Irina-Adriana Horhoianu1,2, Răzvan V. Scăunașu1,3, Mirela Moarcăs2, Mihai Cristian Dumitrașcu1,2
1Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
2Emergency University Hospital Bucharest, Department of Obstetrics and Gynecology, Bucharest, Romania
3Colțea Clinical Hospital, Department of Surgery, Bucharest, Romania
Introduction. Adnexal masses represent a diagnostic dilemma judging from the imaging and serum markers point of view. Making a correct diagnosis is of utmost importance as ovarian cancer represents a real health issue in the entire world nowadays with diagnosis in more advanced stages with low survival rates.
Case presentation. Herein we present the case of a 44-year-old patient who arrived at the emergency ward for asthenia, loss of appetite, weight loss and severe dyspnea. When making the clinical examination a nontender distended abdomen was discovered with a large rather irregular mass in the left iliac fossa. An emergency computed tomography and ultrasound was solicited rendering a high suspicion of malignancy. Further analyses rendered an elevated carcinogenic antigen125 marker with high adnex model risk of malignancy and high risk of malignancy assessment score. A scheduled laparotomy was undertaken in a mixed team of gynecology and oncology surgeons discovering an intense pelvic inflammatory disease with good recovery.
Conclusions. Ovarian masses represent a diagnostic dilemma as neither the imagistic evaluation nor serum markers represent absolute accuracy. A high degree of suspicion is thus imperative and whenever necessary when scheduling laparotomy a specialized oncology surgeon has to complete the surgical team.