By: ACLB/EDBS

Abortion and Vaginal bleeding

Dr. Helen albao
Chadwiks sign= bluish or pinkish
discoloration of the cervix
Differential dx of Major gynecological
problems:
-Vaginal bleeding
-Pelvic pain
-Pelvic Mass
These are categorized according to
age.
Differential Diagnosis
Three most common:
1. Unusual vaginal bleeding
2. Pelvic pain
3. Pelvic/ abdominal mass
Vaginal bleeding
Abnormal Vaginal bleeding:
1. Prepubertal bleeding
2. Menorrhagia
3. Metrorrhagia
4. Postcoital
5. Postmenopausal
6. Determine the Etiology.
7. For pregnancy
-determine the age (15-45)
-to rule in by doing serum
pregnancy test
(+)= rule in
(-)= does not rule out preg.
Differential Dx of pregnancy with
vaginal bleeding:
1. Implantation bleeding
2. Threatened abortion
3. Inevitable
4. Complete
5. Incomplete abortion
6. Ectopic
7. Molar pregnancy
Implantation bleeding
-characteristic:

-minimal bleeding at time of the first

menstrual period
-lasts for a very short time
-Present for 1-2 days w/a flow similar
to the Normal menstrual period
-oftentimes not perceptible to the px.
*majority of abortions are due to
chromosal defects
Molar pregnancy (trophoblastic ds.)
-bleeding at 2nd to 3rd trimester
Threatened Abortion
-Baby still alive
-if bleeding comes from the cervix and
it is closed
-Size of the Uterus- consistent w/ the
normal date of pregnancy. The uterus
may or may not be contracting, and
tender to touch.
Examination:
-Bimanual pelvic exam-Soft cervix
-In threatened abortion- cervix is close
if finger is inserted to the internal os.
-Uterus should be compatible to age of
gestation.
-At 11th to 12th weeks- the abdomen
should be at the level or above the
symphysis pubis
-At 20th week- level of umbilicus.
Inevitable Abortion
-signs:
Amenorrhea
V. bleeding
Abdominal pain
Bag of water rupture
Cervix dilates
There are products of conception at the
Internal os
-bleeding is profuse.

*threatened abortion progresses to

Inevitable abortion

By: ACLB/EDBS

Complete Abortion
-when the uterus has expelled its
contents, the Int. os is closed.
Bleeding is minimal
-uterus returns near normal size
Incomplete abortion
Common at 6 weeks of gestation
-pass out meaty tissues
-a part of the products of conception
are expelled but some remains in the
uterus
-cervix is dilated, there is bleeding and
profuse
Uterus is smaller than the actual AOG
-px experiences Crampy abdominal
pain
*Symptoms of blood loss:
-blurring of vision
-dimming of vision
-pulses are threading?
-may lead to coma and death
Missed Abortion
-Retention of the dead products
-occur 3-4 weeks after fetal death
-Uterus involutes so it is smaller than
the expected date.
-weight loss
-bleeding is often minimal with dark
red to brown blood.
-(+) preg test remain for quite
sometime
-Cervix is round & soft
Ectopic pregnancy
-implantation outside the endometrial
cavity
-may occur in the Cervix, fallopian
tube, ovary, peritoneal cavity
-can occur in distant organs like spleen
but rare.

-Primary Ectopic preg. In a specific

organ implies that preg was implanted
directly within the organ.
-Secondary Ectopic preg Implies that
the pregnancy ruptured from the
fallopian tube & reimplanted.
Vaginal bleeding in Ectopic pregnancy:
-due to the separation of the decidua
from the endometrium as the implant
dies. Direct bleeding from the site of
the ectopic pregnancy, blood is
transported to the uterus and through
the cervix.
-triad of ectopic pregnancy
>amenorrhea 90%
>scanty to significant bleeding
>Pelvic pain
Unilateral pain-limited to one site in
case of fallopian tube pregnancy
-pain is at left or right iliac region
Generalized pain- in ruptured ectopic
pregnancy. Pain is similar to PID.
*in AP, px will have low grade fever.
*PID- present as lower abdominal pain
-2 fallopian tubes are the commonly
affected organs.
-presents vaginal discharges
Pain at both sides- generalized
abdominal pain
-spiking temp., chills
-ovaries are tender
-cervix is soft
In ruptured fallopian tube- there is
bleeding in the peritoneum causing
generalized pain
-there is acute blood loss
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By: ACLB/EDBS

Get history to know the etiology!

