a presentation on few patients with gynaecological malignancy. presented on September 2022. This presentation contains with diagnosis ,investigation, management (both surgical & medical ).

1. Dr.Bedoura Sharmin.
MBBS,FCPS (Obs and Gynae)
HMO, GOU-I
NICRH, Mohakhali, Dhaka.

2. Patient: 01
2
Particulars Case summary Case summary OT Note Final Decision
• Name: Mrs.
Aleya Begum
• Age: 46years
• R/N-
22/11468
• CXN- 7053
• P- 216
K-29
• Address :
Monohorgong
,Comilla
• MOB No:
01727642917
• D/A-
01/05/22
• D/D- 29/05/22
 C/C :
• Excessive P/V discharge for 5
months.
• L/A/P for 2-3 months.
 M/H:
MC – 28-30 days
MP – 4-5 days
LMP – 20.04.22
 O/H:
• Age of marriage: 20 years
• Age of 1st term delivary: 21
yrs
• Para: 2(VD)+0
• ALC-18 yrs.
• Widow for 3 yrs.
 C/H: OCP- 05 years.
 Medical H: Hypothyroidism
for 8 yrs.
 O/E:
 G/E
• ECOG:1
• Anaemia:(+)
• Breast-NAD
• Thyroid-NAD
• Accesible LN- NP
 P/A/E: NAD
 P/V/E:
o Inspection of vulva-NAD
o P/S/E:
• An endophytic growth (2x3cm) extending upto
upper lip of cx, bleeds on touch.
o B/M/E:
• Ut – 8 wks size.
• An endophytic growth extending upto ant. lip of
Cx, which is hard, friable, bleeds on touch.
• Rt fx –free, Lt fx – shallow.
 R/V/E:
• Both para free & Rectal mucosa free
 PRO. DX: Ca Cervix stage IIA1 with
hypothyroidism.
 INV:
 H/P/R of cervical growth: Invasive
Adenocarcinoma,G-1
 MRI of W/A & pelvis :Thickened cx with
obliterated cervical canal. Fluid collection within
uterine cavity. A globular soft tissue structure
(3.5x3.5cm) in its lower part confluent with the
cx .Para metrial fascia appear normal.
 Plan : RH ē BPLND
 Date:21/05/22
 Time: 9:00 AM
 I/O : Ca cx IIA1
 N/O: RH ē
BLPLND
 N/A: G/A
 Procedure &
Findings:
• Incision:
Maylard
• Uterus: 10 wk
• Both FTs &
ovaries: healthy
looking.
• Rt parametrium
– thick.
• Cx-endocervical
lesion (2.5x3cm)
involving ant lip.
 Post operative
period :
Uneventful.
 HPR:
• Size of cx lesion: 1.5x1.5cm
• Histological type: Invasive
SCC
• Histological grade: 2
• Stromal invasion: superficial
1/3
• LVSI: Not identified
• Vaginal cuff: Free of tumour
• Lymph node(3 Rt side,2 Lt
side): Reactive change
• Both sided ovaries & FT:
Free of tumour
 Final Dx: Ca Cervix stage
IIA1.
 Tumour board decision:
CT followed by EBRT & ICRT.
Pt receiving EBRT at Ahsania
Mission Hospital.

