The patient, a 28-year-old woman, presented with 4 months of abdominal heaviness, pain, anorexia, and weight loss. On examination, she had abdominal distension and a 6x5 cm hard, tender mass in her left lower abdomen. Imaging showed adnexal masses in both ovaries. Bloodwork found anemia and elevated tumor markers CEA and CA-125, consistent with a suspected ovarian malignancy. Due to financial limitations, the patient was advised to undergo US-guided FNAC for diagnosis and treatment planning.

3. i. Feeling of heaviness in the lower abdomen for last 4 months.
ii. Pain in the lower abdomen for same duration.
iii. Anorexia & nausea for same duration.

4. According to the statement of the patient, she was reasonably
well 4 months back. Then she gradually developed a feeling of
heaviness in the lower abdomen which is progressively
increasing .
She also complained that she had a pain in the lower abdomen
for the same duration which is continuous, dull aching
,moderate to severe in nature , non – radiating , relieved to
some extent after medication, having no relation with food .
She further complained of severe anorexia & nausea for the
same duration & significant weight loss within this duration.

5. She is non-asthmatic , non-diabetic ,normotensive. Her
bladder habit is normal but she complained of occasional
constipation. She had no history of contact with TB patient.

6. Patient has no significant past medical or surgical history.

7. Age at menarche : 14 years
Menstrual flow : Normal
Menstrual period : 3-5 days.
Menstrual cycle: 28 days.
Last menstrual period : 5 January ,2016

8.  Married for : 12 years
 Para : 0

9. Patient has no significant family history .

10.  Patient has no history of taking any type of oral
contraceptives or other offending drugs.

11.  Patient is non-smoker ,non-alcoholic, take betel leaf with
betel nut .
 She drinks tube-well water & use sanitary latrine .

12. Patient belongs to low socio-economic group.

13. Patient could not mention clearly about her immunization.

14. Patient has not been found to be allergic to any known drugs,
food or pollen so far.

16.  Appearance – ill looking ,but co-operative.
 Body built – below average .
 Anaemia – (+)(+)
 Jaundice – (-)
 Cyanosis – (-)
 Edema – (-)
 Dehydration – (-)
 Pulse – 80 bpm

17.  BP – 110/80 mm (hg)
 Temperature – Normal
 Respiratory rate – 12 /min
 Lymph nodes – accessible lymph nodes are impalpable
 Thyroid gland – not enlarged.
 Heart – normal
 Lungs – normal
 Skin condition – normal

18.  Inspection – Abdomen is mildly distended ,flanks are full , umbilicus
is inverted & central in position . There is no visible mass, peristalsis
, engorged vein ,scar mark or any type of skin pigmentation.
 Palpation – Superficial : Tenderness in the left iliac region.
Deep : a well defined, hard ,tender mass measuring
about (6 x 5 )cm is found in the left iliac region having irregular
surface, fixed with underlying structures & free from overlying skin .
 Percussion – shifting dullness : present .
 Auscultation – bowel sound :present

19.  Inspection : The vulva & perineum looks apparently healthy .
 Per –Speculum Examination : Cervix : pink , smooth & no
discharge from external os.
A small swelling in the posterior fornix is seen.

20.  Bi-Manual Examination : Uterus is ante-verted , normal in
size , mobile .
A hard irregular tender mass is felt through posterior fornix
which is separated from the uterus & another hard fixed small
nodule is present on left lateral fornix.

21.  Rectal mucosa is free .

22. My patient , Mrs. Sufia ,28 years Muslim , married ,nulli-parous
housewife hailing from Katiadi ,Kishoreganj admitted into DMCH
on 16 February, 2016 for the presenting complaints of feeling of
progressively increasing heaviness in the lower abdomen for the
last 4 months, constant severe non radiating dull aching pain in
the same region, anorexia ,nausea & significant weight loss within
this time period.She has no history of contact with Tuberculosis
patient.
On general examination,I found the patient is moderately anaemic
,non icteric , having no edema & any accessible palpable lymph
nodes or thyroid gland.

23. On per abdominal examination, abdomen is distended ,
flanks are full .A well defined ,tender ,hard mass of about
(6 x 5) cm having fixed with underlying structures ,free from
overlying skin is found in left iliac region with presence of
shifting dullness.
On Bi-manual examination , a hard irregular tender mass is
felt through posterior fornix which is separate from uterus &
another hard fixed small nodule is present on left lateral
fornix.

24.  Ovarian Tumour ; most probably malignant .

25.  Adnexal mass due to Tuberculosis.
 Colonic mass .

27. i. CBC – Hb : 8 gm/dL ,ESR : 80 mm in first hour.
ii. Blood grouping & Rh typing- O positive .
iii. RBS : 6.2 mmol / L
iv. S. Creatinine – 0.78 mg/dL
v. X-ray Chest, P/A view – Normal
vi. Urine R/M/E – Normal
vii. S. Electrolytes – Normal
viii. HbsAg – negative
ix. VDRL – Non-Reactive

28.  USG of Whole Abdomen :
Adnexa : There are two mixed echogenic lesions measuring
about (7.4 x 4.7 ) cm seen in the right adnexal region & (6.8 x
4.8) cm in the left adnexal region . Another anechoic area
having echogenic component also seen in the both adnexal
regions measuring about ( RA : 25 mm & LA :21 mm)

29.  CEA : 110.19 ng/ml ( ref. value: <5.0 ng/ml)
 CA 125: 110.1 U/ml ( ref. value : <35 U/ml)
 CA 19-9 : 2.2 U/ml (ref. value : <3.7 U/ml)

30.  For confirming the diagnosis & starting of definitive treatment
patient was advised to do CT guided FNAC . But the patient
is so poor that she can’t afford it . So she is now advised to
do USG guided FNAC .