pelvic mass
Introduction
Introduction The pelvic mass is often one of the main complaints for gynecological patients, and it is also a common sign of gynecological pelvic examination. Most of the pelvic masses come from the female genitalia. The masses can be found unintentionally by the patient or his family. They can also be found when pelvic examination is performed because of other symptoms such as pain and difficulty in diarrhea or other diseases. The pelvic mass of young girls and postmenopausal women is mostly ovarian malignant tumors; the mass of adolescent girls may be congenital genital malformations, or deformed obstruction of menstrual outflow; women of childbearing age of 20-30 should first consider the uterus of pregnancy, ectopic Pregnancy or pelvic inflammatory mass; 30-40 year old women with uterine fibroids, ovarian chocolate cysts are more common; in addition, ovarian tumors can occur in women of any age.
Cause
Cause
The pelvic mass can be divided into the following according to its etiology.
1. Functional color block: for physiological or temporary mass, found in pregnant uterus, ovarian corpus luteum cysts, etc.
2. Inflammatory color block: found in hydrosalpinx, fallopian tube ovarian cysts.
3. Obstructive color block: due to genital atresia or poor intestinal bowel movement, seen in the uterine blood, incarcerated feces and so on.
4. Neoplastic color block: found in uterine fibroids and ovarian tumors.
5. Other masses: including the cause of the disease is unknown, and the mass formed by iatrogenic, seen in the endometriotic cyst of the ovary, residual foreign bodies in the pelvis.
Examine
an examination
Related inspection
Fallopian tube fluid examination vaginal cytology X-ray lipiodol angiography hysteroscopic follicle stimulating hormone (FSH)
Physical examination
A thorough physical examination is necessary, especially when the suspected pelvic mass is a malignant tumor. Pelvic examination is an important part of physical examination, which generally includes abdominal examination, yin examination, speculum examination, double diagnosis and triple examination. Unmarried persons undergo an anal abdominal examination. The urine should be emptied before the examination, and the constipation person should first defecate. When performing a lower abdominal examination, the upper edge of the mass that has exceeded the pelvis should be accessible from top to bottom. When doing pelvic examination, you must know the location, size, shape, hardness, boundary, activity and its relationship with other organs, and whether there is tenderness.
Laboratory inspection
Blood, urine routine and if necessary, cervical smear secretion and culture to find gonorrhea, as well as Chlamydia trachomatis culture and other methods can help diagnose genital tract infections. Blood BHCG or urine enzyme-linked immunosorbent assay is a reliable method for diagnosing normal pregnancy, ectopic pregnancy and gestational trophoblastic disease. Conventional serum annual fetal protein, carcinoembryonic antigen and CA125. Monoclonal antigen assays contribute to the diagnosis of various types of ovarian cancer. Cytology and chromosomal examination, a few pelvic masses with ascites, can be ascites through the abdomen or posterior sacral aspirate to find cancer cells, and do chromosome examination to see if there are polyploid and aneuploid and other distorted chromosomes. For patients without ascites, a small needle can be directly used to puncture a solid mass into a solid mass for smear examination to identify the benign and malignant mass of the mass.
Device inspection
1. Ultrasonography
Pelvic B-mode ultrasonography can determine the location, size, shape, quality of the pelvic mass, the relationship with the uterus, and the presence or absence of ascites in the pelvic cavity. It can also observe the presence or absence of the gestational sac or the embryo and its location. Ultrasound is more accurate than pelvic examination in determining whether the mass is cystic or solid. Ultrasound is considered to be an extremely valuable method for the diagnosis of uterine fibroids, ovarian tumors, intrauterine pregnancy, ectopic pregnancy and hydatidiform moles.
2. Posterior puncture
Puncture of the peritoneal fluid through the posterior malleolus can help to understand the source and nature of the pelvic mass. After taking out fresh blood, it will not condense into ectopic pregnancy rupture or rupture of ovarian corpus luteum cyst; those who take out brown liquid, generally rupture of ovarian endometriosis cyst; when there is pus aspiration, it can be determined as pelvic inflammatory disease; only a small amount There is no diagnostic value when it is clear yellowish liquid or no liquid is aspirated.
3. Laparoscopy
Laparoscopy can be performed on pelvic masses with unknown nature and without extensive adhesion. If necessary, biopsy should be performed to confirm the diagnosis.