3. Ms.Aleya – RH with BPLND

4. Patient: 02
Particulars Case summary Case summary OT Note Final Decision
• Name:
Mrs.Latifa
Khanum.
• Age: 63
years
• R/N-
22/11978
• Ca Vagina
• P- 237
• K-2
• Address :
Tangail
• MOB No:
01731465
100
• D/A-
08/05/22
• D/D-
13/06/22
 C/C :
• Diagnosed case of
Malignant
Melanoma of Vagina
 M/H: Menopause
for 22 yrs.
 O/H:
• Age of marriage: 16
years
• Age of 1st term
delivary: 17 years
• Para: 4(VD)+0
• ALC-35 yrs
 C/H: Nill.
 Medical History:
DM, HTN
 O/E:
 G/E
• ECOG:I
• Anaemia:(+)
• Breast-NAD
• Thyroid-NAD
• Accessible LN-
NP
 P/A/E: NAD
 P/V/E:
o Inspection of vulva: NAD
o P/S/E: Cx flushed with vagina.
Balckenning of entire vagina
involving the introitus, urethra with
nodular growth in ant. vaginal wall.
o B/M/E:
• Uterus: Atrophied. Fx: Free
 R/V/E:
• Both para soft, Rectal mucosa free
 PRO. DX: Malignant Melanoma of
vagina with DM with HTN.
 INV: Biopsy of vaginal tissue:
Malignant melanoma.
• MRI W/A: Circumferential irregular
wall thickening in lower 2/3 of
vagina. Length of lesion is 5.8cm
extends inferiorly up to vulva.
Lesion sparing uterus, UB &
rectum. Few sub centimetic
inguinal lymph nodes are seen.
 Plan: RH with BPLND &
vulvectomy with total vaginectomy
with B/L inguinal LN dissection.
 Date:16/05/22
 Time: 8:30 AM
 I/O : Malignant melanoma of
vagina.
 N/O:RH with BPLND & vulvectomy
with total vaginectomy with B/L
inguinal LN dissection(only
superficial LN dissected, deep LNs
not palpable) under SAB with
epidural followed by bilateral V-Y
plasty under SAB on 21/05/22 .
 Procedure & Findings:
• Abdominal Incision: Maylard
• Uterus: Atrophied, pelvic LNs not
enlarged.
• Both FTs & ovaries: Healthy looking.
• V. melanoma starting beyond clitoris
involving inner aspect of labia majora
labia minora.
• There was multiple enlarged inguinal
LN, largest one(2x3)cm.
 Post operative period: She
developed fever. After proper
treatment ,she recovered
completely.
 HPR:
• Cx- chronic cervicitis with ulcer.
Uterine wall show basal
endometrium.
• Rt & Lt pelvic LN shows
reactive changes.
• Urethra- free of tumour.
• Clitoris- free of tumour.
• Post fourchette- free of
tumour.
• Vaginal cuff- free of tumour.
• Tissue from vagina- Malignant
melanoma.
• Stage-pT4NOMx
• Rt inguinal LN-reactive
changes.
• Lt inguinal LN-only fatty tissue ,
no lymphoid tissue
 Final Dx: Malignant melanoma
of vagina. DM, HTN
 Tumor board decision:
Patient did not attended at the
board.

