scholarly journals Diagnostic Dilemma of a Pelvic-Abdominal Mass in a Teenage Girl

2021 ◽  
Vol 10 (26) ◽  
pp. 1957-1960
Author(s):  
A.S. Dhillon ◽  
Kartika Pandey
Keyword(s):  
Frozen Section ◽  
Abdominal Mass ◽  
Menopausal Status ◽  
Germ Cell Tumour ◽  
Reproductive Age ◽  
Ca 125 ◽  
Diagnostic Dilemma ◽  
Tumour Spread ◽  
Imaging Results ◽  
Fertility Sparing

The differential diagnosis of an abdominal mass in young teenage girls include pelvic inflammatory disease, pelvic abdominal Koch’s, endometriosis, pedunculated uterine leiomyomata, colonic mass, and germ cell tumour. There is a strong possibility of benign, borderline, or malignant ovarian carcinoma to be diagnosed in young girls with abdominal mass. Preoperative diagnosis depends on age, menopausal status, serum cancer antigen (CA) level of 125, ultrasound and radiological imaging of the mass. For better diagnosis of benign borderline serous tumours, borderline ovarian tumours (BOTs) and invasive cancers, magnetic resonance imaging (MRI) and positron emission tomography has to be done. However, among patients with benign cysts, BOTs and invasive cancers, CA-125 levels can be same. Likewise, the imaging results are not unique to BOTs. The diagnosis of BOTs can therefore be not established before surgery and intraoperative decisions regarding the extent of surgical management are based on the results of frozen section examination. In BOTs, an effective frozen section diagnosis is of considerable significance. Women of reproductive age always want traditional fertility-sparing surgery. Benign cysts should be distinguished from BOTs. Inadequate surgical staging of BOT may result in misdiagnosis of BOT as a benign tumour, leading to more vigorous treatment and possible tumour spread.1

scholarly journals Dysgerminoma: diagnostic impasse

2020 ◽  
Vol 7 (11) ◽  
pp. 3811
Author(s):  
Indrajit Anandakannan ◽  
Shanthi Ponnandai Swaminathan ◽  
Vikas Kawarat ◽  
Rajeshwari Mani ◽  
Kannan R.
Keyword(s):  
Abdominal Pain ◽  
Abdominal Mass ◽  
Germ Cell Tumour ◽  
Lower Abdominal Pain ◽  
Gastrointestinal Stromal Tumour ◽  
Reproductive Age ◽  
Ca 125 ◽  
Abdominal Radiograph ◽  
Bowel Loop ◽  
Plain Abdominal Radiograph

Dysgerminoma is a rare malignant ovarian tumour in women of reproductive age group, featuring lower abdominal pain and abdominal mass with elevated tumour markers. The tumour grows rapidly and diagnosed at an earlier stage. We present a short-statured 20 years girl with intermittent abdominal pain and distention for 4 months, on examination huge abdominal mass of size 20x15 cm, firm in consistency was palpable, lower limit not ascertained. Routine blood investigations normal, thyroid function test showed hypothyroidism. A plain abdominal radiograph shows a large homogenous mass fitting mid part of abdomen with displaced bowel loop. Contrast-enhanced computed tomography abdomen and pelvis show up 20x18.5x9.5 cm well defined heterogeneous mass, with areas of necrosis suggesting mesenchymal tumour or germ cell tumour. CA 125, alpha-fetoprotein, lactate dehydrogenase, beta human chorionic gonadotropin were raised. Magnetic resonance imaging abdomen and pelvis show 10x16x17cm hetero intense lesion, bilateral ovary normal. After tumour board discussion image-guided biopsy was done, suggestive of epithelioid gastrointestinal stromal tumour. Laparotomy displayed a large mass 22x16x10 cm arising from left ovary, no enlarged lymph node, completed with left salpingo-oophorectomy. Histopathology examination and immunohistochemistry definitive of dysgerminoma. In this clinical scenario, we narrate the importance of clinical examination and increased dependence on imaging modalities in diagnosing the patient. The treatment is based on the international federation of gynaecology and obstetrics staging with surgical treatment, adjuvant chemotherapy and radiotherapy.

scholarly journals A bizarre highly vascular tumor with alarming presentation: a diagnostic dilemma

2017 ◽  
Vol 6 (12) ◽  
pp. 5621
Author(s):  
Kamal Buckshee ◽  
Rastogi Harsh ◽  
Arora Deepshikha ◽  
Rohatgi B. Tanya
Keyword(s):  
Uterine Artery ◽  
Frozen Section ◽  
Emergency Admission ◽  
Exploratory Laparotomy ◽  
Vascular Tumor ◽  
Preoperative Embolization ◽  
Histopathological Diagnosis ◽  
Diagnostic Dilemma ◽  
Fertility Sparing ◽  
Magnetic Resonance Imaging Mri

