USMLE Step 2 CK Lecture Notes 2019: Obstetrics/Gynecology (Kaplan Test Prep)

GYN TRIAD

Dysgerminoma

In young women, the most common complex adnexal mass is a dermoid cyst
or benign cystic teratoma (discussed below). Other diagnoses include
endometrioma, tubo-ovarian abscess, and ovarian cancer.

Differential diagnosis includes pregnancy and functional cysts.

Diagnosis. Qualitative β-human chorionic gonadotropin (β-hCG) test to rule
out pregnancy; the appearance of a complex mass on U/S will rule out a
functional cyst.

Management. Patients of reproductive age with a complex adnexal mass should
be treated surgically (laparoscopy or laparotomy, depending on experience of the
surgeon).

Solid   pelvic  mass    in  reproductive    years

β-hCG   (–)

↑   LDH level

Cystectomy. At  the time    of  surgery an  ovarian cystectomy  should  be

attempted   to  preserve    ovarian function    in  the reproductive    age.    Careful

evaluation  of  the opposite    adnexa  should  be  performed,  as  dermoid cysts   can

occur   bilaterally in  10–15%  of  cases.

Oophorectomy.   If  an  ovarian cystectomy  cannot  be  done    because of  the size

of  the dermoid cyst,   then    an  oophorectomy    is  performed,  but conservative

management  should  always  be  attempted   before  an  oophorectomy    is  done.