Investigations
A CT abdomen and pelvis identified a 12cm pelvic mass with thickening of the wall in keeping with malignant change. The suspicion of malignancy was confirmed by magnetic resonance imaging (MRI) and positron emission tomography (PET CT) scans which showed a part-cystic part-solid mass with restricted diffusion and high FDG avidity, respectively. The pre-operative MRI pelvis also described adhesions between the pelvic mass and the bowel. Imaging did not suggest any lymph node involvement or distant metastatic disease.
The right ureter was noted to be obstructed by the mass, leading to hydronephrosis and marked right kidney atrophy. A dimercaptosuccinic acid (DMSA) scan revealed minimal right kidney function.
The case was discussed at the Oxford network multidisciplinary team meeting (MDT) in which a two-stage surgical procedure was supported involving firstly an exploratory laparoscopy to assess resectability of disease, followed by ovarian debulking surgery if suitable.