Because EP is the leading cause of
death in the 1st trimester.
In early ectopic pregnancy, 90 %
presents vaginal bleeding, assoc. with
abdominal pain. The uterus may be
enlarged or normal.
Tubal or ovarian pregnancy
-Adnexal mass may be noted (not
uncommon)
-common in normal pregnancies
representing the corpus luteum of
pregnancy .

-Pus seen in PID

Hemoperitoneum is secondary to
ruptured ectopic pregnancy.
Intraperitoneal blood seen on
Ultrasound is also suggestive of
intraperitoneal bleeding.
Risk factors of Ectopic pregnancy (EP)
1. Prior Ectopic pregnancy -40 to 50%
recurrent
2. Previous PID- like salphingitis,
vaginitis etc. can cause adhesion &
scarring leading to obstruction on the
expulsion of zygote.

Transvaginal ultrasound
-Intrauterine preg pregnancy 6th
weeks gestation; it is frequently
possible to see a gestational sac w/in
the uterine cavity.

3. Undergone tubal reparative

procedures
4. Smoking
5. Women exposed in utero to
Diethylstilbetrol (DES)- causes
contraction of the fallopian tube and
scarring
6. Users of Itrauterine Device (IUD)prevents uterine pregnancy but not
uterine preg.
7. Increasing Age
8. Previous abortion

-Ectopic pregnancy- Gestational may

be seen outside the uterine cavity, i.e.
in adnexa

Procedure for Ectopic (tubal)

Pregnancy
-Tubal salphingectomy

-Ruptured Ectopic pregnancy

Gestational Trophoblastic disease

-causes vaginal bleeding
Hydatidiform mole (uray) most
common trophoblastic tumor occurring
about 1/1000 gestations in non-asian
women.

-Adnexal tenderness.
Dx of Ectopic pregnancy:
(+) serum pregnancy test
-in normal preg and ectopic preg.

*Culdocentesis- aspiration of blood in

the abdominal cavity through the
posterior cul de sac (bulging in PID).
-the presence of clotted blood w/in
the peritoneal cavity is evidence for
intraperitoneal hemorrhage.
-Unclotted blood when blood
vessel is hit

Clinical manisfestation of H. mole:

>V. Bleeding
>Enlargement of Uterus beyond the
size of expected date of gestation.
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>Vaginal passage of grapelike
structures (hydropic villi)
> Hpn, edema, proteinuria causing pre
ecclamptic toxemia.
>HCG reaches 100,000 IU/L
Differential Dx of H. mole:
-Normal Gestation (error in LMP)
-Multiple gestation
-Pregnancy w/ Uterine Myoma
-Large fetus from diabetic mother
-Polyhydramnios
-Ultrasound exam in the late
trimester or early second trim
generally rules out H. mole.
> H. mole shows Snow storm
pattern appearance on Ultrasound.
Amniotic fluid is manufactured by the
fetus by urination which is balanced
by fetal swallowing.
>Polyhydramnios is due to obstruction
of the alimentary congenital tract.
Mean interval between menses:
28 days (+/-7 days)
Duration of flow:
4-7 days
Mean blood loss (MBL)
35 ml (31-44)
Abnormal Uterine bleeding (AUB)
-infrequent episodes, excessive,
prolonged duration
Etiology of AUB:
Organic cause
-due to systemic diseases
-diseases of the Reproductive tract
Non organic cause
-dysfunctional or endocrinologic

1.
2.
3.
4.
5.
6.
7.

Oligomenorrhea
Polymenorrhea
Menonorrhea
Metrorrhagia
Menometrorrhagia
Hypomenorrhea
Intermenstrual bleeding

Categories of AUB:
Ovulatory AUB
-Organic pathology: when AUB
interspersed with what is otherwise
regular cyclic ovulatory uterine
bleeding
-confirmed by BBT, plasma
progesterone
Anovulatory AUB
-Endocrinologic pathology: when AUB
assoc w/ anovulation
-rarely caused by other conditions
-Dx is made by exclusion
-seen in postpubertal period when
HPO is still immature.
Etiology- complications of pregnancy:
Most common:
1. Related to products of
conception
2. Incomplete abortion
3. Ectopic pregnancy
4. Endometrial lining degeneration
Dysfunctional Uterine Bleeding (DUB)
-no ovulation, no ovum
-endometrium is non secretory (do
endo. Biopsy)
Management of DUB:
Adolescent px mostly have normal
clotting factor profile, so do:
-Medical treatment 94%
-Dilatation and curettage (D&C) 6%

