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Self-Assessment Questions

Obstetrics & Gynecology

Pelvic Mass: Review Questions

Gerald J. Harkins, MD

Dr. Harkins is an assistant professor of obstetrics and gynecology, Penn State-Milton S. Hershey Medical Center, Hershey, PA.

Choose the single best answer for each question.

Questions 1 to 3 refer to the following case.
A 67-year-old Caucasian woman who had been in good health until approximately 6 months ago presents to her primary care physician with increased abdominal discomfort, persistent “fullness,” and early satiety. Over the past 2 months, the patient has had gradual worsening of these complaints, and she has developed progressive abdominal distention to the extent that her slacks no longer fit. The patient denies significant past medical or surgical diseases. She underwent menopause at age 55 years, and she has no past history of disorders of pregnancy or gynecologic diseases. The patient’s mother had ovarian cancer, and one of the patient’s aunts also had a gynecologic malignancy. The patient is married, has 2 daughters, and is a smoker (1 pack/day). Examination of the abdomen shows obvious abdominal distention. A fluid wave is present, with shifting dullness. No masses are appreciated. Recto-vaginal examination demonstrates a large, firm mass in the right adnexa and nodularity in the cul-de-sac. The limits of the mass cannot be fixed. A chest radiograph shows a small, right-sided pleural effusion. A computed tomography (CT) scan reveals a 12-cm mass of heterogeneous texture in the right ovary. A large number of ascites is present. The patient is informed that she most likely has an ovarian malignancy.

1.  What type of ovarian cancer is most common in this patient’s age-group?
  1. Dysgerminoma
  2. Endodermal sinus tumor
  3. Epithelial ovarian cancer
  4. Mature teratoma
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2.  What is the primary treatment for this type of ovarian cancer?

  1. Chemotherapy
  2. Gamma knife radiotherapy
  3. Surgery with tumor debulking followed by chemotherapy
  4. Tandem and ovoid placement with external beam radiation
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3. What fact in this patient’s history is associated with an increased lifetime risk of ovarian cancer?

  1. Having 2 daughters
  2. Mother with ovarian cancer
  3. Smoking history
  4. Symptom onset of 6 months
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4. What is the most likely diagnosis for this ovarian neoplasm?
  1. Ectopic pregnancy
  2. Epithelial ovarian cancer
  3. Hemorrhagic corpus luteum
  4. Mature cystic teratoma
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5. If a cytogenetic analysis of the ovarian mass is performed, what would the resultant karyotype be?

  1. 45,X
  2. 46,XX
  3. 46,XY
  4. 47,XXY
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6. During a routine pelvic examination, a 19-year-old woman is found to have “fullness” on her lower right pelvis. She denies pelvic pain or discomfort. A pelvic ultrasound is ordered and reveals a 4-cm unilocular, simple cyst on her right ovary. The uterus and left ovary are normal. What is the next step in the management of this patient?

  1. CT of the abdomen and pelvis
  2. Immediate surgical evaluation of the cyst via laparoscopy
  3. Initiate oral contraceptive pills to help resolve the asymptomatic cyst
  4. No immediate intervention; order a follow-up pelvic ultrasound in 6 to 8 weeks
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7. A 14-year-old girl presents to the emergency department with a 1-day history of acute right lower pelvic pain. She is afebrile, and a urine pregnancy test is negative. An abdominal pelvic computed tomography CT scan shows a 6-cm right adnexal mass. Transvaginal ultrasound confirms a swollen right adnexa with absent blood flow to the right ovary. An ovarian torsion is suspected. What is the next step in the management of this patient?

  1. Urgent surgical intervention with laparoscopy and plan to detorse or untwist the ovary and adnexa
  2. Urgent surgical intervention with laparoscopy and plan to excise or remove the torsed adnexa and ovary
  3. Urgent surgical intervention via laparotomy and plan to excise or remove the torsed adnexa and ovary
  4. Admission to the hospital for observation and repeat transvaginal ultrasound in 6 hours
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