5. Mrs Latifa 63 yrs
Malignent melanoma of vagina

6. Patient:03
Par ticulars Case summary Case summary OT Note Final Decision
• Name:
Mrs.
Hasna
Hena
• Age: 45
years
• R/N-
21/8056
• CxN 6058
• P-52
• K-25
• Address
:Gazipur
• MOB No:
01730995
390
• D/A-
08/05/22
• D/D-
04/06/22
 C/C: P/V foul smelling & blood
stained discharge for 3-4 months.
 Diagnosed case of Ca Cx stage IIB
since April,2021.
 Received EBRT(25 cycle) +ICRT (3
cycle) upto 13.11.2021.
 HPR: Invasive SCC,G-2 (30.03.22)
 M/H: Menopause for 2 years.
O/H: Age of marriage -16 yrs .
Age of 1st term delivary 17 yrs.
P-3(NVD)+2MR,ALC-14 yrs.
 Con/H: COCP for 8 yrs.
 Medical H: NC.
 Family History: NC.
 O/E:
 G/E
• ECOG:0
• Anaemia:(+)
• Breast, Thyroid-NAD
• Accessible LN- NP
 P/A/E: NAD
 P/V/E: Inspection of vulva-NAD
 P/S: Cx was fiushed with the
vagina, small nodule(0.5x0.5cm) in
upper part of post vaginal wall.
 B/M/E :Uterine size could not
be delineated. Fx- shallow.
 R/V/E: Both para-soft.
• Rectal mucosa free
 Pro Dx: Ca Cx post
Radiotherapy with local
recurrence.
 INV:
 MRI: Uterus N/S,
Cx is broad with a soft tissue
intensity mass(2.6x1.7cm) in
posterior wall.
 Details of cervical mass:
• Involvement of vagina-N
• Parametrial invasion-N
• Local invasion-None
• Pelvic side wall involvement-
None
• Ureteric encasement-N
• Locoregional
lymphadenopathy-N
• Pelvic bone involvement-None.
 Plan:
Modified Radical
Hysterectomy .
OT Note:
Date:21/05/22
 I/O : Ca Cx post
Radiotherapy with local
recurrence.
 N/O:Modified Radical
Hysterectomy with
BPLND.
 N/A: G/A
 Procedure & Findings:
• Incision: Maylard
incision.
• Findings: Uterus N/S,
densely adherent with
UB.
• There was small
superficial lesion in
upper part of post.
Vaginal wall.
• There was multiple
enlarge pelvic LNs on
both sides.
 Post operative period:
Uneventful.
 HPR:
• Histological type: Invasive
Squamous cell carcinoma.
• Histological grade: G-III.
• Stromal invasion: Superficial one
third.
• Lympho vascular invasion: Not
identified.
• Perineural invasion: Not identified.
• Vaginal cuff: Out of five fragments
one fragment is involved.
• Lt ovary with FT and parametrium:
Free of tumour.
• Rt ovary with FT and
parametrium: Free of tumour.
• Rt sided pelvic LNs: Show reactive
changes.
• Lt sided pelvic LNs: Show reactive
changes.
 FINAL Dx: Ca Cx post Radiotherapy
with local recurrence.
 TB decision- Further Radiotherapy.
 Radiotherapy going on (received 3
cycle)

7. Mrs Hasna Hena, 45 yrs,
Modified Radical Hystectomy with BPLND

8. Patient: 04
Particulars Case summary Case summary OT Note Final Decision
• Name: Mrs
Amena
Begum
• Age: 70 yrs
• R/N-
22/8505
• Vulva- 233
• K-2
• P-11
• Addres:
Cumilla
• MOB No:
018304652
47
• D/A-
16/5/22
• D/D-
29/5/22
 C/C :
• Per vaginal discharge &
itching for 10 years.
• Pain & burning at vulval area
for 5 years.
• Anorexia, nausea for 2 mo.
 M/H:
• Menopause for 18years
 O/H:
• Married at the age of
14 years
• Para: 6+2(ab)
• Widow for 16 yrs
 Medical H: NC.
 Family History: NC.
 C/H: nil
 O/E: G/E
• ECOG:1
• Anaemia: (+)
• Thyroid-NAD
• Breast-NAD
• Edema: (-)
• Accessible LN- not
palpable
• BP-120/80 mmhg
 P/A/E: NAD
 P/V/E:Inspection of vulva: A
large growth seen on mons
pubis, labia majora, minora
involving urethral orifice
extending up to lower vagina
& perinium.
o P/S/E:
• Cx – Flushed with vagina , no
growth seen.
o B/M/E:
• Uterus: Atrophied.
• Fx- Free.
 R/V/E:
• No mass felt.
• Rectal mucosa-Free.
 HPR- Vulval biopsy: VIN-
III)
 PRO. DX: VIN- III
 INV:
 HPV DNA (16,18)- positive
 Pap’s smear : Squamous cell
carcinoma
 USG W/A: NAD
Plan: Local radical excision of
vulva with ECC & Cervical
biopsy (4 quadrant)
 Date: 21/5/22
 I/O : VIN -III
 N/O: Local
radical excision
of vulva with ECC
& Cervical biopsy
(4 quadrant)
 N/A: SAB
 Procedure &
Findings:
• Growth present
on whole of the
Labia majora,
minora, clitoris,
lower third of
vagina involving
urethral orifice.
• Cx: Flushed with
vagina.
 HPR:
• Section made from vulval growth reveals
Invasive squamous cell carcinoma.
• Grade: Grade II.
• Lympho-vascular invasion: present.
• Perineural invasion: not identified.
• Tumour necrosis : present.
Upper end: involved by the tumour.
Lower end: 5 mm away from the resection margin.
Peripheral resection margin: free of tumour.
Sections from cervical tissue reveals ch. Cervicitis
with squamous metaplasia.
 Final Dx: Squamous cell ca of Valva.
 TB decision: Radio therapy.
 But patient did not come for therapy.

