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.