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  1. Kiss The Rain… A Case of Ovarian New Growth Highly Suspicious of Malignancy Mayella Mercado - Montemar, M.D. Dr. Ahmed Abanamy Hospital Department of Obstetrics & Gynaecology Powerpoint Templates

  2. Objective: • To present the management of debilitated patient diagnosed to have ovarian cancer • To discuss the role of ancillary procedures and tumour markers in the diagnosis and management of ovarian cancer • To discuss the preventive measures of ovarian cancer

  3. General Data: • E.G. • 53 years old • Married • Muslim • Riyadh, K.S.A. • May 23, 2013

  4. Chief complaint: Abdominal enlargement x 6 months

  5. HPI:

  6. Whole abdominal UTZ • Ascites, seen in the perihepatic, perispleenic, paracolic and pelvic region • Large pelvo-abdominal cystic mass: a large multiloculated mass in the midpelvic abdomen seen above the urinary bladder which measured 8.6 x 9.0 x 8.7 cm • Cholelithiasiswith gallbladder wall thickening • None visualized right kidney maybe due to overlying bowel gas

  7. Whole abdominal CT scan • Absent uterus (s/p subtotal hysterectomy) • Pelvo-abdominal mass t/c ovarian new growth: huge multiloculated mass noted in the midline extending to the left hemi abdomen approximately measuring 18.39 x 11.31 x 16.08 cm. Some locules contain anechoic fluid while some contain very fine scattered echoes. Locule walls with solid components and slightly thickened at 3-4 mm • The peritoneum is outlined by anechoic fluid • Normal ovarian structures

  8. CBC • Hgb- 10.7 g/dL • Hct- 0.33 • WBC- 9.72 • Segmenters- 82.1 • Lymphocytes- 13.1 • Platelets- 471

  9. CA 125 143 U/mL (< 35 u/ml)

  10. Admission

  11. Menstrual history: • Menarche: 11 years old • Interval: 28-30 days • Duration: 3-4 days • Amount: moderately soaked, 2-3 pads/day • (+) dysmenorrhoea

  12. OB history: G4P3 (3103)

  13. Gyne History: • (-) history of contraceptive use • (-) history of STD • (-) history of dyspareunia and post-coital bleeding • Last pap smear was 1977 (normal), no further check-up since then

  14. PMH: • (+) HPN with poor medical compliance • HBP: 150/100 mmHg • UBP: 120/80 mmHg

  15. Family History: • (+) HPN, paternal side • (-) DM • (-) Asthma • (-) Malignancy

  16. Personal, Sexual and Social History: • Coitarche: 15 years old • Monogamous • Housewife • Unemployed • High fat and meat diet • Non- smoker • Non-alcoholic beverage drinker

  17. Review of Systems: • Unremarkable

  18. P.E. • General Survey: conscious, coherent, weak and dry looking, ambulatory, not in cardio-respiratory distress • BP: 120/70 mmHg HR: 110 bpmRR: 21 cpm Temp: 36.5 C BMI: 21.6 kg

  19. P.E. HEENT:Pale palpebral conjunctivae, anicteric sclera, no naso-aural discharge, no tonsillopharyngeal congestion

  20. Neck: Supple, no neck vein engorgement, no palpable cervical LN • Chest/Lungs: Symmetrical chest expansion, no retractions, decrease breath sounds, bibasal • CVS: Adynamic precordium, normal rate, regular rhythm, no murmur

  21. Abdomen: globular with abdominal girth of 100.5 cm, (+) fluid wave, (+) shifting dullness, (+) fixed, palpable, solid mass at the hypogastric area, non tender, approximately measuring 8.0 x 8.0 cm

  22. Speculum examination: cervix smooth with minimal mucoid discharge, non foul smelling, no bleeding • Internal Examination: cervix firm, closed

  23. Initial Impression: Gravida 4 Para 4 (3-1-0-3) Pelvo-abdominal mass probably Ovarian in origin, t/c malignancy, Anemia 2⁰, HPN Stage II, s/p Subtotal Hysterectomy (1978)

  24. Course in the Ward

  25. Abdomen: globular, dull in percussion, (+) fluid wave with palpable irregular nodular pelvo-abdominal mass enlarged to 6 months size since with a floater, solid which is palpable at the left hypochondriac area

  26. IE: Cervix is 2.5 cm, firm, closed, nontender and posteriorly directed, anterior fornix is distended probably due to ascitic fluid RVE: There is a multinodular firm to stony mass distending the posterior fornix with very limited mobility

  27. Paracentesis:-Post paracentesis – drained 3.35 L serosangenous ascitic fluid, abdominal girth of 96 cm (from 103 cm) -Ascitic fluid analysis was suspicious for adenocarcinoma

  28. Final diagnosis: Gravida 4 Para 4 (3-1-0-3) Ovarian New Growth highly suspicious of malignancy w/ pelvic and peritoneal spread, t/c Malignant Pleural effusion, Massive Ascites 2⁰, Anemia 2 ⁰- corrected, Electrolyte derangement- resolved, Upper GI Bleed probably 2⁰ to Stress ulcer, Acute Peptic Disease- resolved, Hypertension Stage II- resolved, Chemotherapy (Carboplatin/Paclitaxel) x 1st cycle, Blood transfusion, s/p Subtotal Hysterectomy (1978)

  29. Clinical Discussion

  30. E.G. 53 yo G4P3 (3103) Salient Feature:

  31. 2nd Edition of Clinical Practice Guidelines for the Obstetrician Gynecologists (November 2010)

  32. 2nd Edition of Clinical Practice Guidelines for the Obstetrician Gynecologists (November 2010)

  33. E.G. 53 yo G4P3 (3103) Clinical Manifestation Symptoms Toralba et. al., Ovarian Cancer: Diagnosis, Staging and Management, 2010 Annual Postgraduate Course

  34. E.G. 53 yo G4P3 (3103) Clinical Manifestation Signs Toralba et. al., Ovarian Cancer: Diagnosis, Staging and Management, 2010 Annual Postgraduate Course