9. Mrs Amena Begum, 70yrs
Local radical excision of valva with ECC & Cervical biopsy (4 quadrant)

10. Patient: 05
Particulars Case summary Case summary OT Note Final Decision
• Name: Mrs.
Taslima
• Age: 50 yrs
• R/N-
22/10055
• Address :
Pirojpur
• Ut:263
P-177
• MOB No:
0171526078
1
• D/A- 19/5/22
• D/D-
01/6/22
 C/C :
• Menorragia for 3 yrs.
• Biopsy of Endometrial tissue & Endocervical
Tissue: decidual change.
Cervical tissue : CIN I
 M/H:
• Menarche at 12 yrs.
• MC: 26-28 days
• MP: 5-6 days.
• LMP : 24.4.22
 O/H:
• Age of marriage: 12 yrs.
• Age of 1st term delivary : 13 yrs
• Para: 4(NVD) + 1 (ab)
• H/O OCP: Use for 8-10 yrs
 Medical History: DM ,HTN for 7 yrs, H/O
Stroke : 7 yrs back.
 Surgical History : No.
 Family History: NC
 O/E:
 G/E-
• ECOG: 1
• Anaemia:(+)
• Breast & thyroid: NAD
• Accesible LN: Not palpable
• BP:130/85 mm of Hg
 P/A/E: NAD
 P/V/E:
o Inspection of vulva : NAD
o P/S/E:
• Cx: Small ulceration seen at 12
O’ clock position.
o BME: Uterus 10 weeks size.
Fx-Free.
o R/V/E: Rectal mucosa free, No
mass felt.
 Pro. Dx: Adenomyosis with
CIN I with H/O DM,HTN.
 INV:
 USG W/A: Enlarged uterus with
features of adenomyosis with
broad Cx.
 Biopsy of Cervical tissue:
Chronic Cervicitis with CIN I
 Plan:
TAH with BLSO
 Date:28/5/22
 I/O : Adenomyosis with
CIN I with DM & HTN
 N/O: TAH with BLSO
 N/A: SAB
 Procedure & Findings:
• Incision: Pfannenstiel.
Uterus 10 weeks size.
On cut section : features of
adenomyosis, multiple
small intramural fibroid
with degenerative change.
• Rectal serosa was injured
and repaired.
 Post op period: Un evenful.
 HPR:
Sections made from
cx : Ch. Cervicitis.
Sections made from
wall of uterus:
Features of
Adenomyosis.
Sections made from
both ovaries:
Unremarkable.
Sections made from
both FT:
unremarkable.
No evidence of
malignancy.
Final Diagnosis:
Adenomyosis
with Chronic
Cervicitis with
DM with HTN.

