Gynecologic Exam & Pathology
Recommended Reading
Board Questions
A 45-year-old female sees you for follow-up after an emergency department visit in which CT of the abdomen and pelvis was performed to detect kidney stones. Kidney stones were not seen and her flank pain was determined to be musculoskeletal in origin. She is feeling better now. However, the CT showed a simple-appearing 5.2-cm ovarian cyst with assessment limited by artifact. She does not have any symptoms, pelvic pain, bloating, fevers, night sweats, or unintentional weight loss. There is no family history of ovarian or breast cancer. She reports regular menstrual cycles.
Which one of the following would be most appropriate at this point?
A) Reassurance only
B) A CA-125 level
C) Ultrasonography of the pelvis
D) MRI of the pelvis
E) Referral to a gynecologic oncologist
ANSWER: C
Ovarian incidentalomas are very common, and appropriate management depends upon the size and appearance of the incidentaloma as well as the menopausal status of the patient. The Society of Radiologists in Ultrasound states that simple cysts 5 cm in premenopausal women and simple cysts 3 cm in postmenopausal women are considered normal and do not require follow-up. The American College of Radiology recommends that immediate ultrasonography be performed in the evaluation of simple-appearing cysts that are incompletely characterized by CT and are >5 cm in premenopausal women or >3 cm in postmenopausal women. This patient’s cyst appears benign, but further evaluation is recommended due to the large size. CA-125 levels have low sensitivity and specificity in premenopausal women and would not be indicated in this case. The initial imaging of choice is pelvic ultrasonography, so MRI of the pelvis is not necessary. Referral to a gynecologic oncologist is not indicated because there is no current evidence to suggest malignancy.
