An unlikely culprit of abdominal pain in a 23-year-old female: a case study




Garda, Jacqueline
Bunyard, Julie


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Background: Ovarian cancer is the most common cause of gynecologic cancer death in the United States. Ovarian cancer is most commonly seen in women over the age of 60, and the incidence of women aged 20 to 29 at diagnosis is 1.8 to 2.2 per 100,000 cases. Ovarian cancer can present either acutely or subacutely, and patients can remain asymptomatic for extended periods of time. Acute presentations involve shortness of breath due to malignant pleural effusion or severe nausea and vomiting due to a bowel obstruction, whereas subacute presentations involve bloating, urinary symptoms, early satiety, and pelvic or abdominal pain. Case Information: A 23-year-old female with no past medical history presented to the Emergency Department with sharp abdominal pain for 3 days duration, associated with subjective fever, chills, and nausea. On examination, she was hypertensive and tachycardic with abdominal distension and tenderness in the left lower quadrant. Her white blood cell count was elevated, and an abdominal and pelvic CT scan showed an extremely large complex solid and cystic mass measuring 31 by 27 by 20 cm concerning for ovarian malignancy. The patient was transferred to Obstetrics and Gynecology, where she reported further history of 15 pound weight gain, early satiety and new-onset irregular heavy bleeding for the last 3 months. A heavy, immobile mass was palpated during bimanual exam. An exploratory laparotomy was conducted, at which time the right ovary was found to fill the entire abdominal cavity up to the diaphragm. Right salpingoophorectomy and pelvic washings were performed and sent for preliminary frozen pathological examination, which resulted as possible mucinous adenocarcinoma. The mass excised was more than 10 kilograms. Gynecologic Oncology was consulted, and completed omentectomy, appendectomy and staging procedure. The patient recovered well post-operatively, and was discharged home 3 days later. The final pathology report was resulted as invasive adenocarcinoma of the right ovary arising in borderline mucinous cystic neoplasm, with no evidence of tumor in omentum, appendix, or lymph nodes. Conclusions: This case calls attention to the insidious progression of ovarian cancer, which is all the more dangerous when occurring in a patient demographic with such low incidence of disease. As the most common cause of gynecologic cancer death, ovarian cancer is an important differential to consider when patients present with even one vague subacute symptom.