Diagnosis
Differential diagnosis
The diagnosis should be differentiated from the following symptoms:
Pelvic pain
The clinical features of pelvic septicemia are "three pains, two more and one less". That is, pelvic pain, low back pain, sexual pain, menstruation, vaginal discharge, gynecological examination with fewer positive signs. Pelvic venography is often required. Laparoscopic or surgical confirmation of pelvic vein thickening, detour, varicose veins, and other organic diseases of the reproductive organs are excluded. This disease is more common in early marriage, early childbirth, prolific, post-uterine, habitual constipation and long-term standing women, especially in patients with chronic abdominal pain after female sterilization, laparoscopic examination, the intrinsic detection rate is 29.76% At present, the main cause of this disease is surgical treatment.
2. There is extensive infiltration in the pelvic cavity
Rectal cancer spread out of the intestinal wall when there is extensive infiltration in the pelvic cavity (or recurrence in the pelvic cavity after surgery), which can cause soreness in the waist and ankle, and a feeling of swelling.
3. Pelvic abscess
Most of the pelvic abscesses are not treated promptly by acute pelvic connective tissue inflammation. The suppuration forms a pelvic abscess. This abscess can be confined to one or both sides of the uterus, and the pus flows into the deep pelvic cavity.
diagnosis
The patient's age, menstrual history, marriage and childbirth history, past history, and the development of the mass and accompanying symptoms all contribute to the diagnosis of the mass.
Women of childbearing age with pelvic mass with menopause should consider pregnancy uterus, pregnancy with ovarian corpus luteum cyst or ectopic pregnancy mass; with excessive menstrual flow, may be uterine fibroids; secondary dysmenorrhea history and progressive aggravation Most of them are endometriosis or adenomyosis; with less menstrual flow, menstrual thinning or long-term amenorrhea, mostly tuberculous masses; periodic vaginal bleeding in young women, irregular menstruation or menopause in women of childbearing age When women have vaginal bleeding combined with pelvic mass, ovarian sexual cord stromal tumors should be considered.
Unmarried women with pelvic masses must consider uterine malformations, ovarian tumors or tuberculous pelvic inflammatory disease; those who use intrauterine contraceptives or have a history of secondary infertility may also have inflammation; those with a history of repeated abortions When pelvic masses, the possibility of uterine malformations or fibroids should be considered. Hematoma should be thought of in the recent history of pelvic mass. The possibility of residual inflammation or foreign body; previous history of pelvic surgery, multiple postoperative adhesion mass or chronic attachment inflammation; history of gastrointestinal cancer, pelvic mass, especially in bilateral masses, Metastatic ovarian cancer should be considered. Patients with a history of uterine fibroids, endometrial cancer or ovarian cancer in their immediate family members should be alert to the possibility that the patient is also a cancer of this type.
There are pelvic masses in the past, long-term no change or very slow growth, benign tumors; short-term tumor growth is rapid, many malignant tumors; no pelvic mass in the past, rapid emergence in a short period of time, abnormal uterus with pregnancy, Ectopic pregnancy, the possibility of chocolate cysts; the mass shrinks or even disappears, for physiological or. Inflammatory mass.
When acute pelvic mass occurs in acute abdominal pain, when considering ovarian tumor pedicle torsion or rupture; bleeding after menstruation with abdominal pain and mass, mostly ectopic pregnancy; with abdominal pain, high heat mass is acute attachment inflammatory block; menstruation Too little, low fever, night sweats and abdominal pain are mostly tuberculous blocks.
Second, physical examination
A thorough physical examination is necessary, especially when the suspected pelvic mass is a malignant tumor. Pelvic examination is an important part of physical examination, which generally includes abdominal examination, yin examination, speculum examination, double diagnosis and triple examination. Unmarried persons undergo an anal abdominal examination. The urine should be emptied before the examination, and the constipation person should first defecate. When performing a lower abdominal examination, the upper edge of the mass that has exceeded the pelvis should be accessible from top to bottom. When doing pelvic examination, you must know the location, size, shape, hardness, boundary, activity and its relationship with other organs, and whether there is tenderness.
Third, laboratory inspection
Blood, urine routine and if necessary, cervical smear secretion and culture to find gonorrhea, as well as Chlamydia trachomatis culture and other methods can help diagnose genital tract infections. Blood BHCG or urine enzyme-linked immunosorbent assay is a reliable method for diagnosing normal pregnancy, ectopic pregnancy and gestational trophoblastic disease. Conventional serum annual fetal protein, carcinoembryonic antigen and CA125. Monoclonal antigen assays contribute to the diagnosis of various types of ovarian cancer. Cytology and chromosomal examination, a few pelvic masses with ascites, can be ascites through the abdomen or posterior sacral aspirate to find cancer cells, and do chromosome examination to see if there are polyploid and aneuploid and other distorted chromosomes. For patients without ascites, a small needle can be directly used to puncture a solid mass into a solid mass for smear examination to identify the benign and malignant mass of the mass.