An exceedingly rare, highly vascular tumor with atypical and alarming presentation posed diagnostic and management challenges. A 29 years old lady, complained of abdominal and pelvic pain, nausea, vomiting and repeated spells of fainting attacks following the jumping episode (2-3 times). Emergency admission and investigations at United States of America (USA) revealed a large, complex, highly vascular, irregular mass displaying finger like projections, filling the lower abdomen, pelvis and large amount of intra peritoneal bleed. A provisional diagnosis of arteriovenous malformation (AVM), arteriovenous fistula (AVF), and rupture/leak was made. Uterine artery angiography (UAA), preoperative embolization and possibility of hysterectomy as a life saving measure were suggested, to which the couple declined and got discharged. To save uterus and fertility they presented to us for second opinion and further management. Angiography, magnetic resonance imaging (MRI) and preoperative uterine artery embolization were done followed by exploratory laparotomy which revealed hemoperitoneum and a large weird looking vascular tumor (a veil of sea weeds/dark purple nodules of various sizes resembling cotyledons of placenta). Intra-operative tissue analysis (frozen section) suggested benign pathology. Mass was removed completely and fertility sparing surgery was undertaken. Histopathological diagnosis was cotyledonoid dissecting leiomyoma (CDL). No recurrence/metastasis has been observed on follow up of 5 years.

scholarly journals KANKER OVARIUM DISGERMINOMA

2016 ◽  
Vol 19 (1) ◽  
pp. 51
Author(s):  
Hegaria Rahmawati ◽  
Darmawaty ER ◽  
Ruland DN Pakasi
Keyword(s):  
Ovarian Cancer ◽  
Frozen Section ◽  
Germ Cell Tumour ◽  
World Health Organisation ◽  
Reproductive Organ ◽  
Tumour Markers ◽  
World Health ◽  
Ca 125 ◽  
Survival Prognosis ◽  
Germinal Cells

Ovarian cancer is a female reproductive organ malignancy and the second most common gynaecological type cancers. World Health Organisation classifies ovarian cancer based on their origin: superficial stroma-epithelium tumour, cord-stroma sex tumour, and germ cell tumour originated from germinal cells (yolk sac). Epithelium type of ovarian cancer is common, while the germinal type is rare and can be found in teenagers and young women aged 16-20 years old. A case of suspected dysgerminomas ovarian cancer grade IIIA was reported in a 12 years old girl. The diagnosis was established by tumour markers, USG/CT Scan of abdomen, surgery, and frozen section evaluations. The reviewer expected better survival prognosis after surgery and three cycles of chemotherapy combinations were executed. The evaluations of when serial tumour markers CA-125 were suggested during chemotherapy to detect any recurrences factors possibility of the related cancer.

scholarly journals Huge Sertoli-Leydig cell tumor: a rare case report

2019 ◽  
Vol 9 (1) ◽  
pp. 432
Author(s):  
Mridula Raghav ◽  
Ashok R. Anand
Keyword(s):  
Leydig Cell ◽  
Frozen Section ◽  
Abdominal Mass ◽  
Total Abdominal Hysterectomy ◽  
Leydig Cell Tumor ◽  
Cell Tumor ◽  
Ca 125 ◽  
Free Fluid ◽  
Tumour Mass ◽  
Umbilical Hernia Repair

Sertoli-Leydig cell tumors (SLCTs), constitute less than 0.5% of all ovarian tumors. SLCT are rare after menopause (less than10%), 75 years, unmarried, postmenopausal since 30 years, presented with complaints of abdominal swelling. On examination, abdominal mass of 36 weeks, hard, immobile felt. Ultrasonography of abdomen showed lobulated solid cystic lesion of size 22 x 15 x 27 cms with bilateral ovaries not separately visualized. Moderate free fluid in the abdomen, suggestive of malignant neoplastic etiology. CECT Abdomen + pelvis suggestive of primary ovarian malignancy with omental deposits and pelvic adenopathy. CA 125- 415.1 Patient underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy with huge tumour mass excision (weight 5.25 kg) with umbilical hernia repair. Frozen section suggestive of a huge mass of 30 x 20 x 15 cm, multilobulated, yellowish white tan in colour, solid-cystic in consistency, seen arising from right ovary. Omentum appears normal. Histopathology report s/o- Moderately differentiated Sertoli Leydig cell tumor. Reporting the first, this huge, in this age group with atypical presentation.