11. MRS Taslima 50 yrs
Adenomyosis win DM with HTN

12. Patient: 06
Particulars Case summary Case summary OT Note Final Decision
• Name: Mrs
Firoza
• Age: 50 yrs
• R/N-
16/18645
• Address :
Savar
• MOB No:
01964858442
• D/A-
22/5/22
• D/D-
16/6/22
 C/C :
PMB 1 month back.
Diagnosed case of Ca Breast
(post
OT, CT, RT)- 19/7/17
Taking tamoxifen for last 6 yrs.
 M/H: Menarche: At 13 yrs of
age
Menopause for 16 yrs
 O/H:
• Age of marriage: 14 yrs.
• Age of 1st term delivary:16
yrs.
• Para: 4 (NVD)
 C/H: Nil
 Medical history: DM for 12 yrs
 O/E:
 G/E
• ECOG: 0
• Anaemia: (+)
• Breast: Rt- absent (
H/O mastectomy) Lt-
NAD
• Accessible LN: Not
palpable
• P/A/E: NAD
• P/S/E: Cx-Broad,
hypertrophied,
discharge present.
• P/V/E: Uterus normal
size, A/V, mobile.
• Fx: free.
• R/V/E: NAD.
 Pro. Dx: Endometrial Ca with
DM with H/O Ca Breast on
tamoxifen ( post OT, CT, RT)
 INV:
* TVS: Uterus – N/S ,
Myometrium
inhomogenous with
centrally placed
endometrial Echo,
Endometrial
thickness – 10 mm,
Both ovary & adnexal
region appears
normal.
 Plan: F & C with EUA
 Date: 04/6/22
 I/O : PMB with DM with H/O Ca
Breast on tamoxifen ( post OT, CT,
RT)
 N/O: EUA with hysteroscopic
evaluation with fractional
currattage
 N/A: SAB
 Procedure & Findings:
Uterus 8 weeks size,
A/V Fx – free,
Cx – broad, uterine
cavity 5 cm
• Hysteroscopy- Endometrium was
healthy looking & moderate
amount of endometrial tissue
came out.
• HPR: endometrial tissue- simple
endometrial hyperplasia,
endocervical tissue – Chronic
cervicitis.
Then LAVH done Under G/A on
11.6.22 ( uterus was 8 weeks size with
both ovaries was aperantly healthy
looking.)
 HPR:
 Cx: Chronic Cervicitis
with CIN I
 Simple Endometrial
hyperplasia with
adenomyosis.
 Rt & Lt ovary –
Unremarkable
No evidence of
malignancy seen.
 Final Dx:
Simple endometrial
hyperplasia with CIN I
with DM with H/O Ca
Breast on tamoxifen (
post OT, CT, RT)
After operation patient
came once for F/U.

13. Mrs Firoza 50 yrs
PMB due to simple endometrial hyperplasia with CIN I
with DM with H/O Ca Breast on tamoxifen ( post OT, CT, RT)

14. Patient: 07
Particulars
Case summary Case summary OT Note Final Decision
• Name:
Mrs.
Romiza
Begum
• Age: 50
years
• R/N-
22/835
• Ova- 1753
• P- 431
• K- 9
• Address :
Gazipur
• MOB No:
018406540
91
• D/A-
25/5/22
• D/D-
7/6/22
 C/C :
• A diagnosed case of Ca
ovary.
• CT guided core biopsy –
High grade serous adeno
carcinoma.
• Received 3 cycle NACT (
pacli + carbo) up to 31.3. 22
 M/H:
• Menopause for 10 yrs
• Age of menarche 13 yrs
 O/H:
• Married for 20 yrs
• Para: 4 (NVD) + 1 Ab
 C/H: Nil
 Family History: NC
 Medical History: NC
 G/E-
• ECOG:1
• Anaemia: (+)
• Breast: NAD
• Thyroid: NAD
• Oedema: (-)
• Accessible LN: NP
 P/A/E : No mass felt.
 P/V/E:
o Inspection of vulva: NAD
o P/S/E: Cx – healthy looking
o B/M/E: Uterus N/S, A/V
No mass felt through fornix.
 R/V/E: No mass felt in pelvis,
& Rectal mucosa was free.
 Pro. Dx: Ca Ovary ( post NACT )
 INV:
 CT scan: Before chemo 27.1.22
Rt adnexal irregular soft tissue dense mass
(3.8x3.1 cm), Huge ascites, Mild Hepatomegaly,
Compression fracture of body of L1 may be
deposit.
After chemo 5.5.22 Rt adnexal complex mass (
Solid & cystic 3x2 cm),No ascites, No Hepatic SOL.
USG of W/A: Septate cystic mass ( 3.75 x 5.5
cm) post chemo.
CA 125 Before chemo 4082.8 U/ml & After chemo
7.93 U/ml
AFP: 2.48 n gm /ml
CEA : 1 n gm /ml
CA 19-9: < 2 U/ml
 Plan: IDS
 Date:7/5/22
 I/O : Ca Ovary (post
NACT)
 N/O: IDS ( Laparotomy
followed by TAH ē
BLSO with total
omentectomy &
removal of peritoneal
deposit)
 N/A: G/A
 Procedure & Findings:
Incision: Midline
extending Upwards.
 Dense adhesion of I-P
with Recto-Sigmoid
junction. Ovary was
buried in the
adhesion(3X2.5cm).
There was a big
deposit in the POD
(3x2cm) & also another
deposit in the ant.
Abdominal wall above
the umbilicus.
 HRP:
• Both ovaries:
 Histological type:
Serous adenocarcinoma
 LVSI- not identified.
 Perineural invasion: not
identified.
• Cervix : Chronic
cervicitis.
• Omentum :
Metastatic serous
adenocarcinoma.
• Deposit in POD:
Metastatic serous
adenocarcinoma.
 Final Dx: Serous
adenocarcinoma of
ovary (post NACT)
 TB decision:
• Adjuvant CT
Pt received 2 cycle. 3rd cycle
will be received on
25.09.2022.