AUB may occur frequently in:

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DUB in menopause women
-Irregular pattern
-Scanty flow w/ prolonged spotting
-Dx: Endometrial Biopsy-Generally
sufficient to establish the appropriate
diagnosis of non-secreting
endometrium or hyperplasia.
DUB may be associated with:
-Polycystic ovarian disease (Steinlevintal syndrome)
-thyroid disease
-Pituitary disease
DUB may be secondary to;
-stress
-Excessive weight change
-excessive exercise performance
DUB in Reproductive years:
-Manifestation?
-Diagnosis: Endometrial biopsy
-Women older than 35 yrs old with
abnormal vaginal bleeding
-In women at risk for endometrial
hyperplasia or cancer, biopsy is
necessary even in younger women.
-complex endometrial hyperplasia=
Pre-malignant lesion.
Procedure:
-Measurement of menstrual blood
-Serum ferritin, hemoglobin, serum
iron, hCG
-Endometrial curettage
-Hysteroscopy-to visualize the
endometrial cavity and measure the
thickness of the lining endometrium
-Sonography (ultrasound) - measure
the depth of the lining
-Hysterosonography
DUB treatment
Medical treatment
-instead of surgical treatment
-in absent organic cause

-desires fertility
Definitive tx is determined by Dx:
-estrogens, progestins, NSAIDs,
Antifibrinolytics, Danazol, GnRH
DUB is anovulatory
-Progestin tx with Estrogen therapy
-After bleeding stops, CE is continued
and progestin ( Medroxyprogesterone
acetate 1o mg) once a day is added
-both hormones are given

Neoplastic causes of Vaginal

bleeding
-Can be caused by a wide variety of
neoplastic lesions
-both benign and malignant affects the
various organs of the female
reproductive tract.
Cancers of the Vulva and Vagina
-may present with vaginal bleeding
-usually occur in women at
postmenopausal period.
-in reproductive years, bleeding is
generally intermittent.
-presents as metrorrhagia or postcoital
bleeding rather than menses in normal
menstrual cycle
Tumors of the Cervix
-Squamous cell carcinomas-85%
-Adenocarcinomas -15 %
-Other cervical lesions, endocervical
polyps, may also cause metrorrhagia
Manifestations:
-metrorrhagia
-postcoital staining with larger lesions
bleeding may quite profuse.
Uterine Lesions:
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Submucous myomas
-the most common cause abnormal
bleeding during reproductive yrs.
-Benign lesion of the uterus.
-Rarely causes bleeding in
postmenopausal women.
-May cause menorrhagia or menometrorrhagia
-Generally assoc. with severe
menorrhagia

-severe inflammation in tissue leads to

Capillary oozing
Blood vessel erosion

Endometrial carcinoma is the most

common gynecologic malignancy in
Postmenopausal women, 90% of which
presents postmenopausal bleeding.
-Bleeding may be scanty or profuse
-Women are most often exposed to
continuous endogenous estrogen
stimulation.

>Acute salphingitis or tuboovarian

abscess may be also assoc. with
vaginal bleeding.
-secondary to endometrial
inflammation or
-abnormal uterine bleeding secondary
to ovarian dysfunction.
-the symptoms & signs of
inflammation, including discharge,
pain. Tenderness, generalized signs &
symptoms of infection will help in
Differential diagnosis

Fallopian tube cancer

-Rare & generally occurs in the
postmenopausal women.
-Scant vaginal bleeding associated
frequently with a;
-watery discharge
-Crampy pain
-Occasional adnexal mass (physician
should be alert)
Ovarian cancer
-Vaginal bleeding often results when
intraperitoneal blood enters the
fallopian tube and through uterus &
vagina.
-Functioning ovarian tumors
-Granulosa cell tumor or thecoma
-Bleeding may be caused by:
Hyperplastic endometrium
Endometrial cancer

Inflammatory conditions

>Vulvitis, vaginitis, cervicitis &

Endometritis
-May all be associated with vaginal
spotting
-Generally w/o relationship with
menstrual cycle

Traumatic conditions
Direct trauma to the female external
genitalia and internal reproductive
tract may occur:
>secondary to accidental injury
>placement of foreign bodies w/in the
vagina
>traumatic coitus.
> Coital lacerations
-bec. of rape or as part of
normal sexual function.
>Tears of the hymen or lacerations of
the vagina when tissue is rigid may
lead to severe vaginal bleed.
>Conization of the Cervix
>Bleeding of the vaginal cault after
hysterectomy.

