Case Presentation and Discussion on Intra-abdominal Tumor
Marlou O. Padua, MD
General Data: J.S., 13 y/o F, from Sampaloc, Manila
Chief Complaint: Hypogastric mass
History of Present Illness:
2 mos PTA enlarging mass on hypogastric area
(-) BM changes
(-) bleeding per vagina
1 mo PTA increase in size of mass with abdominal enlargement
Past Medical History: unremarkable
Family History: unremarkable
Personal Social History: non-smoker, non-alcoholic beverage drinker
Gen. Survey: conscious, coherent, ambulatory, NICRD
Vital Signs: BP:90/70 CR:84 RR:20 T:37ΊC
HEENT: pink palpebral conjunctiva, anicteric sclerae, supple neck, (-) cervical LAD
Chest/Lungs: symmetrical chest expansion, clear breath sounds
CVS: adynamic precordium, normal rate & regular rhythm
Abdomen: globular, distended, NABS, soft, nontender, (+) large soft mass over the entire abdomen which is nontender, movable, (-) fluid wave
Extremeties: (-) cyanosis, (-) pallor
Rectal: no skin tags, good sphincter tone, rectal vault not collapsed, no mass, (+) feces on examining finger
(+) enlarging hypogastric mass
(-) abdominal pain
(-) BM changes
(-) bleeding per vagina
(+) large soft mass over the entire abdomen which is nontender, movable Rectal: no skin tags, good sphincter tone, rectal vault not collapsed, no mass, (+) feces on examining finger
Do I need a para-clinical diagnostic procedure?
Yes, because I am not certain of my primary diagnosis.
Para-clinical Diagnostic Procedure:
Large complex mass with septations occupying almost the entire abdomen measuring 29 x 13.5 x 21 cms
The uterus is unremarkable and displaced anteriorly. No ascites seen
Diagnosis: Large complex cystic lesion, primary consideration is ovarian in origin
Goals of Treatment:
removal of the mass
Informed consent secured
Psychosocial support provided
Optimized patients physical health
Patient screened for any health condition
Operative materials secured
Patient placed under GA
Asepsis and antisepsis
Sterile drapes placed
Midline infraumbilical incision done and carried done to the peritoneum
Intra-op findings noted
Incision extended superiorly
Ovarian mass delivered thru the incision
Right Oophorectomy done
Correct instrument and sponge count
Abdomen closed by layers
Patient tolerated the procedure well
Right ovary was markedly dilated with cystic consistency displacing the uterus anteriorly and the whole small bowel posteriorly to the left.
No signs of bowel obstruction was noted.
Operation done: Laparotomy, Oophorectomy, R
Final Diagnosis: Mucinous Cystadenoma, Ovary, Right
Daily wound care
Removal of sutures after 1 week
Resolution of the intra-abdominal mass (ovary)
No medico-legal suit
Ovarian cyst - sac filled with liquid or semiliquid material
The number of diagnoses has increased with the widespread implementation of regular PE and ultrasound technology.
The finding of an ovarian cyst causes considerable anxiety for women because of the fear of malignancy, but the vast majority of ovarian cysts are benign.
Majority of ovarian cysts - asymptomatic.
Even malignant ovarian cysts commonly do not cause symptoms until they reach an advanced stage
Pain or discomfort may occur in the lower abdomen
Torsion or rupture may lead to more severe pain
Having bowel movements may be difficult, or pressure may develop, leading to a desire to defecate
Micturition may occur frequently and is due to pressure on the bladder
Young children may present with precocious puberty and early onset of menarche
Frequently on a pedicle and may undergo torsion leading to pain and infarction
Mucinous cystadenoma cystic tumor containing sticky, gelatinous material
Mucinous tumors are less likely to be malignant than the serous cystadenoma
20% of the serous and 5% of the mucinous tumors are bilateral
An ovarian mucinous cystadenoma does not cause symptoms until it becomes very large.
Benign - allowing a conservative approach to treatment, especially in young patients who wish to maintain fertility.
among the largest tumors in humans.
as large as 149 kg (328 lb) has been reported.
usually occur in younger patients.
Unilateral 95% of cases
Malignant transformation is uncommon
Unusually large (15-30 cm)
Cyst filled with sticky, gelatin-like material
Multilocular cystic spaces
Benign type more common than malignant
Clinical: Pressure, pain, increased abdominal girth
US: simple or septate thin-walled multilocular cysts
primary imaging tool considered to have an ovarian cyst
help define morphologic characteristics of ovarian cysts
uniformly thin wall surrounding a single cavity that contains no internal echoes
more than one compartment (multilocular)
thickening of the wall
projections (papulations) sticking into the lumen or on the surface,
abnormalities within the cyst contents
Common Complex Masses
Cystadenoma (serous or mucinous)
Endometrioma (low level echoes)
Excision of the cyst alone, with conservation of the ovary, may be performed in patients who desire retention of their ovaries for future fertility or other reasons (endometrioma, dermoid, and functional cysts)
The prognosis for benign cysts is excellent
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Clement PB: Anatomy and Histology of the Ovary. In: Kurman RJ, ed. Blaustein's Pathology of the Female Genital Tract. 4th ed. New York, NY: Springer-Verlag; 1989: 438-70.
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1. What is the primary imaging tool for a patient considered to have an ovarian cyst?
2. What segment of the GI tract mesenteric cyst commonly occur?
Modified Multiple Choice:
A if 1,2,3 is correct
B if 1,3 is correct
C if 2,4 is correct
D if only 4 is correct
E if all is correct
3. The following condition(s) appear as complex mass on ultrasonography:
4. The following describes mucinous cystadenoma:
5. The following statements are true regarding pseudomyxoma peritoneii.
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