scholarly journals Case Hepatic Endometriosis: A Continuing Diagnostic Dilemma

HPB Surgery ◽  
2009 ◽  
Vol 2009 ◽  
pp. 1-4 ◽  
Author(s):  
P. J. Goldsmith ◽  
N. Ahmad ◽  
D. Dasgupta ◽  
J. Campbell ◽  
J. A. Guthrie ◽  
...  
Keyword(s):  
Frozen Section ◽  
Liver Function Tests ◽  
Cystic Mass ◽  
Ca 125 ◽  
Liver Mass ◽  
Quadrant Pain ◽  
Diagnostic Dilemma ◽  
Cystic Liver ◽  
Time Of Operation ◽  
Ct And Mri

Background. Intraparenchymal endometriosis of liver is rare. It may present as liver tumour and the diagnosis is not usually established till after surgery. Case Outline. A 48-year-old postmenopausal woman presented with right upper quadrant pain and a cystic liver mass. Liver function tests and tumour markers (αFP, CEA, CA 19-9, and CA 125) were normal. Radiological imaging (USS, CT and MRI) suggested a thick walled cystic mass involving segments IV and VIII with complex intracystic septations. Frozen section at operation suggested a benign cystadenoma. The cyst was enucleated using a CUSA (Cavitron ultrasonic aspirator). The final histology confirmed endometriosis. Discussion. Eleven cases of hepatic endometrioma have been reported and only four in postmenopausal women. Preoperative diagnosis poses a challenge and so far none of the cases have been diagnosed preoperatively. Surgery remains the treatment of choice. Accurate diagnosis at time of operation may avoid extensive liver surgery and its associated morbidity.

scholarly journals Borderline Ovarian Tumors and Diagnostic Dilemma of Intraoperative Diagnosis: Could Preoperative He4 Assay and ROMA Score Assessment Increase the Frozen Section Accuracy? A Multicenter Case-Control Study

2014 ◽  
Vol 2014 ◽  
pp. 1-10 ◽  
Author(s):  
Salvatore Gizzo ◽  
Roberto Berretta ◽  
Stefania Di Gangi ◽  
Maria Guido ◽  
Giuliano Carlo Zanni ◽  
...  
Keyword(s):  
Frozen Section ◽  
Menopausal Status ◽  
Laparoscopic Approach ◽  
Preoperative Assessment ◽  
Figo Stage ◽  
Serum Markers ◽  
Ovarian Tumors ◽  
Diagnostic Dilemma ◽  
Additional Information ◽  
Borderline Ovarian Tumors

The aim of our study was to assess the value of a preoperative He4-serum-assay and ROMA-score assessment in improving the accuracy of frozen section histology in the diagnosis of borderline ovarian tumors (BOT). 113 women presenting with a unilateral ovarian mass diagnosed as serous/mucinous BOT at frozen-section-histology (FS) and/or confirmed on final pathology were recruited. Pathologists were informed of the results of preoperative clinical/instrumental assessment of all patients. For Group_A patients, additional information regarding He4, CA125, and ROMA score was available (in Group_B only CA125 was known). The comparison between Group A and Group B in terms of FS accuracy, demonstrated a consensual diagnosis in 62.8% versus 58.6% (P: n.s.), underdiagnosis in 25.6% versus 41.4% (P<0.05), and overdiagnosis in 11.6% versus 0% (P<0.01). Low FS diagnostic accuracy was associated with menopausal status (OR: 2.13), laparoscopic approach (OR: 2.18), mucinous histotype (OR: 2.23), low grading (OR: 1.30), and FIGO stage I (OR: 2.53). Ultrasound detection of papillae (OR: 0.29), septa (OR: 0.39), atypical vascularization (OR: 0.34), serum He4 assay (OR: 0.39), and ROMA score assessment (OR: 0.44) decreased the probability of underdiagnosis. A combined preoperative assessment through serum markers and ultrasonographic features may potentially reduce the risk of underdiagnosis of BOTs on FS while likely increasing the concomitant incidence of false-positive events.

scholarly journals Goblet Cell Carcinoids of the Appendix

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Nanna Holt ◽  
Henning Grønbæk
Keyword(s):  
Goblet Cell ◽  
Chromogranin A ◽  
Abdominal Mass ◽  
Distant Metastases ◽  
High Volume ◽  
Right Hemicolectomy ◽  
Ca 125 ◽  
Ki67 Index ◽  
Proliferation Markers ◽  
Mucinous Component