15. Mrs. Romiza Begum, 50 years
IDS ( Laparotomy followed by TAH ē BLSO
with total omentectomy & removal of peritoneal deposit)

16. Patient: 08
16
Particulars Case summary Case summary OT Note Final Decision
• Name:
Mrs.
Salma
begum
• Age: 60
years
• Address:
Chittago
ng
• R/N:
• 21/1946
6
• Ova-
1626
• K-9
• Page:
170
• MOB
No:
0171617608
3
• D/A:
26/5/22
• D/D:
21/6/22
 C/C :
• A known case of Ca Ovary.
• USG guided core biopsy (serous
adenocarcinoma. (3.9.21)
• Received 6 cycle CT (Pali+Carbo) up
to 24.2.22
• Known case of Ca Breast (Post OT,CT
15 yrs back)
 Past Medical history: Hypothyroid
 Family history: NC
M/H:
Menopause for 20 yrs
Menarche at the age of 12 yrs
O/H:
• P- 4(VD)+0
• Married at the age of 16 yrs.
• Widow for 30yrs.
 C/H: Nil
O/E: G/E-
• ECOG:1
• Anaemia:+
• Thyroid-Not enlarged
• Breast- Rt breast absent
(Mastectomy due to Ca breast)
• Accessible LN: Not palpable
 P/A/E:
• No mass felt
 P/S/E:
• Cx Healthy looking
 B/M/E:
• Ut- N/S, A/V
• Fx-free
 R/V/E:
• No nodule in POD
• Rectal mucosa free
• No mass feit
 Prov. Dx: Serous adenocarcinoma of ovary
(post NATC) with H/O Ca Breast (Post OT,CT,
RT) with hypothyroid.
 INV:
CA-125-before CT 963,after CT 9.1 u/ml
CA 19-9: before CT 7.7 ,AFP 1.74 ngm/ml
CA 15.3 before CT 226.3,after CT 17.6 nml
 CT scan: Before chemo malignant
Lt tubo Ovarian mass with local (6x5cm)
metastasis to Uterus & sigmoid colon. Ascites &
mesenteric metastasis. Para caval & mesenteric
lymphadenopathy with Bilateral Plural effusion.
After chemo No definite mass in adnexa. No
residual recurrence of lesion , no hepatic SOL or
ascites. No abdominal lymphadenopathy.
** Plan: IDS
 Date:14/5/22
 I/O : Ca Ovary (post NACT)
with H/O Ca Breast
(PostOT, CT, RT) with
hypothyroid.
 N/O : IDS (Laparotomy
followed by TAH and BSO
with omentectomy)
 N/A: Combine Spinal &
Epidural anesthesia.
 Procedure & Findings:
• Incision: Midline extending
upwards.
• Finding: Omentum adhere
with small gut & Transverse
colon. Uterus & Ovaries
were densely adhere with
gut & Urinary bladder.
Ovaries were normal size.
No ascites & metastatic
deposit was present.
 Patient developed wound
infection. After dressing
secondary stitch given on
11.6.22.
 HPR:
• Lt Ovary: Papillary
serous cyst
adenocarcinoma.
• Rt Ovary: Free of
Tumor.
• Stromal invasion:
present.
• LVSI, pre neural
invasion- not
identified.
• Cx: Chronic Cervicitis,
endometrial polyp.
• Rt & Lt FT: free of
tumor.
• Omentum:
metastatic
adenocarcinoma.
 Final Dx:Serous
adenocarcinoma of
Ovary post NACT.
 TB:Further 6 cycle
CT( Pac+Gem).
CT going on(received 4
cycle)

