USMLE Forum Archives - USMLE Step 2 CK - gyne
gyne
sudha2015 - 01-12-11 12:48
A 37-year-old female presented to your office with an ultrasound report suggestive of bilateral ovarian masses. You take her to the operating room for an exploratory laparotomy and note the left ovary to be replaced by an 8 x 9 cm neoplastic process. The right ovary appears to have a small 2 x 2 cm cystic process, similar in appearance to the left ovary, involving only a small portion of the right ovary. After obtaining pelvic and upper abdominal washings, you remove the left ovary and then perform a cystectomy on the right ovary, removing all visible disease without rupture. The frozen section on both resected specimens reveals a serous tumor of low malignant potential (LMP). The best procedure for the patient at this point is which of the following?
A. termination of the procedure; await final pathology report on the resected specimens
B. total abdominal hysterectomy and right salpingo-oophorectomy
C. omentectomy and peritoneal biopsies
D. omentectomy, peritoneal biopsies, selected pelvic and peritoneal lymph node sampling
E. terminate procedure and prescribe postoperative chemotherapy
sudha2015 - 01-12-11 12:48
A 37-year-old female presented to your office with an ultrasound report suggestive of bilateral ovarian masses. You take her to the operating room for an exploratory laparotomy and note the left ovary to be replaced by an 8 x 9 cm neoplastic process. The right ovary appears to have a small 2 x 2 cm cystic process, similar in appearance to the left ovary, involving only a small portion of the right ovary. After obtaining pelvic and upper abdominal washings, you remove the left ovary and then perform a cystectomy on the right ovary, removing all visible disease without rupture. The frozen section on both resected specimens reveals a serous tumor of low malignant potential (LMP). The best procedure for the patient at this point is which of the following?
A. termination of the procedure; await final pathology report on the resected specimens
B. total abdominal hysterectomy and right salpingo-oophorectomy
C. omentectomy and peritoneal biopsies
D. omentectomy, peritoneal biopsies, selected pelvic and peritoneal lymph node sampling
E. terminate procedure and prescribe postoperative chemotherapy
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#1
Re: gyne babbu5508 - 01-12-11 13:12 B. total abdominal hysterectomy and right salpingo-oophorectomy...because of the tendency to progress to a potential malignancy...
#2
Re: gyne
sudha2015 - 01-12-11 13:44 The answer is D.
EXPLANATION: Borderline tumors of the ovary, or tumors of low malignant potential (LMP), represent approximately 15% of all epithelial ovarian tumors. The average age at diagnosis is 40 years of age, 15–20 years earlier than is the average age at diagnosis for the invasive ovarian counterpart.
Roughly 50% of all borderline tumors are serous. Because most borderline serous tumors occur in women of reproductive age and are classified as stage I at the time of diagnosis, treatment is usually conservative. Most patients can be managed with cystectomy or oophorectomy alone; in fact, cystectomy is the treatment of choice in the presence of bilateral borderline ovarian cystic tumors, or when only one ovary remains and fertility is desired. If the patient is perimenopausal, postmenopausal, or has no desire for fertility, hysterectomy with bilateral salpingo-oophorectomy is recommended.
When the diagnosis of borderline tumor is made on the basis of an intraoperative frozen section evaluation, a complete staging procedure is still recommended in the event the final pathology report reveals an invasive cancer. The staging information will be critical in that setting in order to determine the stage of disease present and the need for chemotherapy postoperatively. Surgical staging should include pelvic and abdominal cytology, random peritoneal biopsies (right hemidiaphragm, paracolic gutters, ovarian fossa bilaterally, cul-de-sac, and bladder flap), partial omentectomy, and lymph node sampling.
Unlike invasive ovarian neoplasms, chemotherapy has not been shown to be helpful in the management of ovarian tumors of LMP. LMP tumors have such a low cellular turnover rate that any DNA damage that results following exposure to chemotherapy is easily repaired prior to S-phase associated DNA replication.
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