PATHOPHYSIOLOGY OF OVARIAN NEW GROWTH

PREDISPOSING FACTORS CONTRIBUTING FACTORS

Gender (F) Second-hand smoker (husband)

Age (72) Hx of irregular menstrual
Postmenopausal Lifestyle:
- Diet : yam (camote)
- Lack of exercise

Increase in estrogen

Hormonal Increase in human Nausea and

imbalance chorionic gonadotropin vomiting
 Increase in luteinizing
hormone

Hyperstimulation of
ovaries

Abnormal proliferation
of follicles

Failure of follicles to rupture & Irregular

continue to grow menstruation

Increase abdominal girth

Dull, lower quadrant pain Cyst grows in size
February 6, 2017: 32cm

February 7, 2017: 32cm

February 13, 2017: 32.5cm

February 14, 2017: 32.5cm

 Ultrasound Increase pelvic pressure
Dec. 22, 2016

Uterus: 3.03 cm x 3.24 cm x 2.22 cm Anteverted

Endometrium 0.34 Isoechoic

Fatigue and sense of Pain Scale
Cervix: 3.35 cm x 1.62 cm x 2.27 cm heaviness in the pelvis of 8/10
Others: At the time of the scan, there is a note of
huge pelvo-abdominal cystic mass measuring 25 cm
from the symphysis pubis. Thick walled
multiloculated with thick septum. Sassone score 12.
Constipation and
painful defecation

Ultrasound
Feb. 6, 2017

Uterus: 3.46 x 3.47 x 2.42 anteverted

Endometrium 0.37 Isoechoic

Cervix 2.72 x 2.06 x 1.7 cm

Others: At the time of scan, there is a note of a huge

pelvo-abdominal cystic present measuring
approximately 32 cm from the symphysis pubis,
thick walled, multiloculated with septum. Sassone
score 12.
 Chest PA
Feb. 11, 2017

History:

Findings:

CHEST:

Elevated right diaphragm

Heart is not enlarged
Trachea is at the midline
Both hemidiaphragms are sharp and distinct
Osseous thoracic cage shows no significant abnormality
Conclusion: Subpulmonic effusion right lower lung.
 CT scan
Feb. 15, 2017

The liver is normal in size and parenchymal attenuation, contours are smooth. There are small cysts (0.4 cm) seen
in the right lobe (segment VIII & VI). There are no focal mass lesions or abnormal calcifications seen. Intraheptic
ducts are not dilated. Gallbladder is normal in size and outline. Wall is not thickened. No calculi seen within. The
pancreas and spleen are normal in size with no focal mass lesion seen. There are no enlarged retroperitoneal
nodes seen. Minimal fluid is seen in the abdomen.

There is a large, cystic mass lesion with internal septations seen in the abdomino-pelvic region, closely related to
the uterus. This measures about 11.8 x 20.0 cm in diameter with focal wall thickening noted in the inferior
portion of the mass. Uterus is small in size with calcified fibroids within.

Both kidneys show normal excretory function. The bilateral pelvocalyceal structures and proximal ureters are
mildly dilated, most likely due to extrinsic pressure effects of the mass on the ureters. Rest of the ureters are not
dilated. The urinary bladder is normally distended with no filling defects seen.

There is persistent mucosal thickening seen in the posterior wall of the opacified stomach. Rest of the opacified
intestinal segments, vascular, and other soft tissue structures are otherwise unremarkable. Minimal free fluid is
seen in the right lower hemithorax.

IMPRESSION:

LARGE ABDOMINO-PELVIC CYSTIC MASS, AS DESCRIBED.

OVARIAN ETIOLOGY IS CONSIDERED.
MUCOSAL WALL THICKENING POSTERIOR PORTION OF THE STOMACH.
GASTROSCOPIC CORRELATION IS SUGGESTED.
SMALL HEPATIC CYSTS.
MINIMAL ABDOMINAL ASCITES AND RIGHT PLEURAL EFFUSION.
 Referral to Gyne-Oncologist

Rupture of cyst Surgery

Determine
malignancy
Infection Hemorrhage Acute pain

Death Increase chance of

survival

Legend:
Signs and symptoms

Book-based