Afsheen Wasif and Limci Gupta
Department of Cellular Pathology, St George’s hospital London
A 46 year old lady with history of hypertension, hyperlipidemia, Type 2 diabetes, cardiovascular accidents, asthma, polycystic ovaries and seizures presented with nine weeks history of constipation which failed to resolve with standard laxatives. She had an ultrasound scan which revealed a huge (30 cm) complex cyst occupying the pelvis and abdomen. She was then referred to the gynaecologist and MRI scan was requested at that point. A week after, she was admitted via accident and emergency department with vomiting, shortness of breath, urinary frequency and difficulty in lying flat with a large palpable abdominopelvic mass.
The MRI report stated that there was a complex multiseptated cystic mass measuring 30 x 23 x 16 cm arising from the left ovary with free fluid in peritoneal cavity. The septations were apparently thicker towards the superior aspect of the mass with some solid components.
Clinical impression: The tumor markers were done which showed raised CA125 of (182 kU/L) and normal CA15-3 (9kU/L) and CEA (1ug/L) respectively. The clinical suspicion was of an epithelial tumour and she underwent total hysterectomy with biltateralsalpingopherectomy with appendicectomy.