A CASE PRESENTATION on OVARIAN TUMOR.pptx

A case of mucinous cyst adenoma which presented to us with the features of full term pregnancy. From history and clinical examinations, we predicted it to be malignant but the imagings and tumor markers made is believe it is benign. The histopathology report is yet to come out.

1. CASE PRESENTATION ON OVARIAN TUMOR PRESENTED BY: Dr. WASIKA NUHA Intern Doctor Dept. of Obstetrics & Gynaecology CIMCH

2. Particulars of the patient Name of the patient Mrs. Gofura Begum Age 39 years Occupation Housewife Husband’s name Md. Nazmul Hakim Religion Islam Address Sadaha , Satkania Contact No 01832177304 Date of admission 24.09.24 @ 11.15am Date of examination 24.09.24 @ 11.30am

3. Chief Complaints Feeling of heaviness in the lower abdomen for 1year . Feeling of lump in the abdomen for 5 months.

4. History of Presenting Illness According to patient’s statement, she was relatively well 1year back. Then she developed feeling of heaviness in the lower abdomen. For the last 5 months she has been feeling a lump in lower abdomen which is gradually increasing in size . She is a regularly menstruating woman with average flow and duration.

5. The mass is not associated with any pain, weight loss, anorexia, dyspepsia, chest pain, hemoptysis, jaundice or joint pain. Her bowel and bladder habit is normal. With these complaints, she consulted with a local doctor 1 month back and was advised for USG of whole abdomen. The USG revealed hugely enlarged left ovarian cystic mass. Thereafter she got admitted to CIMCH for further management.

6. Past History Medical: She has no relevant past medical history. Surgical: She has no relevant past surgical history.

7. Drug History Nothing contributory .

8. Family History She has no family history of ovarian, endometrial, breast or colon carcinoma.

9. Immunization History Not immunized against tetanus, hepatitis or covid-19.

10. Socioeconomic history She belongs from a lower class family.

11. Contraceptive history Nil

12. Menstrual History Age at menarche 13 years MP/MC 3-4days/28days LMP 22.09.24 Menstrual flow Average Dysmenorrhea Absent

13. Obstetric history Married For 39 years Para 6 (VD) + 0 Age of last child 11 years

14. Obstetric chart No. of birth Date of birth Gestational age at delivery Mode of delivery Place of delivery PN Complication Birth weight sex Outcome Alive/dead Remarks 01 2004 Full term NVD Home nil - Female Alive - 02 2006 Full term NVD Home nil - Female Alive - 03 2007 Full term VD Home - - - Dead - 04 2009 Full term VD Home - - - Dead - 05 2011 Full term NVD Home nil - Female Alive - 06 2013 Full term NVD Home nil - Male Alive -

15. General examination Appearance: Ill looking Body built: Average Co-operation: Co-operative Height: 4.11 Ft Weight: 58kg BMI: 25.1kg/m 2

16. Anemia: Absent Jaundice: Absent Cyanosis: Absent Dehydration: Absent Edema: Absent Pulse: 88 bpm BP: 130/90 mmHg Temp: 98.6˚F R/R: 18 br /min

17. Heart: No abnormality detected. Lung: Clear Thyroid gland: Not enlarged Lymph Node: Not palpable Breast: Normal according to age.

18. PER-ABDOMINAL EXAMINATION

19. PELVIC EXAMINATION

20. Provisional diagnosis Ovarian tumor (probably benign).

21. Differential diagnosis Fibroid uterus. Ascites

22. INVESTIGATIONS For Diagnosis: Findings USG of whole abdomen: CT scan of whole abdomen: CEA: CA-125: AFP: Hugely enlarged (35x30cm) cystic mass lesion in left adnexa. Large abdomino -pelvic cyst (possibility: ovarian cyst) 3.33 ng/ml 32.7 U/ml 0.511 ng/ml

23. For management: Findings CBC: Hb: 11.3 gm/dl Blood grouping and Rh typing: O positive FBS: 5.73 mmol/L 2HAB 75gm glucose: 6.45 mmol/L HBsAg: Negative S. TSH: 1.058 μ IU/ml S. creatinine: 0.75 mg/dl Urine RME & C/S: Pus cell:1-2/HPF ECG Normal

24. Management Counselling was done with the patient and patient’s attendant regarding her condition, treatment plan, outcome and need of blood donor. Preoperative evaluations were done.

25. Definitive management Laparotomy followed by TAH with right sided salpingectomy with left sided salpingo -oophorectomy with conservation of right sided ovary.

26. PER- OPERATIVE Note

27. Findings: A large left ovarian tumor was found. Size: 50x50 cm Content: mucinous fluid ( Almost 10 liters) Right ovary looked healthy.

28. POST-OPERATIVE FOLLOW UP

29. Discharge Patient was happily discharged with following advices : Take medicines regularly as prescribed. Keep the wound clean and dry. Take rest for 1 month. Avoid heavy work for 3 months. Per vaginal bloody discharge is normal for 1.5 months. Come to hospital with histopathology report. Alternate stitch off on 10 th POD and rest on 12 th POD.

30. acknowledgement Dr. Nazmin Sultana Assistant Professor Dept. of Obs & Gynae CIMCH Dr. Afrin Noor Bithy Medical officer Dept. of obs & Gynae CIMCH

31. THANK YOU