OVARIAN TUMOUR

A 46 year old lady with history of hypertension, hyperlipidemia, Type 2 diabetes, cardiovascular accidents, asthma, polycystic ovaries and seizures presented with nine weeks history of constipation which failed to resolve with standard laxatives. She had an ultrasound scan which revealed a huge (30 cm) complex cyst occupying the pelvis and abdomen. She was then referred to the gynaecologist and MRI scan was requested at that point. A week after, she was admitted via accident and emergency department with vomiting, shortness of breath, urinary frequency and difficulty in lying flat with a large palpable abdominopelvic mass. The MRI report stated that there was a complex multiseptated cystic mass measuring 30 x 23 x 16 cm arising from the left ovary with free fluid in peritoneal cavity. The septations were apparently thicker towards the superior aspect of the mass with some solid components. Clinical impression: The tumor markers were done which showed raised CA125 of (182 kU/L) and normal CA15-3 (9kU/L) and CEA (1ug/L) respectively. The clinical suspicion was of an epithelial tumour and she underwent total hysterectomy with biltateralsalpingopherectomy with appendicectomy. Frozen section: The left ovarian cyst was sent to our histopathology department for frozen section which revealed sheets of spindle cells and appeared to be a stromal tumour. No epithelial lining was seen. The case was deferred to paraffin sections. Gross Examination: It was a 280mm x 230x 70mm and 3788 grams partly cystic ovary. Slicing revealed a mutliloculated partly cystic tumour with some solid areas and was filled with haemorrhagic and mucinous secretions. The uterus was within normal limits. The right ovary measured 33x28x22mm and showed multiple small cysts measuring 3 to 5mm in maximum dimensions. Microscopy: Histopathological figures 1-3