-bleeding is not a common symptom

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Systemic diseases
-Clotting defects may be associated
with the natural hx. Of the dse.
-Coagulopathies
-blood dyscracia
-Endocrinopathies

Postmenopausal Bleeding
(PMB)
-accounts for 5% of all gynecologic
office visits.
-mostly caused by pre-malignant or
malignant
-the most common premalignant and
malignat causes are
>Complex hyperplasia w/ atypia
>Carcinoma of the endometrium
Other causes of PMB:
-Atrophic vaginitis
-Cervical polyps
-Leiomyomata uteri
-Endometrial hyperplasia
-Cervical erosion
-Trichomoniasis
-Hematuria
-Trauma
Diagnostic Procedures for PMB:
-Endometrial Biopsy
-Vaginal Ultrasonography w/
endometrial thickness estimation
-Sonohysterography
-Hysteroscopy w/ directed biopsy &
D&C.

Differential Diagnosis of Pelvic

and Abdominal pain
-Pain is defined as an unpleasant
sensory & emotional experience
assox. w/ actual or potential tissue
damage or described in terms of
such damage.

Acute Abdomen
The abdominal cavity is a
continuum & overlap of signs is
extremely common.
-Disease w/ in a tubular viscus may
cause crampy pain interspaced
with no pain or periods of dull pain.
(Bowel, fallopian tube, ureter)
-Inflammatory conditions involving
the ovary are frequently assoc. w/
continuous pain often described as
sharp and throbbing
Manifestations:
-sudden onset of abdominal pain
-tenderness to palpation
-rebound tenderness
Diminished or absent bowel sounds
Etiology:
may be caused by
-infection
-Hemorrhage
-Infarction of tissue
-obstruction of bowel
Differential Diagnosis of Acute
abdomen:
Preadolescent and adolescent
girls
-Acute appendicitis
Often presents initially as
periumbilical pain that localizes to
the right lower quadrant and is
accompanied by anorexia or
nausea and vomiting.
-Mesenteric lymphadenitis
-Torsion of an adnexa
-Salpingitis
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>tends to have a higher fever

than Appendicitis
>pain may be severe, they tend
to be less ill than those w/
appendicitis
Acute abdomen in Older
women
Differential Dx:
-Torsion or rupture of an adnexa
-acute cholecystitis
-Perforated ulcer
-Acute diverticulitis
Pelvic inflammatory disease is less
common in older women
- acute exacerbations are rare in
those who had tubal ligation.
Acute pelvic pain
-Acute pain of gynecologic origin
presents as both pelvic and lower
abdominal pain.
Differential diagnosis includes
diseases and dysfunction of the:
-Genito-urinary tract
-GIT
-Masculoskeletal system
Possible Causes of Acute Pelvic
and Lower Abdominal pain
Pregnancy-related:
>Abortion
>Ectopic preg.
Disorders of the Uterus & Cervix:
>Cervicitis
>Endometritis
>Degenerating myoma

Secondary to N. gonorrhoeae or C.
trachomatis, may frequently assoc.
w/ lower abdominal & pelvic pain.
-pain is often Dull, aching nature
-may radiate to the low back or the
upper thighs.
Clinical manifestation:
-Cervical and vaginal discharge
-Low grade fever
-Slight leukocytosis
-slight increase in ESR
Definitive Diagnosis is made by
Culture of the organism.
Degenerating myoma
-Presents w/ acute, sharp, or aching
pain in the region of the myoma
-The uterus is irregular & enlarged
& tender to palpation.
-There may be a mild leukocytosis
but generally in laboratory
parameters its normal.
Torsion of the Adnexa
-with or without an ovarian cyst or
tumor may lead to acute, crampy
or continuous pain w/c maybe
unilateral but may progress to
generalized lower abdominal pain.
Differential dx of Adnexal torsion:
-appendicitis
-PID
Acute Pelvico-abdominal pain
Ovarian Tumors
-Rupture of an ovarian cyst- may
cause a sudden onset of pain

