CASE REPORT:
An 80‐year‐old multiparous woman presented with complaints of lower
abdominal pain and back pain for two weeks. There was no history of
weight loss and loss of appetite. Bowel and bladder habits were normal.
There was no other significant clinical or family history. On abdominal
examination, she had mild tenderness at the left iliac region. Per
vaginal examination showed mild cervical erosion and a hard palpable
mass in s left adnexa and pouch of Douglas’. Abdominal ultrasound
revealed a complex adnexal cyst measuring 5.3 X 5.0 X 9.7 cm adjacent to
the fundus of the uterus, likely originating from the right adnexa. The
cyst had thick walls with polypoid projections and mural nodules
measuring up to 15mm in thickness. Serum CA 125 and CEA were 200 IU/mL
and 63.62 IU/mL, respectively. A computerized tomography scan of the
abdomen and pelvis revealed a 10 X 6 X 6 cm cystic lesion in the pelvis
anterosuperior to the uterus. Multiple enlarged para-aortic lymph nodes
measuring 20 X 14 mm, a few sub-centimeter-sized left external, and
common iliac lymph nodes were noted. A suspicious enhancing nodule was
also noted in the Pouch of Douglas. A presumptive diagnosis of advanced
ovarian cancer was made. The patient underwent total abdominal
hysterectomy with bilateral salpingo‐oophorectomy with bilateral pelvic
lymph node dissection, para-aortic lymph node dissection, total
omentectomy, appendectomy, bladder peritoneal deposit removal with left
Double J stenting.