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What is yourdiagnosis? Kavita KhoiwalJuhi MishraSandipan Chowdhuri2021 год

What is your diagnosis?
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Аннотация: What is your diagnosis?A 33-year-old woman, P2L2, presented with complaints of intractable dry cough for three months with nausea, vomiting, loss of appetite, and occasional episodes of fever.She had no menstrual complaints.Her past and family histories were unremarkable.On clinical examination, her performance status score was "2" according to the Eastern Cooperative Oncology Group (ECOG).Vital signs were normal, except for low-grade fever and World Health Organization grade 3 anemia (hemoglobin: 7.6% gm).Abdominal examination revealed a firm to hard, abdominopelvic mass of 22-24 week's size occupying hypogastrium, right and left iliac fossa with restricted mobility.Cervix and vagina were healthy on pelvic examination.Vaginal examination revealed a similar mass, uterus was not felt separately, pouch of Douglas and bilateral fornices were full.These findings were reconfirmed on rectal examination.Rectal mucosa, recto-vaginal septum, and parametrium were found to be healthy on P/V/R examination.Complete fever profile including blood culture was normal.She tested negative for Coronavirus disease-2019 (COVID-19).Chest X-ray and contrast-enhanced computed tomography (CECT) of the chest were ordered to look for a cause of refractory cough, but the reports were absolutely normal.Any possibility of tuberculosis was also ruled out.Ultrasonography (USG) of the abdomen and pelvis was suggestive of a large solid-cystic mass occupying the whole pelvic cavity.CECT showed an 18.5x16.5x15cm lobulated heterogeneous mass lesion with multiple peripheral enhancing excrescences and nodules with a large, central, non-enhancing area suggestive of neoplastic etiology, uterus, and ovaries were not visualized separately (Figure 1).No enlarged lymph nodes were reported.Serum tumor markers including CA125 (408.2U/mL) and CA19-9 (312.3U/mL) were markedly raised while lactate dehydogenase, carcinoembryonic antigen, alpha-fetoprotein, and human chorionic gonadotropin were within normal limits.Pap smear was negative for malignant cells.USG of breast, and upper and lower gastrointestinal endoscopies were insignificant.Her cough could not be relieved with broad-spectrum antibiotics, cough suppressants, and other conservative measures advised by a chest physician.She started having fever more frequently and her total leucocyte count was rising.Eventually, a plan of staging laparotomy was made because of high suspicion of malignancy and deterioration in the general condition of patient.
Год издания: 2021
Авторы: Kavita Khoiwal, Juhi Mishra, Sandipan Chowdhuri, Pranoy Paul, Anchal Agarwal, Amrita Gaurav, Jaya Chaturvedi
Издательство: Galenos Yayinevi
Источник: Journal of the Turkish-German Gynecological Association
Ключевые слова: Veterinary Orthopedics and Neurology
Другие ссылки: Journal of the Turkish-German Gynecological Association (HTML)
Europe PMC (PubMed Central) (PDF)
Europe PMC (PubMed Central) (HTML)
PubMed Central (HTML)