(Disclaimer: This article is for general use only, and the information in the following content has been processed to protect patient privacy)
Abstract: This case is a 42-year-old woman who came to our hospital with irregular vaginal bleeding for 3 months and wasting for 6 months, neglecting that the wasting was caused by a disease because she was in a weight loss phase. After surgery and postoperative chemotherapy, the patient was cured clinically and the disease has not recurred in 3 years of follow-up.
Basic information】Female, 42 years old
Type of disease】Endometrioid adenocarcinoma of ovary
Hospital】Guangzhou Huadu District People’s Hospital
Date of consultation】July 2017
Treatment plan】Surgery (total hysterectomy + bilateral adnexal resection + partial omentectomy + pelvic lymph node dissection) + medication (sodium glucose chloride injection, ceftriaxone sodium for injection) + chemotherapy (cisplatin injection, paclitaxel injection)
Treatment period】6 months of treatment (hospitalization + chemotherapy)
【Treatment effect】The clinical indexes returned to normal
I. Initial interview.
The patient is a 42-year-old woman who visited the clinic for irregular vaginal bleeding for 3 months and weight loss in the last 6 months. 3 months ago, irregular vaginal bleeding appeared without obvious cause, and the clinical effect of oral medication was not obvious. Her last menstrual period was always clean, and her menstrual cycle used to be once every 30 days. In the past 3 months, her menstrual flow was disordered, dripping, and her menstrual flow was not heavy. In the past six months, she has been on a restricted diet because of weight loss, but her appetite is normal and her bowel movements are normal. Body temperature, blood pressure, pulse and respiration were normal, general condition was good, no obvious anemia appearance, no abnormality was heard on cardiopulmonary auscultation, abdomen was flat and soft, no obvious pressure pain, vaginal bloody discharge, not much but odor, cervical local smooth uterus, normal size, 5×6×6 cm size mass could be palpated in the right adnexal area with unclear boundary. On color ultrasonography, no abnormality was seen in the uterus and the left adnexa, and an irregular 5×6×6 cm size mixed mass with unclear boundary and blood flow signal could be detected in the right adnexal area. Gynecologic tumor marker laboratory tests showed that CA-125 and CA-199 levels were significantly elevated, and the preliminary diagnosis of ovarian cancer was admitted to hospital.
Ultrasound diagram
II. Treatment history
After the patient completed all the preoperative examinations and the family signed the consent, the patient’s abdomen was explored and a 5×6×6 cm sized mass of the right ovary with an unsmooth surface and multiple bumps was seen intraoperatively. Therefore, the patient was recommended to undergo total hysterectomy + bilateral adnexal resection + partial greater omentum resection, along with pelvic lymph node dissection. Postoperatively, the patient was given primary care, treated with intravenous rehydration with sodium chloride glucose injection, and treated with injectable ceftriaxone sodium for infection prevention. After surgery, combined chemotherapy with cisplatin injection and paclitaxel injection was applied for a total of about 6 months from the time of hospitalization to the end of chemotherapy.
III. Treatment results
The patient had a smooth surgical procedure and the incision healed in one stage after surgery, with normal urine, stool and diet, no vaginal bleeding and no enlarged inguinal lymph nodes. There was no abnormality in the vaginal stump, normal body temperature, and no anemia. Two months after surgery, the ultrasound of the pelvis did not show any abnormality, and the gynecological tumor marker test had no positive results. Two years after the surgery, the patient was reexamined again, and the pelvic CT scan showed no abnormality and no enlarged lymph nodes, and the patient’s indexes returned to normal.
IV. Notes
We are glad that the patient’s condition has improved. The patient was advised to have ultrasound examination and gynecological examination as well as gynecological tumor marker laboratory test once every six months. If abnormal manifestations such as irregular vaginal bleeding, abdominal pain and whether inguinal lymph nodes appear enlarged appear again, if there is any abnormality, it is recommended to visit the clinic for review in time. After discharge, avoid heavy physical labor, strengthen nutrition and increase body resistance. Also, pay attention to whether your diet is normal, whether your urine and stool are normal, and whether your weight has decreased. Pay attention to relaxation, optimism and positive life, and family members to accompany, comfort and encourage more.
V. Personal insight
In this case, the patient was found in time and was cured through surgery and chemotherapy, and there was no sign of recurrence through CT examination for 3 years. Therefore, once women have symptoms such as irregular vaginal bleeding, abnormal discharge, pain in the lower abdomen and a feeling of swelling, they must seek medical attention in time to detect the abnormality and deal with it in time. In addition, even without any uncomfortable situation, gynecological examination including vaginal color ultrasound, cervical cancer screening and routine laboratory examination of white belt is needed once every 1 year, which is important for the prevention of ovarian endometrioid adenocarcinoma.