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Abstract: Ovarian malignant tumors can develop at all ages. The ovaries are located deep in the pelvic cavity and early lesions are not easily detected, once symptoms appear they are mostly advanced and should be highly alert. In this paper, due to the phenomenon of increasing belly size and abdominal circumference in a short period of time, the patient thought that she had gained weight, but after examination, she was found to have ovarian malignant tumor, and after timely open surgery for removal, she was reviewed regularly without recurrence.
Basic information】Female, 74 years old
Type of disease】High-grade plasmacytoma of the left ovary
Hospital】Beijing Friendship Hospital Xicheng Campus, Capital Medical University
Date of consultation】November 2020
Treatment plan】Surgery (ovarian cancer staging surgery) + drug therapy (carboplatin + paclitaxel injection)
Treatment period】10 days of hospitalization
Treatment effect] The patient has no uncomfortable symptoms and no recurrence at present with regular follow-up.
I. Initial consultation
The patient, Ms. Wang, came to our gynecology department in January with an increase in abdominal girth and urinary frequency for 4 months, which was aggravated. She complained that she had been menopausal for 20 years and had a pelvic mass of about 4 cm in diameter on physical examination at an external hospital 10 months ago, without any abdominal distension or other discomfort, and was not given any attention or further treatment. In the past month, the increase in abdominal circumference was obvious and the frequency of urination increased, while a lower abdominal mass could be palpated when lying down. The gynecological examination revealed a large pelvic mass up to one finger below the umbilicus, and the gynecological ultrasound showed a clear echogenic mass on the upper left side of the uterus with a size of about 14×14.1×11.4cm, with multiple internal separations and an unsmooth inner wall, and multiple irregular moderate echogenic masses, the larger of which was about 7.8×6.1cm. ×A blood flow signal was detected, and it was considered to be of adnexal origin, and the patient was admitted with the diagnosis of ovarian malignancy.
II. Treatment history
The patient was admitted to the hospital for further improvement of preoperative examinations, and the tumor marker test did not indicate any significant abnormality. The pelvic MRI (scan+enhancement) showed a cystic mass in the pelvis with a size of about 13.8×11.3×11.8 cm and clear borders, with multiple segregations and solid components. High signal on DWI, low signal on ADC, delayed enhancement on enhanced scan, and peritoneal, uterine and bladder compression and displacement were seen. Nuclear magnetic diagnosis: pelvic cystic mass of left adnexal origin with possible malignant cystic gland-like tumor. Preoperative diagnosis: cystic adenocarcinoma of the left ovary. Preoperative preparations were improved, the patient and family were explained the condition, informed of the risks and signed the surgical consent form. The intraoperative frozen pathology suggested high-grade plasmacytoma of the left ovary, and ovarian cancer staging surgery was performed. There was no infiltration of the right ovary, uterus and bilateral fallopian tubes, no lymph node metastasis, no tumor thrombus in the vasculature and no metastasis in the greater omentum. Postoperative diagnosis of high-grade plasmacytoma of the left ovary stage IC was made, and postoperative chemotherapy with injectable carboplatin + paclitaxel injection and regular outpatient follow-up checks were given.
III. Treatment effect
The patient was operated as scheduled, and the operation was smooth with little bleeding. The postoperative abdominal wound healed well, and the postoperative pathology was in accordance with the intraoperative diagnosis of stage IC high-grade plasmacytoma of the left ovary. There was no infiltration of the right ovary, uterus and bilateral fallopian tubes, no lymph node metastasis, no tumor thrombus in the vasculature and no metastasis in the greater omentum. The patient had no uncomfortable symptoms and was discharged at 10 days of hospitalization. Post-operative chemotherapy and regular outpatient follow-up checkups were performed, and the patient has no recurrence at present.
IV. Notes
We are glad that the patient’s symptoms have improved after treatment, but we still need to remind the patient to pay attention to some matters in daily life.
1. Many side effects of chemotherapy often appear after chemotherapy and discharge from the hospital, so patients are advised to regularly visit the outpatient clinic for follow-up examinations and review of blood routine, liver and kidney functions. In addition, if symptoms of discomfort appear, promptly seek medical examination and treatment.
2. It is recommended that patients should pay attention to a light diet, avoid spicy and stimulating foods, maintain a healthy lifestyle, and do aerobic exercises, such as walking, to enhance their physical fitness.
V. Personal insight
By understanding the situation of the patient in this case, we can see that ovarian malignant tumors are mostly asymptomatic in the early stage, so we should pay attention to regular gynecological checkups, and once ovarian masses are found, we should be alert and treat them in time. Usually pathological diagnosis is the gold standard for ovarian malignancy diagnosis, while the main treatment modality is surgery plus adjuvant chemotherapy. In addition, since the thoroughness of surgery is closely related to the patient’s prognosis, timely diagnosis and thorough surgery are beneficial to the long-term prognosis of patients. However, patients with advanced disease often have ascites and poor systemic condition, which limits the thoroughness of surgery and may require chemotherapy followed by surgery. The mortality rate of ovarian malignant tumors is the highest among gynecologic malignant tumors, and the 5-year survival rate decreases with the increase of disease stage, from 70%-90% to 10%, so timely diagnosis and treatment have been the focus and difficulty of ovarian malignant tumors.