Acute cervicitis
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-Leaking from a corpus luteum cyst

generally occurs midcycle and, if it
is on the right side, may be
misdiagnosed as appendicitis
-A hemorrhagic corpus luteum cyst
may cause acute pain.
Musculoskeletal disorders
-most pain that is limited to the
lower back but not to the
abdominal region
-generally of musculoskeletal origin
rather than from gynecologic dis.
Chronic and Recurrent pelvic
pain
-One of the major problems seen
by the gynecologist
-the most common examples of
recurrent pelvic pain include:
1. Dysmenorrhea
2. Premenstrual syndrome
3. Premenstrual Dysphoric disorder
Chronic pelvic pain is defined as
noncyclic recurrence of pelvic pain
for 6 or more months duration
-incidence: prevalent in
reproductive age women as high as
15-20%.
Etiology of Chronic pelvic pain:
-incomplete treated pelvic
infections
-recurrent pelvic infections
-Endometriosis
-postoperative pelvic adhesions
-Diseases of the Urinary tract,
bowel, neurologic systems

-Vascular engorgement of the

uterus & the vessels of the broad
ligament and lateral pelvic walls,
which may lead to chronic pelvic
pain.
-May be cystic or solid and occur in
any age group
-may originate from the Cervix,
uterus, or the Adnexa
-other organs: GUT, Bowel,
Musculoskeletal system, vascularlymphatic system, nervous
system

Pelvic & lower abdominal

masses:
May be cystic or solid and occur in
any age group
-may originate from
The Cervix, uterus, or Adnexa
-other organs: GUT, Bowel,
Musculoskeletal system, vascularlymphatic system, nervous
system
REPRODUCTIVE AGE
-majority of adnexal masses are
follicle cysts
FOLLICLE CYSTS

-Functional, disappears in 1 to 3
mos.
-size varies from few centimeters
to as large as 8 to 10 cm in
diameter.
-Thin-walled and frequently rupture
during pelvic examination
-No clinical significance.
Diagnosis of Follicle cyst:
Transvaginal ultrasound

Pelvic congestion syndrome

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-establishes Dx and follow up the

progression of cyst
-it can be reassuring to the px and
the doctor alike if a simple cyst is
found.
-it can help differentiate between a
simple and a multiculated cyst and
can rule out a solid tumor.
Corpus Luteum cyst
-Physiologic cyst
-Rarely become larger than 5 cm in
diameter
-Frequently tender to palpation
-If bleeding, they may mimic an
ectopic pregnancy.
-Generally regress w/in a few
weeks.
Hemorrhagic Corpus luteum
-Also common during the
reproductive yrs.
-Rarely become larger than 5 cm in
diameter
-frequently tender to plapation
-If blood leaks, it mimics an ectopic
pregnancy
-they generally regress w/in a few
weeks.
Masses in Childhood
Newborn with abdominal mass are
generally Follicular cysts.(adnexal
occasionally)
-secondary to maternal hormone
stimulation of fetal ovaries.
-regress within the first few months
of life.

-thereafter, cysts and all tumors of

the female pelvic organs are quite
rare during childhood.
-Abdominal masses found in the
young child are more likely to be
wilms tumors or neuroblastomas.
-Tumors of the GIT, musculoskeletal
system, or lymphatic system may
also occur occasionally.
-Solid or mixed solid and cystic
adnexal masses are rare, but when
they do occur are almost always
-dysgerminomas or
-teratomas
-although benign and malignant
teratomas have been reported in
childhood, they are quite rare
before the age of 10
Masses in Adolescence
(Menarche to 19 Years)
-Etiology:
-once menses begins, obstruction
of the lower reproductive tract,
-imperforate hymen,
-agenesis of the vagina with
intact cervix and uterus,
-vaginal septum,
-may give rise to a
hematocolpos or a
hematometrium
Adnexal Masses in Childhood
-Majority are non-neoplastic
-functional cysts and vary in
size from 3 to 10 cm
-Neoplastic ovarian tumors
-the most common is BENIGN
CYSTIC TERATOMA of the
ovary
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-measures 5 and 10 cm
in diameter
-slow-growing,
-frequently
asymptomatic
Benign Cystic Teratomas
-may cause adnexal abdomen
-May present as an acute
abdomen
-Rarely, the tumor may rupture,
spilling oily, irritating contents into
the peritoneal cavity and creating
evidence of an acute abdomen
-the tumors frequently have
a thickened capsule, and
rupture is unusual
-Diagnosis:
-may contain bone or teeth,
abdominal roentgenograms
or ultrasound may identify
these.
-transvaginal sonogram of a
4.0x3.6 cm dermoid cyst
Masses in Adolescence
-Solid or solid and cystic adnexal
tumors, although rare in
adolescence, are almost always
dysgerminomas or malignant
teratomas.
Masses during the
Reproductive Years
-Masses seen at 20 to 44 y.o
women may develop from
-the uterus and cervix,
-The adnexa, and
-other organ systems

