTA) Group. Terms, definitions and measurements to describe the sonographic features of adnexal tumors: a consensus opinion from the International Ovarian Tumor Analysis (IOTA) Group. Ultrasound Obstet Gynecol. 2000;16(5):500–5. CrossRef Timmerman D, Valentin L, Bourne TH, Collins WP, Verrelst H, Vergote I; International Ovarian Tumor Analysis (IOTA) Group. Terms, definitions and measurements to describe the sonographic features of adnexal tumors: a consensus opinion from the International Ovarian Tumor Analysis (IOTA) Group. Ultrasound Obstet Gynecol. 2000;16(5):500–5. CrossRef
Metagegevens
Titel
Benign pelvic mass
Auteurs
Toon van Gorp
Dr Peggy M. A. J. Geomini
Copyright
2019
Uitgeverij
Bohn Stafleu van Loghum
DOI
https://doi.org/10.1007/978-90-368-2131-5_24