Presentation
Abdominal pain and fullness
Patient Data
Huge abdominal-pelvic mass measuring 19 x 18 x 10 cm, composed of solid and cystic elements interspersed with foci and streaks of fat and calcification. Mildly infiltrated mesenteric fat adjacent to left upper aspect with engorged vessels, perhaps due to mass effect; contiguous spread less probable. Uterus and right ovary appear normal, left ovary not demonstrated. Free fluid in paracolic gutters, normal-appearing appendix floating in fluid.
Findings most compatible with immature ovarian teratoma, probably originating from left ovary.
Case Discussion
A 20-year-old woman presented to the ED complaining of stabbing abdominal pain and fullness. She had had an abdominal ultrasound on the same day, which demonstrated a fullness of mixed echotexture in the middle and lower abdomen, large parts of which contained fluid content.
CT findings were most compatible with an immature ovarian teratoma, probably originating from the left ovary. There was no clear evidence of metastatic disease.
Tumor markers: CEA 3.0 ng/mL, CA 19-9 380.3 U/mL, CA-15-3 39.1 U/mL, CA 125 81.6 U/mL.
Several days later, the patient underwent left salpingo-oophorectomy. Frozen section - teratoma. In light of the mass's size and appearance, full staging was decided on. Pelvic and left para-aortic lymph node dissection plus omentectomy were performed. Samples were taken from the peritoneum and diaphragm.
Pathology: Immature teratoma of ovary, grade 3. Findings consistent with stage 3A.
The patient was started on BEP (bleomycin, etoposide, cisplatin).
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