-Intrauterine pregnancy, ectopic

pregnancy, and trophoblastic
disease
-should always be considered
in women of reproductive
years who develop such
masses.
-can often be ruled in or out
by use of
-pregnancy test
-ultrasound
-Leiomyomas of the
-uterus, the cervix, the round
ligament, or other pelvic
organs are quite common in
this age group
-seen in 25% to 50% of
women in the reproductive
years
-may develop myomas of the
uterus and accessory organs
-The majority are benign and
vary in size from very small
to large enough to fill the
entire abdominal cavity.
Leiomyomas
-are composed of smooth muscle
cells in concentric whorls and are
generally benign.
-Leiomyosarcoma
-malignant degeneration of
myoma
-rare
-usually solid but with degeneration
may give the impression of a cystic
consistency.
-Rarely may occur in the cervix or
lower uterine segment

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-may become quite large and

may put pressure on the
bladder neck, causing acute
urinary retention
-Mymas tend to enlarge
premenstrually and in pregnancy.
Adnexal masses in the
reproductive Years
-ovarian tumor,
-cysts of mesonephric origin,
-functional cysts of the ovary
-the most common adnexal
masses found, and
-benign cystic teratomas
-the most common neoplastic
adnexal mass
-Endometrioma of the Ovary
-endometriosis occurs, and
ovarian endometriomas may
develop
-accompanied by the usual
symptoms for endometriosis
in association with a tender
adnexal mass.
-Tumors emanating from other
organ systems should also be
considered in the differential
diagnosis as in other age groups.
-Diagnosis:
-An ultrasound or
-IVP (intravenous pyelogram)
-should be useful in
differentiating this
entity from other
pathologic conditions
Masses in the Perimenopausal
and Postmenopausal Years
(45 years old & older)

-consider masses originating from

the uterus and cervix, from the
adnexa, and from other organ
systems.
-myomas of the uterus regress
postmenopausally.
-a uterus that is growing in size
should be investigated for the
possibility of malignancy.
-Adenocarcinoma of the
endometrium,
-Sarcomas, and
-Mixed tumors of the uterus
-are all more common in the
postmenopausal period, and
many will be responsible for
enlargement of uterine size,
as well as PMB.
Adnexal masses occurring in
postmenopausal women
-may still be benign, but the
chance of malignancy increases
with age,
-the presence of ascites and the
detection of the tumor bilaterally
suggest malignancy
Malignant Adnexal Tumors
(Perimenopausal Period)
-Epithelial Tumor
-The majority of these
malignant
-Most were larger than 10
cm.
-the chance of
malignancy increased
with size of tumor and
with age

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Clinical Considerations to asses

Differential Diagnosis
-Clinical findings associated with
abdominal mass may help direct
the physician to the appropriate
diagnosis.
-If ascites is present, by (PE or UTS)
a malignant tumor, frequently of
the ovary, is strongly suspected.
-Benign fibromas of the ovary may
also be associated with ascites and
pleural effusion (Meigs syndrome).
-Defeminization or musculinization
of the patient may suggest a rare
musculinizing tumor of the ovary:
-Sertoli-Leydig tumor
-preadloscent female,
precocious puberty of a
heterosexual type may
be the presenting
symptom
Sertoli-Leydig Ovarian tumor
-Post-pubertal girl may manifest
-cassation of menses
-early musculinization
-may also be the presenting
symptoms in women in the
reproductive years

Brenner Tumor
-It is composed of epithelial cells in
clusters within a deep fibrous stroma.
-The cells closely match the cells
that line the bladder
-In a Brenner tumor, you may see a
coffee bean nucleus with a stripe down
the middle.
General Diagnostic Considerations
-Differential diagnosis of abdominal and
pelvic masses is made by:
-abdominal and transvaginal
ultrasound,
-CT,
-MRI scan,
-special radiographic studies,

-such as intravenous
pyelogram,
-barium enema, and
-upper GI series

Feminizing ovarian tumors

-Granulosal cell tumors
-Thecomas, are more common.
-In the prepubertal girl-may
present as precocious puberty
-In menstruating women-may
cause menometrorrhagia
-In postmenopausal womenmay present with PMB
-Brenner tumor,
-may produce sex steroids and
present in a similar fashion.
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