Goblet cell carcinoid (GCC) tumors are a rare subgroup of neuroendocrine tumors almost exclusively originating in the appendix. The tumor most often presents in the fifth or sixth decade with a clinical picture of appendicitis or in advanced cases an abdominal mass associated with abdominal pain. Histologically tumors are most often positive for chromogranin A and synaptophysin, however, less homogenous than for classic appendix carcinoids. The malignant potential is higher than that for the classic appendix carcinoids due to local spread and distant metastases at diagnosis and the proliferation markers (Ki67 index) may determine prognosis. Octreotide receptor scintigraphy is usually negative while CT/MRI scans may be useful. Chromogranin A is usually negative and other biomarkers related to the mucinous component or the tumor (CEA, CA-19-9, and CA-125) may be used. Surgery is the main treatment with appendectomy and right hemicolectomy while patients with disseminated disease should be treated with chemotherapy. Overall 5-year survival is approximately 75%. The diagnosis and treatment of GCC tumorss should be restricted to high volume NET centers in order to accumulate knowledge and improve survival in GCC NET patients. The aim of this paper is to update on epidemiology, clinical presentation, and diagnostic markers including Ki67 index, treatment, and survival.

Outcome of Reproductive Age Women With Stage IA or IC Invasive Epithelial Ovarian Cancer Treated With Fertility-Sparing Therapy

2003 ◽  
Vol 58 (4) ◽  
pp. 254-255
Author(s):  
Jeanne M. Schilder ◽  
Amy M. Thompson ◽  
Paul D. DePriest ◽  
Frederick R. Ueland ◽  
Michael L. Cibull ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Epithelial Ovarian Cancer ◽  
Reproductive Age ◽  
Reproductive Age Women ◽  
Fertility Sparing ◽  
Stage Ia ◽  
Invasive Epithelial Ovarian Cancer

Keratin Granulomas in the Peritoneum on Frozen Section: A Case Report with Multiple Suspects and the Search for the Culprit

2021 ◽  
pp. 106689692110160
Author(s):  
Levon Katsakhyan ◽  
Xiaoming Zhang ◽  
Maria C. Reyes ◽  
Lauren E. Schwartz ◽  
Ashley F. Haggerty ◽  
...  
Keyword(s):  
Case Report ◽  
Dermoid Cyst ◽  
Frozen Section ◽  
Endometrioid Adenocarcinoma ◽  
Diagnostic Significance ◽  
Rare Finding ◽  
Fertility Sparing ◽  
Endometrial Endometrioid Adenocarcinoma

Keratin granulomas in the peritoneum are a rare finding with multiple etiologies and can be especially challenging for both the pathologist and the surgeon when these lesions are grossly visible. We report a case of a unique frozen section diagnostic scenario of evaluation of keratin granulomas in the peritoneum of a 47-year-old woman in the setting of multiple potential culprits: endometrial endometrioid adenocarcinoma following fertility sparing treatment, and a concurrent dermoid cyst. We discuss the various etiologies of keratin granulomas in the peritoneum, mechanism of their formation, diagnostic significance, as well as implications of fertility sparing treatments. To the best of our knowledge, this is the only case of keratin granulomas in the peritoneum with multiple distinct potential pathologic culprits as well the only case following fertility sparing treatment.

Struma ovarii-A rare entity

2021 ◽  
Vol 11 (1) ◽  
pp. 1898-1901
Author(s):  
Moushami Singh ◽  
Raghu Ram Bhandary ◽  
Jitendra Pariyar ◽  
Swechha Maskey ◽  
Hari Prasad Dhakal
Keyword(s):  
Benign Tumor ◽  
Histopathological Examination ◽  
Frozen Section ◽  
Abdominal Mass ◽  
Thyroid Tissue ◽  
Blood Parameters ◽  
Immature Teratoma ◽  
Rare Entity ◽  
Struma Ovarii ◽  
Ovarian Mass

Struma ovarii, also known as goiter of the ovary is a rare disease.1 Considering the rarity of this tumor and constrained literature in Nepal’s context, we hereby present a case of a 46-year-old female, asymptomatic, with normal blood parameters who presented with an abdominal mass. She was suspected of malignant ovarian mass on an ultrasonogram. Intraoperative frozen section examination revealed a benign tumor suggestive of dermal tumor versus struma ovarii. Postoperatively, histopathological examination was performed to assess the percentage of thyroid tissue and a diagnosis of benign struma ovarii was made which was confirmed by thyroglobulin positivity on immunohistochemistry. No features of immature teratoma and malignancy were identified.

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