CLINICO-PATHOLOGICAL

CONFERENCE
 Section: B
Group no.: 6-B
Group members:
• MUTHAVARAPU ANISH CHOWDARY
• MURARI KIRAN KUMAR
• NAIDU MOHANA SUDHA
• PADALIYA URVISH
• PADHIYAR MILAPSINH
• PALLETI PRANEETH
• PALLEKONDA NOEL
• PAPASANI MAHESWARAREDDY
 SALIENT FEATURES
• 50 year old female • 2 days PTA
• Chief complaint - Abdominal • Increase of abdominal girth
enlargement • Dyspnea
• 1 month PTA
• Anorexia
• Abdominal pain, generalized ,
• Weight loss
colicky, 3/10 in severity
radiation to back ROS:
• Palpable pelvic abdominal • 50% weight loss over one
mass month
• Treated with unrecalled • Anorexia
medication as a case of • Orthopnea
urinary tract infection • Dyspnea
 PHYSICAL EXAMINATION
• Vital signs : BP- 90/60 • Pelvic examination :
mmHg •  Atrophied cervix,
• RR - 19 cpm deviated to right
• HR - 92 bpm • Pelvo Abdominal mass
• T- 36.5 C extends from pubic
• Breath sounds decreased symphysis to 3 finger
over the bilateral lower breadths from xiphoid
lung fields process
• Grade (II) edema on both • Mass size - 30x26 cm ,
extremities. cystic & movable
 Emergency room
Chest x-ray
• CHEST PAL  
• Pleural effusion, right
• Left lower lobe pulmonary lesion, inflammatory vs
neoplastic
• Pleural thickening vs minimal pleural effusion
• Left degenerative osseous changes
• TVS-UTZ
• Pelvo Abdominal mass with sonographic findings
suggestive of uterine pathology
LABORATORY INTERPRETATION

• CBC
• Thrombocytosis
• Neutrophilia
• Anemia
• Low Hct, high RDW
• Electrolytes - low Na
• Urinalysis -  few bacteria
 Renal cell carcinoma
RULE IN RULE OUT
• Palpable • Hematuria
abdominal mass • Fever
• Anorexia • Hypertension
• Weight loss • Malaise
• Thrombocytosis • Hypercalcemia
• Pleural effusion on
chest x-ray
• Anemia
• FHx of cancer 
• Hx of Smoking
 Uterine leiomyoma

RULE IN RULE OUT

• Abdominal • Oligomenorrhea
enlargement  • Pelvic pain
• Abdominal girth • Constipation
• Abdominal pain
• Anemia
• Frequent urination
• Menopause
 Endometrioma

RULE IN RULE OUT

• Abdominal pain • Reproductive age
• Abdominal mass, group
cystic large in size • Uterine Bleeding
• Vomiting
•  Dizziness
• Nausea
 Mucinous  cystadenoma of ovary
• RULE IN
• Abdominal pain
• Abdominal enlargement
• Abdominal girth
• Weight loss
• Anorexia
• Shortness of breath
• Pelvoabdominal mass larger, cystic
• Thrombocytosis
• Neutrophilia
• Pleural effusion in chest x- ray
• Pulmonary lesions
• Degenerative bone changes
• FHx of cancer
• Smoking
 WORKING DIAGNOSIS

• Cardiorespiratory failure due to anesthesia

secondary to ovarian mucinous cystadenoma
stage IV
 Incidence

• Mucinous tumors account for about 20% to 25%

of all ovarian neoplasms.
• Overall, only 10% of mucinous tumors are
malignant, another 10% are borderline, and 80%
are benign.
• Benign mucinous cystadenomas  are 80% of the
mucinous  ovarian tumors.
• The estimated peak incidence is at 30-50 years of
age.
 Etiology : 

• The most common primary cause of the

ovarian mucinous cystadenoma in our case is
because of certain risk factors like being female
with an age 50 or above who is menopausal
and also caused by heavy smoking and
sometimes by alcohol beverage consumption.
• Hormonal problems and drugs used to induce
ovulation are also an etiology for ovarian
mucinous cystadenoma.
Pathophysiology
 Diagnostics
• Transvaginal ultrasound :
• Computed Tomography scan
• Magnetic Resonance Imaging :
• Positron Emission Tomography :
• Chest X- ray :
• Serum biomarkers like CA-125 which are
elevated in the ovarian cancers.
 Treatment
• This patient needs a combined modality of
treatment, maximum possible debulking surgery
followed by chemotherapy.  surgery is the initial
step in the management,it provides an opportunity
to know the stage of the disease, exact spread of
the disease and also helps in removing maximum
possible amount of the disease from abdomen and
pelvis. this surgical procedure is called debulking
surgery (cyto reductive surgery),
 CONSERVATIVE SURGERY

• INTERVAL DEBULKING SURGERY

• Because of coexisting respiratory problem
these patients is managed by initially giving
three cycles of chemotherapy (Pachtaxel+
Carboplatin) at the three weekly intervals
followed by debulking surgery. 
• By these patients improves, ascites reduces and
he becomes fit for anaesthesia and surgery.
 CHEMOTHERAPY FOR OVARIAN CARCINOMA

• After initial surgical management almost all

cases need adjuvant chemotherapy.
DRUGS USED FOR CHEMOTHERAPY

• Currently the most commonly used

combination of drugs in the treatment of
epithelial ovarian cancers is Paclitaxel +
Carboplatin. These drugs are given
intravenously every 3 weeks for six cycles.
•  Doses of these two drugs are ;
• Paclitaxel Dose 175 mg/m², intravenously over
3 hours. Main side effect: Neurotoxicity.
• Carboplatin: Dose is calculated by area under
curve (AUC) which is generally taken as 5-6.
However, in subjects with compromised renal
function a smaller dose is given.
• Side effects: Nephrotoxicity, bone marrow
suppression.
 FOLLOW-UP

• Epithelial ovarian cancers treated by surgery

and chemotherapy are seen at a regular
interval of 3 months for initial 2 years and
subsequently every 6 month for next 3 years
for any recurrences. Clinical examination and
serum CA-125 every 3 months help in
detection of recurrences. Imaging studies are
carried out in case of any suspicion of
recurrences.
 Prevention
• The patient must stop her habits of smoking and
alcohol beverage consumption which triggered the
condition Ovarian Mucinous cystadenocarcinoma.
• The patient must have a good knowledge on
nutrition and diet to keep herself healthy from
harmful carcinomas and other diseases.
• The patient must also have some general knowledge
on postmenopausal diseases and their causes so
that she can prevent them from happening.
Immediate Cause Cardio respiraory
of Death failure
Antecedent Cause Anesthesia
of Death
Underlying Cause ovarian mucinous
of Death cystadenoma stage IV
 REFERENCES

• Harrison’s Principles of Internal Medicine 19th

Edition
• Robbins and Cotran Pathologic Basis of Disease
9th Edition
• SHAWS TEXTBOOK BOOK OF GYNAECOLOGY 17
TH EDITION