CLINICAL CASE PREENTATION

DR. ASMA CHOWDHURY

FCPS COURSE STUDENT
DEPARTMENT OF OBSTETRICS AND GYNAECOLOGY
BSMMU
Mrs Merina 33 years, para 1(c/s)+0, housewife of a low
socioeconomic status hailing from Natore, got herself
admitted in BSMMU on 12th September 2023 with the
complaints of

• Feeling of a lump and mild discomfort in lower abdomen

for 1 month.
• She is a known case of ovarian malignancy, post surgery
post chemo state.
According to the statement of the patient she was
reasonably well 9 years back, then on 2014 at her 24 years
of age she was diagnosed as a case of malignant ovarian
tumor. For that she underwent surgery, after that completed
chemotherapy as scheduled. Last dose of chemotherapy
was on March 2015. She was not on regular follow up.
After 9 years of completion of treatment she suddenly
noticed a mass in lower abdomen 1 month back. She had
mild abdominal discomfort but no pain.
Shortly after noticing the mass she came to BSMMU OPD
for further management.
She had no history of
● difficulty in defecation, constipation, loose stool or passage
of dark stool
● Loss of appetite, bloating sensation, anorexia, early satiety
and feeling of fullness after small meals
● Urinary frequency, urgency, dysurea or retention
● Fever, cough
● shortness of breath or chest pain
Her menstrual history revealed, she had attained her
menarche at the age of 13. Her menses were regular with
average flow and duration before and after operation and
chemotherapy. She had no dysmenorrhoea or passage of
clots.

Regarding her obstetric history she is married for 17 years.

She delivered her only child at her 20 years of age by LSCS.
Age of her daughter is 13 years.
Couple practiced barrier method as contraceptive and they
never tried for conception after her treatment of malignancy.
She is normotensive, non diabetic. No History of thyroid
disorder. The patient did not have TB or contact with TB
patient.
She is not taking any medicine for any chronic disease.
She had no h/o any surgery except LSCS and laparotomy
for ovarian malignancy.
She gave no history of breast, ovary or colon cancer in any
of her family member.
With due consent and maintaining adequate privacy, I have
examined and found her well alert, co operative, but anxious.
Her ECOG PS is 0.
BMI: 23.9 kg/m², Pulse -82/min, BP-120/80 mm of hg, RR 16
breaths/min,Temperature: Normal
Mildly anaemic ,Non icteric , Non oedematous
Thyroid gland is not enlarged, accessible lymphnodes are
not palpable,
Both breasts are normal with no discharge or palpable lump
Cardiorespiratory system reveals no abnormality.
On Per Abdominal examination,
On inspection-Lower abdomen is distended, umbilicus is
centrally placed and inverted. There was a midline incision
mark.There was no dilated vein or visible pulsation.
On Palpation-
Abdomen was soft, non tender.
A mass measuring 13cmx10cm, occupying hypogastric, left
iliac, left lumber and umbilical region, partly solid partly cystic
in consistency, surface was irregular, ill defined margin
movement was partially restricted from side to side and from
above downwards. Lower pole of mass could not be
delineated. No local rise of temperature, no organomegaly
found.
On Percussion
Dull over the mass, no ascites.
On Auscultation
Bowel Sound present.
No Bruit over the mass.

On Per vaginal examination:

On inspection -External Genitalia apparently looks
healthy.
On Per speculum examination-Cervix looks apparently
healthy & no active bleeding or discharge is present,
vaginal walls are normal.
On Bi-manual examination:
Size of the Uterus can't be delineated, an irregular partly
solid partly cystic mass of about 13×10 cm felt through
anterior and left fornices which is mildly tender. There was
no nodular deposit on pouch of douglas.
On Per Rectal examination:
Rectal mucosa is free. Lower limit of the mass felt
anteriorly
So, from history and clinical examination my provisional
diagnosis is:

RECURRENT MALIGNANT OVARIAN TUMOR.

Thank you