17. Mrs Salma Begum 60 yrs
IDS ( Laparotomy followed by TAH ē BLSO
with Omentectomy.)

18. Patient: 09
18
Particulars Case summary Case summary OT Note Final Decision
Name :Mrs
Nur Banu
Age: 60 yrs
Address:
Feni
Reg no:
22/13532
OVA: 1945
Khata-10
Page:234
Mobile no-
0181815170
6
D/A:
1/5/22
D/D:
19/6/22
C/C:
 Heavyness in the lower abdomen
for 6 months
 Feelings of lump in the lower
abdomen for 2 months.
 Occasional dull aching pain for the
same duration.
M/H:
 Menopausal for 7 yrs
 Age of menarche 12 yrs
O/H :
• Age of marriage 13 yrs
• Para-4- 1(NVD)
Medical history: NC
Family history: NC
CH: NC
G/E:
ECOG-1
Anaemia- +
Breast-NAD
Thyroid-NAD
Accessible LN- not palpable
 oedema- absent.
P/A/E: A hard mass (8x10cm) at the supra
pubic area, surface smooth, margin regular,
lower limit –can’t be felt.
Another solid mass (8x6cm) in the Rt iliac fossa
which was freely mobile, non tender, surface
smooth, margin regular.
P/S/E: Cx: atrophied, deviated to anterior.
B/M/E: A hard mass continuous with the
uterus(8x10cm). Another mass (4x8cm) felt
through Rt Fx.
P/R/E: Rectal mucosa free.
Mass can be felt through ant rectal wall.
 Inv:
Ca 125 – 8.9 U/ml, Ca 19.9 – 4.5 U/ml, LDH –
179 U/ L
CT: Mildly thick wall loculated cystic leson at
left adnexal region.
Possible pedunculated subserous leomyoma
of uterus.
Mild hepatomegaly with fatty change.
USG of W/A: Suggestive of prominent & multi
cystic both Ovaries.
Rt - 4.4x5cm & 4.3x4.2cm
Lt – 7.7x7cm & 6.7x6.6cm
Pro dx: Bilateral Ovarian tumor.
Plan: Laparotomy with FSB
Date—11/6/22
I/O: Bilateral Ovarian tumor.
N/O: Laparotomy with FSB
(TAH with BSO)
N/A: SAB
Procedure & finding:
Incision: Lower mid line
No ascitic fluid.
Cystic lesion (6x7cm) on right
sided ovary & (10x10cm) on
left sided ovary.
No peritoneal deposit.
Frozen was negative.
 HPR:
• Both Ovaries:
Papillary serous
cyst adenoma.
• Both
FT:Unremarkable.
• Cx: Ch. Cervicitis.
• Wall: Atrophic
change.
 Final Dx:
• Papillary serous
cyst adenoma of
Ovary.

19. Mrs Nur Banu 60 yrs
Laparotomy followed by FSB with TAH with BSO
With removal of Ovarian Tumor.