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Abstract: Plasmacytoid cystic adenocarcinoma is most commonly seen in female ovaries and often presents with an unexplained abdominal mass as the first symptom. In this case, the patient came to the clinic for one month because of a left lower abdominal mass. After examination, she was initially suspected of ovarian cancer and was hospitalized for surgery. The patient recovered well and the tumor was removed. No recurrence of the tumor has been detected and the patient is in complete remission.
[Basic information] Female, 52 years old
Disease Type】Plasmacytoid cystic adenocarcinoma
Hospital】The Second Hospital of Guangzhou Medical University
Consultation date】September 2019
Treatment plan】Surgical treatment (dissection + total hysterectomy with bilateral adnexa and ovaries + regional lymph node dissection) + drug treatment (paclitaxel (albumin-bound) for injection, carboplatin injection, niraparib mesylate capsule)
Treatment period】30 days of hospitalization, 6 courses of chemotherapy, followed by maintenance with targeted therapy
Treatment effect] The tumor was removed, and no tumor recurrence was found in complete remission at follow-up.
I. Initial consultation
The patient is a middle-aged woman who is menopausal. She came to our hospital one month ago because of a left lower abdominal mass. One month ago, the patient felt an egg-sized mass in her left lower abdomen without any obvious cause. Later, he found that the mass was growing larger and larger, and he experienced abdominal distension, decreased appetite and other discomforts. Physical examination revealed that the patient could feel a mass in the left lower abdomen with a firm texture, good mobility and no pressure pain. The pelvic magnetic resonance examination suggested that the cystic solid occupancy in the pelvis and the possibility of ovarian cancer was high. The preliminary diagnosis was pelvic occupancy to be investigated and ovarian cancer was likely, and she was admitted to the hospital.
II. Treatment history
The patient was admitted to the hospital and underwent preoperative examination and general anesthesia for a total hysterectomy with bilateral adnexal and ovarian resections and regional lymph node dissection. The patient was discharged after 30 days of hospitalization and was given 6 courses of adjuvant chemotherapy with paclitaxel (albumin-bound) + carboplatin injection, and after completing chemotherapy in April 2020, she started oral maintenance treatment with the targeted drug niraparib mesylate capsules.
III. Treatment results
The patient’s surgery removed most of the tumor tissue visible to the naked eye, and the postoperative wound recovery was good. After 6 courses of adjuvant chemotherapy, the patient’s thoracic and abdominal enhancement CT was repeated and no new tumor tissue was found in the abdominal cavity, and the serum CA125 and HE-4 concentrations were within the normal range. At present, it has been more than 2 years since the treatment with oral targeted drugs, and the CA125 and HE-4 concentrations did not increase in the outpatient clinic every 1 month, and the CT of chest and abdomen was reviewed every 3 months, which did not suggest any sign of tumor recurrence.
IV. Precautions
The patient’s condition was effectively controlled through treatment, and I was very happy for the patient. However, the patient is at high risk of recurrence because of late detection of the disease (stage IIIC). After discharge from the hospital, he must have regular outpatient follow-up according to the doctor’s prescription and have serum CA125 and HE-4 concentrations checked every half to one month, because many early signs of recurrence are rising tumor marker concentrations; and have an enhanced CT scan of the chest and abdomen every three months as an outpatient. In addition, other symptoms such as irregular vaginal bleeding may also occur in case of recurrence, so patients need to pay close attention to the changes in their body. They should pay attention to balanced nutrition, mainly low-fat diet rich in high quality protein, and pay attention to proper exercise and maintain an optimistic and positive attitude.
V. Personal insight
Plasmacytoid cystic adenocarcinoma is the most common type of epithelial ovarian cancer, mostly seen in middle-aged and elderly postmenopausal female patients, often with an abdominal mass of unknown origin as the first symptom. Postmenopausal female patients have more physical changes, especially the incidence of malignant tumors of the reproductive system will increase significantly, such as cervical cancer, endometrial cancer, ovarian cancer, etc. Therefore, female friends in this age group should pay closer attention to the changes occurring in their bodies, the earlier the tumor is detected, the better the treatment effect and the longer the survival period. In addition, malignant tumor is the common enemy of both patients and doctors. Only with the concerted efforts of doctors and patients, we can finally overcome it.