Pelvic masses

Epidemiology and demographics
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
In alphabetical order:


 * 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

History and Symptoms

 * Determine whether the mass is painful

Abdomen

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

Other

 * Full breast exam
 * Full lymph node exam

Laboratory Findings

 * Labs include:
 * BUN/creatinine
 * CBC w/ differential
 * Culture for gonorrhea and chlamydia
 * Hemoccult testing
 * Liver function tests
 * Pap smear
 * Urinalysis

Electrolyte and Biomarker Studies

 * Tumor markers if ultrasound is abnormal
 * Beta-hCG
 * Serum CA-125
 * LDH

MRI and CT

 * Pelvic CT
 * Abdominal CT

Echocardiography or Ultrasound

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

Other Diagnostic Studies

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

Acute Pharmacotherapies

 * Leiomyoma
 * Hypoestrogenic medications

Indications for Surgery

 * 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

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