2. History 41 year Para 3 lady, from Rukum Post TAH with ? BSO done 6 years back at valley Hospital Presented to our centre with complaint of Mass per abdomen – 1 year Abdominal pain and increase in size of mass for last 5 months Loss of appetite for 5 months
3. History …contd.. Menstrual history- Post TAH Obstetric history- Para 3, all vaginal deliveries at home Contraceptive history- none
4. History …contd.. Past history- TAH done 6 years back for fibroid uterus The per operative finding revealed : A mass around 3 ×3 cm arising from the intestine which was removed. Lumen not involved Uterus was enlarged, tubes and ovaries not commented on Histopathology. Separate mass removed from the intestine shows leiomyoma with hyaline degeneration Endometrium: proliferative; Cervix: chronic cervicitis Status of tubes and ovaries not mentioned
5. History …contd.. Personal history- non smoker, doesn’t consume alcohol Family history – no family h/o malignancy
6. Clinical examination General condition- fair..thin built. Weight: 38 kg Vitals: stable Pallor, edema, dehydration, jaundice- nil No lymphadenopathy Breast, axilla : normal Chest- normal vesicular sounds all over bilateral equal air entry CVS- S1 S2 M0
7. Clinical examination..contd.. Per abdomen- A huge mass(size 30 × 40 cm), solid, stony hard in consistency, bosselated, irregular, well defined margins in the upper and lateral parts, lower border could not be felt, non tender, immobile No ascites
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10. Clinical examination..contd.. Vulval inspection- no abnormality P/S- vault/vagina : normal P/V Vaginal vault appeared normal Firm mass felt in anterior fornix Upper pole could not be reached
19. Findings: A large, solid mass seen in pelvis measuring approximately 173 ×153 mm suggestive of ovarian tumor. Upper abdomen: no abnormality detected
41. CT scan report : 2068/1/12 Post hysterectomy status Huge (30x27x25cm)heterogeneously enhancing mixed attenuation abdominopelvic mass with ovaries not separately identified from this mass –most likely malignant mass of ovarian origin ? side of origin. Diffuse omental thickening and omental caking with small round enhancing nodule (17.5x15.6mm)in rectovesical pouch –s/o omental and peritoneal metastatic deposits Poorly enhancing hypodense nodule(20.7x20.5mm) in right lobe of liver –s/o metastatic lesion
42. CT scan report : 2068/1/12 Multiple mildly enhancing round and oval nodules in scanned part of both lungs,largest 21.5x20.4mm in size –s/o metastatic lesions.No pleural effusion Bilateral mild hydronephrosis most likely secondary to ureteric compression by the above described mass Mild ascites around lesion in pelvis No enlarged LN
43. Barium enema (3/2/068) (Colonoscopy was tried but not able to go beyond 80 cm so, advised for barium enema ) Soft tissue density (probably cystic) mass at periumbilical region Fairly smooth outlined displacement of sigmoid colon, ascending and transverse colon, more of sigmoid with mildly dilated sigmoid loop
