Medical brain notes 42

  Ovarian Neoplasms The area between the lateral pelvic wall and the  cornu of the uterus is called the adnexal space.   The structures in this space are called the adnexa and include the ovaries, fallopian tubes, upper portion of the broad ligament and mesosalpinx, and remnants of the embryonic müllerian duct. Of these, the organs most com-monly affected by disease processes are the ovaries and fallopian tubes.

  DIFFERENTIAL DIAGNOSIS   Because the adnexal space is located near urinary and gastrointestinal organs, disorders of these organs may cause symptoms in the pelvic area that need to be distin-guished from gynecologic disorders. The most common urologic disorders are upper and lower  urinary tractinfection,  and the less common  renal and ureteral cal-culi.  Even rarer are anatomic abnormalities such as a  ptotic kidney,  which may present as a solid pelvic mass.An isolated pelvic kidney may likewise present as an asymp-tomatic, solid, cul-de-sac mass. Right adnexal signs and symptoms are associated with acute  appendicitis,  which should be considered in the differential diagnosis of acute right-lower-quadrant pain. Less commonly, symp-toms in the right adnexa may be related to intrinsic  inflammatory bowel disease  involving the ileocecaljunction. Left-sided bowel disease involving the recto-sigmoid is seen more often in olde...

  EVALUATION OF OVARIAN DISEASE   A thorough pelvic examination is essential for evaluation of the ovary. Symptoms that may arise from physiologic and pathologic processes of the ovary must be correlated with physical examination findings. Also, because some ovarian conditions are asymptomatic, incidental physical examina-tion findings may be the only information available when an evaluation begins. Interpretation of examination find-ings requires knowledge of the physical characteristics of the ovary during the stages of the life cycle.   In the  premenarchal age group,  the ovary should not be palpable.   If it is, a pathologic condition is presumed, and further eval-uation is necessary.   In the  reproductive-age group,  the normal ovary is palpable about half the time.  Important considerations includeovarian size, shape, consistency (firm or cystic), and mobil-ity. In reproductive-age women taking oral contracep-tives, the ovaries a...

  FUNCTIONAL OVARIAN CYSTS   Functional ovarian cysts  are not neoplasms, but, rather,anatomic variations that arise as a result of normal ovarian function.  They may present as an asymptomatic adnexalmass or become symptomatic, requiring evaluation and possibly treatment.   When an ovarian follicle fails to rupture during follic-ular maturation, ovulation does not occur, and a  follicularcyst  may develop. This process, by definition, involves alengthening of the follicular phase of the cycle, with resul-tant transient secondary amenorrhea. Follicular cysts are lined by normal granulosa cells, and the fluid contained in them is rich in estrogen.   A follicular cyst becomes clinically significant if it is large enough to cause pain or if it persists beyond one men-strual interval. For poorly understood reasons, the granulosa cells lining the follicular cyst persist through the time when ovulation should have occurred and continue to enlarge throug...

  BENIGN OVARIAN NEOPLASMS   Although most ovarian enlargements in the reproductive-age group are functional cysts, about 25% prove to be  nonfunctionalovarian neoplasms.  In the reproductive-age group, 90% ofthese neoplasms are benign, whereas the risk of malignancy rises to approximately 25% when postmenopausal patients are also included. Thus, ovarian masses in older patients and in reproductive patients who show no response to oral con-traceptive treatment are of special concern. Unfortunately, unless the mass is particularly large or becomes symp-tomatic, these masses may remain undetected for some time. Many ovarian neoplasms are first discovered at the time of routine pelvic examination.   Ovarian neoplasms are usually categorized by the cell type of origin:   ·              Epithelial cell tumors,  the largest class of ovarian neo-plasm   ·       ...

  MALIGNANT OVARIAN NEOPLASMS   Ovarian cancer is the fifth most common of all cancers in women in the United States and the most common cause of gynecologic cancer. The mortality rate of this disease is the highest of all the gynecologic malignancies,  primarily because of the difficultyin detecting the disease before widespread dissemination. Of the estimated 25,000 new cases of ovarian cancer yearly, approximately 60% will die within 5 years. Sixty-five to seventy percent are diagnosed at an advanced state when the 5-year survival rate is 20–30%. Risk Factors and Early Symptoms   Ovarian cancer presents most commonly in the fifth and sixth decades of life.  The incidence of ovarian cancer in WesternEuropean countries and in the United States is higher, with a five- to sevenfold greater incidence than age-matched populations in East Asia. Whites are 50% more likely to develop ovarian cancer than blacks living in the United States.   Symptoms of ovarian ca...