The PMPO Syndrome (Postmenopausal Palpable Ovary Syndrome)

Abstract

If we are to save more women and diminish the mortality rate from ovarian cancer, we must become more liberal in our indications for operation. We suggest that the palpation of what appears to be a normal‐sized ovary for a patient three to five years postmenopausal is indicative of an ovarian tumor and should be investigated promptly. These patients should not be followed and re‐evaluated but rather subjected to proof as to the presence or absence of an ovarian tumor. To wait until one feels a solid tumor mass of up to 5 cm. and expect a cure is an exercise in fancy and futility. John Gardner said, “We are all faced with wonderful opportunities brilliantly disguised as insoluble problems.” Ovarian cancer is not insoluble. Perhaps, by adding a small segment at a time, the total picture will emerge to the benefit of our patients. Remember the PMPO Syndrome!

Bilateral Oophorectomy in Asymptomatic Women over 50 Years Old Selected by Ovarian Cancer Screening

“…Tumors of 130 mm in diameter are defined as being of abnormal size in postmenopausal women according to the report of Barber and Graber [3]. Granberg and Wikland [12] found that !1% of masses !5 cm were malignant, and 72% of masses 110 cm were malignant.…”

“…0.75 ! 0.5 cm approximately 2-5 years after the last menstrual period [3]. Therefore adnexal masses were classified according to the following ultrasonographic criteria: (1) size 630 mm and simple cyst; (2) ascites (depth of echo-free space in Douglas pouch) 650 mm, or (3) solid or mixed pattern regardless of tumor size.…”

“…Because the postmenopausal ovary should not be physiologically enlarged and functional cysts should not be present, ovaries found to be of normal premenopausal size on palpation are not considered normal in postmenopausal patients [3]. In general, removing the ovaries is the most effective means of preventing ovarian cancer.…”

Early detection of ovarian cancer

“…The most notable use of the physical examination in the screening of early ovarian cancer has been the postmenopausal palpable ovary syndrome. 10 In this usage, any palpable ovary in a postmenopausal patient was considered abnormal because a senescent ovary should not be detectable by palpation. This type of physical finding, as an indication for operative diagnosis, has never been validated.…”

Evaluation of the validity of risk malignancy index in clinically diagnosed ovarian masses and to compare it with the validity of individual constituent parameter of risk malignancy index

“…[7][8][9] This study was aimed to assess the validity of RMI in clinically diagnosed ovarian masses in pre-operative women & comparing it with the validity of individual constituent parameter of RMI.…”