Clinical case tumors
A 24-year-old woman has a 4 cm simple, thin-walled ovarian cyst, as shown on an ultrasound. She is asymptomatic. What is the most likely diagnosis?
Functional cyst/simple cyst.
A 26-year-old woman has vulvar itching, redness, and a white, granular vaginal discharge. She has recently used antibiotics. What is the most likely diagnosis?
Vulvovaginal candidiasis
What is the most important acute complication of a large ovarian cyst?
Ovarian/Adnexal torsion
Which benign tumor is the most common?
Myoma
Which pregnancy complication is associated with untreated bacterial vaginosis?
Bacterial vaginosis is associated with PPROM, chorioamnionitis, and preterm birth.
A 32-year-old woman presents with dysmenorrhea, dyspareunia, and a homogeneous, "ground-glass"-like ovarian finding. What is the most likely diagnosis?
Endometrioma/"chocolate-cyst".
A 31-year-old woman has a thin, greyish-white vaginal discharge with a fishy odor. She experiences little pain and little itching. What is the most likely diagnosis?
Bacterial vaginosis
A 25-year-old woman suddenly develops unilateral right-sided abdominal pain, nausea, and vomiting. Which two acute diagnoses must be ruled out?
Appendicitis and Adnexal torsion
What is a benign ovarian tumor that can contain fat, hair, and tooth structures called?
Teratoma/Mature teratoma
Why should bacterial vaginosis be considered in pregnant women with symptoms?
It can contribute to PPROM, chorioamnionitis, and prematurity.
A 28-year-old woman with a known 7 cm dermoid cyst experiences sudden pain and vomiting. Ultrasound shows an enlarged ovary and reduced Doppler flow. What is the diagnosis?
Adnexal torsion
A 24-year-old woman presents with the recent onset of bilateral pelvic pain, abnormal vaginal discharge, dyspareunia, and fever. A gynecological examination reveals tenderness upon movement of the uterus. What is the most likely diagnosis, and for which two STIs should she be tested?
PID; test for chlamydia and gonorrhea
What is the appropriate acute management when there is a high suspicion of ovarian torsion?
Acute laparoscopy with detorsion and ovarian preservation, if possible
What is a benign epithelial ovarian tumor with viscous contents called?
Mucinous cystadenoma
Which infection can cause neonatal conjunctivitis and pneumonia in newborns?
Chlamydia trachomatis
A 45-year-old woman has menorrhagia, iron-deficiency anemia, and several intramural fibroids. What is the most likely cause of the bleeding problems?
Intramural/submucosal myomas
A 29-year-old woman with PID develops, after a few days, pain under the right costal margin, fever, and pain upon deep inspiration. What is this complication called?
Fitz-Hugh–Curtis syndrome, can confuse with symptoms of lungdisease/infection and/or biliary tract disease.
A woman with a tubo-ovarian abscess develops sudden, diffuse abdominal pain, vomiting, hypotension, and a worsening general condition. What should be suspected?
Rupture of the abscess with peritonitis and possible sepsis.
What is the combination of a benign ovarian fibroma, ascites, and pleural effusion called?
Meigs syndrome
Why is primary genital herpes near term a feared condition?
It can cause neonatal herpes, which can be life-threatening for the baby.
presents with dyspnea, a dry cough, and painful abdominal distension. Upon examination, you find diminished breath sounds, signs of ascites, and a palpable mass in the lower abdomen. What is the most likely diagnosis?
Meigs syndrome
A 35-year-old woman presents with fever, severe unilateral pelvic pain, and a tender, complex adnexal mass on ultrasound. She shows no improvement after 48 hours of intravenous antibiotics. What is the most likely diagnosis, and what is the next step in management?
Tubo-ovarian abscess; consider continuing or switching intravenous antibiotics and surgical drainage
A corpus luteum cyst ruptures, and the patient experiences a sudden drop in blood pressure and becomes drowsy. What has happened?
Hemoperitoneum and hemodynamic instability = severe bleeding in the abdominal cavity
What is the difference between a functional cyst and a neoplastic cyst?
A functional cyst is a harmless, temporary fluid-filled sac that forms as a normal part of the menstrual cycle and goes away on its own. In contrast, a neoplastic cyst is an abnormal, independent growth of tissue (a tumor) that does not resolve on its own and can be either benign or malignant.
A 27-year-old pregnant woman at 24 weeks' gestation presents with fever and joint pain. Ultrasound shows fetal hydrops, ascites, and an MCA-PSV of 1.8 MoM (indicating that the fetus has severe anemia). What is the diagnosis, and how do you treat the fetal severe anemia?
Infection with parvovirus B19. Transfusion!