A Rare Case of Ovarian Tumor

Citation: Kumari G, Taralekar V, Dhabadkar S, Rathi J (2021) A Rare Case of Ovarian Tumor. Obstet Gynecol Cases Rev 8:198. doi.org/10.23937/2377-9004/1410198 Accepted: April 03, 2021: Published: April 05, 2021 Copyright: © 2021 Kumari G, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Introduction
Ovarian cancer is the third most common cancer in Indian women, accounting for 3% of all malignancies and 6% of deaths from cancer. It is fifth most common cause of death from malignancy in women [1].
Ovarian cancer is associated with low parity and infertility. Because parity is inversely related to the risk of ovarian cancer, having at least one child is protective for the disease, with a risk reduction of 0.3 to 0.4 [2].
This case is presented to highlight the varied presentation of ovarian masses and to outline the approach of management of ovarian mass in perimenopausal patients and to highlight the importance of ruling out gastrointestinal malignancy before proceeding for surgery. Metastatic tumours to the ovaries are most frequently from the breast and gastrointestinal tract. Krukenberg tumours can account for about 2% of ovarian cancers at some institutions, and they are usually bilateral. The lesions are usually not discovered until the primary disease is advanced, and, therefore, most patients die of their disease within 1 year. In some cases, a primary tumour is never found [3].
Before exploration for an adnexal tumour in a woman older than 40 years, a barium enema is indicated to exclude a primary gastrointestinal carcinoma with metastases to the ovaries, particularly if there are any gastrointestinal symptoms [4].
In first two decades of life almost 70% of ovarian tumours are of germ cell origin, and one-third of these are

Obstetric history
Married since 23 years, Nulligravida • Her Ultrasound report done outside showed gallbladder polyp with bilateral enlarged ovary.
• She was operated for lap cholecystectomy on 27/6/20. She was detected to have bulky ovaries intraoperatively ( Figure 1) and her ascitic fluid showed cells suspicious of malignancy ( Figure 2).
• Hence her staging laparotomy with frozen section with pan hysterectomy was planned.

Post-operative
Patients' histopathology report came as metastatic adenocarcinoma or Malignant sex cord tumour. Her IHC marker of IHC-CK7 AND CK 20 POSITIVE, INHIBIN -NEG-ATIVE Which was favouring adenocarcinoma.
• Post-operative patient underwent 2 cycles of chemotherapy.
• She presented with acute abdomen after 1 month of surgery and was diagnosed with bowel perforation -> ileostomy was done.
• Colostomy bag was put. Patient was shifted to ICU postoperatively for further management.
• She was shifted towards on (0 + 3 rd ) post-operative day and was discharged on 10 th postoperative day.
• She didn't follow up later.

Discussion
Early ovarian cancer has nonspecific symptoms resembling those of less serious conditions. Pain in abdomen and burning micturition are common complaints which may present to a general-practioner. Thus, the diagnosis of ovarian cancer is challenging, since it is detected at an advanced stage, requiring exploratory laparotomy.
Whenever a patient of ovarian tumour is posted for surgery the staging laparotomy with frozen section remains the preferred approach.

Conclusion
In this case the patient presented with vague symptoms. Ovarian cancers present with very vague symptoms; hence it is generally diagnosed in very late stage, hence whenever any perimenopausal women presents to a Primary health care with vague symptoms, possibility of ovarian cancer must be kept in mind and per vaginal examination to rule out any adnexal pathology must be done and they must be referred to tertiary care hospital for further management. Also, Gastrointestinal malignancy or Krukenberg tumour must be kept in mind as differential diagnosis of carcinoma ovary and CEA also should be done.
Frozen section may not be conclusive in every case of ovarian tumor, so staging laparotomy is ideal modality of management.