A 45-year-old woman presented with pelvic pain and abdominal distention. Imaging studies including ultrasound, CT scan and MRI revealed a large heterogeneous pelvic mass. The differential diagnosis included ovarian neoplasm, pelvic inflammatory disease, or endometrioma. She was referred to a gynecological oncologist for surgical resection of the mass to arrive at a definitive diagnosis and treatment.
A 45-year-old woman presented with pelvic pain and abdominal distention. Imaging studies including ultrasound, CT scan and MRI revealed a large heterogeneous pelvic mass. The differential diagnosis included ovarian neoplasm, pelvic inflammatory disease, or endometrioma. She was referred to a gynecological oncologist for surgical resection of the mass to arrive at a definitive diagnosis and treatment.
A 45-year-old woman presented with pelvic pain and abdominal distention. Imaging studies including ultrasound, CT scan and MRI revealed a large heterogeneous pelvic mass. The differential diagnosis included ovarian neoplasm, pelvic inflammatory disease, or endometrioma. She was referred to a gynecological oncologist for surgical resection of the mass to arrive at a definitive diagnosis and treatment.
A 45-year-old woman presented with pelvic pain and abdominal distention. Imaging studies including ultrasound, CT scan and MRI revealed a large heterogeneous pelvic mass. The differential diagnosis included ovarian neoplasm, pelvic inflammatory disease, or endometrioma. She was referred to a gynecological oncologist for surgical resection of the mass to arrive at a definitive diagnosis and treatment.
SJ, a 45-year-old woman, presented to the radiology department with complaints of progressive
pelvic pain and abdominal distention over the past six months. She reported a feeling of fullness and
occasional discomfort in her lower abdomen. SJ's menstrual history indicated that she was
postmenopausal for the past two years. She denied any recent weight loss, changes in bowel habits,
or urinary symptoms.
Clinical Examination:
On clinical examination, SJ had mild tenderness on palpation of the lower abdomen but no palpable
masses or organomegaly. Gynecological and rectal examinations did not reveal any abnormalities.
Her vital signs were within normal limits.
Imaging Studies:
Ultrasound: An initial transabdominal ultrasound was performed, which showed a large pelvic mass with complex cystic and solid components. Blood flow within the mass was noted, raising suspicion for a neoplastic process. The ovaries appeared normal, and there was no evidence of free fluid in the pelvis. CT Scan: A follow-up contrast-enhanced abdominal and pelvic CT scan was ordered to further evaluate the mass. The CT scan revealed a large, heterogeneous pelvic mass measuring approximately 12 cm in diameter. The mass appeared to arise from the left adnexa and was adherent to the left pelvic sidewall. There were no signs of distant metastasis or lymphadenopathy. MRI: To obtain a more detailed characterization of the mass, an MRI of the pelvis was performed. The MRI confirmed the presence of a complex cystic and solid mass with internal septations and areas of high T2 signal intensity. The mass showed enhancement on post- contrast imaging. Diagnosis:
Based on the radiological findings, the differential diagnosis included:
Ovarian Neoplasm: The presence of a complex mass with blood flow raises concern for ovarian malignancy. Pelvic Inflammatory Disease (PID): Infection-related pelvic masses can sometimes mimic neoplasms. Endometrioma: Endometriomas can appear as complex cystic masses on imaging.
Management:
SJ was referred to a gynecological oncologist for further evaluation and management. Given the size
and complexity of the mass, surgical intervention was planned for definitive diagnosis and
treatment. Preoperative workup included tumor markers (CA-125) and consultation with an
anesthesiologist to assess her fitness for surgery. The surgical procedure would involve a
laparotomy or minimally invasive surgery (laparoscopy) with the aim of complete resection of the
mass and staging.
This case underscores the importance of radiological imaging in the evaluation of pelvic masses,
particularly in postmenopausal women. Early and accurate diagnosis is crucial for timely
intervention and optimal patient outcomes. Further pathological evaluation of the excised mass will
be essential to confirm the diagnosis and guide subsequent management.
