OVARIAN TUMOUR

By : J.kavyasri, final year MBBS

MODERATOR: Dr. Dhivya Sethuraman,
Professor, OBGYN
Mrs.sakthi, a 35 year old P2L2,W/O
Neelagandan , is a homemaker belonging to
socioeconomic class -3 according to modified
BG Prasad scale,coming from samayapuram
came to the OPD with the chief complaints of

LOWER ABDOMINAL MASS × 1 YEAR

• History of presenting illness:
The patient was apparently normal before 1 year after which she
noticed a mass in the lower abdomen, which was insidious in Onset
and slowly progressive to reach the present size,
The mass is not associated with pain
No H/O menstrual irregularity
No H /O dyspnoea and fatigue
No H/O Urinary symptoms
No H/O Constipation
No H/O pedal edema
No H/O dilated veins in the leg
No H/O dyspareunia
No H/O vaginal discharge
No H/O acne,facial hair growth, voice changes, clitromegaly
No H/ O nausea, vomiting, dyspepsia
No H/O loss of appetite and loss of weight
No H/O yellowish discoloration of skin,eyes and urine.
PAST HISTORY:
NO H/O similar complaints in the past
Not a known case of diabetes, Hypertension, Tuberculosis, Bronchial
asthma, seizures and thyroid disorder
NO H/O any drug intake

MENSTRUAL HISTORY:
Menarche attained at 14 years of age
Regular 28 days cycle with 4 days bleeding
Changes 3 – 4 pads / day not associated with passage of clots and
pain
• MARITAL HISTORY:
Married since 10 Years , non consanguineous marriage.
OBSTETRIC HISTORY: P2L2
1st pregnancy- spontaneous conception after 6 months of
marriage. delivered a full term female baby by normal vaginal
delivery in institution. Antenatal and postnatal period was
uneventful and now the child is 9 years old.
2nd pregnancy- spontaneous conception after 1 year of 1st
pregnancy. Delivered a full term male baby by normal vaginal
delivery in institution. Antenatal and postnatal period was
uneventful and now the child is 7 years old
NO H/O any contraceptive usage.
FAMILY HISTORY:
NO H/O Similar complaints in the family
NO H/O any malignancy in the family.

PERSONAL HISTORY:
Consumes mixed diet
Normal bowel and bladder habits
Normal sleep pattern.
GENERAL EXAMINATION:
The patient is comfortable, oriented to time ,place and person.
Moderately built and nourished.
NO pallor, NO icterus, NO cyanosis, NO clubbing, NO generalized lymphadenopathy,NO
pedal edema.
Height- 155 cm
Weight- 52kg
BMI – 21.6 kg / m²
Breast ,thyroid and spine are normal.
VITAL SIGNS :
Temperature – 98.4 F
R.R – 16 breaths/ min
P.R- 80 beats/ min
B.P- 110/70 mmHg.
ABDOMINAL EXAMINATION:
After getting consent, ask the patient to empty the bladder and later expose the patient
from neck to mid thigh.

Inspection: Abdomen is distended in the lower quadrant.

Umbilicus in midline-inverted.
All quadrants moves equally with respiration.
Linea alba and stretch marks are seen
No dilated veins
skin over the swelling in the lower quadrant is stretched and
shiny.
NO lymph node enlargement in left supraclavicular fossa
Palpation:
No warmth and No tenderness
A single mass of size 5×10 cm , spherical in shape, occupying
hypogastric region slightly to the left corresponding to 18 weeks of gestation
is felt.
Extent:
Upper border: 5 cm below from the umbilicus
Right lateral border : 3 cm medial to the right midclavicular line.
Left lateral border : 1cm lateral to the Left midclavicular line.
positive groove sign
no transmitted mobility
Well defined borders
Smooth surface
Tense / cystic consistency
Mobile from side to side
Percussion:
dullness over the mass, resonant at the flanks
No fluid thrill ,NO shifting dullness
Auscultation: normal bowel sounds heard.

Per speculum,per vaginal, per rectal examination- not done.

Summary :
Mrs.sakthi, a 35 year old P2L2,is a homemaker
belonging to socioeconomic class 3 from
samayapuram came to the OPD with the chief
complaints of LOWER ABDOMINAL MASS × 1
YEAR with no h/o suggestive of feminising or
virilizing tumor or malignancy. On examination A
single cystic, spherical, mobile mass of size 5×10
cm , occupying hypogastric region
corresponding to 18 weeks of gestation with dull
note and fluid thrill is present.
DIAGNOSIS:
A 35 year old P2L2 came with lump in
lower abdomen probably a benign ovarian
tumour with no other medical complications.
INVESTIGATION:
USG
CT and MRI
COLOUR FLOW DOPPLER
Tumour markers : CA- 125 , CEA
OTHERS:
Paracentesis
IVP
Upper GI endoscopy
Chest X- ray
Treatment for these patient : Ovarian cystectomy/ Unilateral ovariotomy.

Other treatment: Abdominal hysterectomy + bilateral salpingo oophorectomy.

Laparoscopy / ultrasound guided aspiration and removal of
the cyst.
நன்றி