GY case 고 O 자 (F/45)

CC: Low abd distension for 1 M CC: Low abd distension for 1 M (Pap: N these day, CA125: 15) (Pap: N these day, CA125: 15) Wt loss 2 kg/1 M Wt loss 2 kg/1 M P: 2 (C/S x 2) P: 2 (C/S x 2) PMH: NR PMH: NR Menses: NR Menses: NR PE: Cx: NR PE: Cx: NR Ut & adn: preg 18 wk size, cystic, movable & not tender mass in low abd Ut & adn: preg 18 wk size, cystic, movable & not tender mass in low abd

Ultrasound Uterus : RVF 7.4X4.7X4.1cm

Ultrasound Endo. : 0.6cm Rt. Ov : 3.4X1.4cm

Ultrasound Multiple nodule. Color flow(-)

Ultrasound 6.0X4.4X6.6cm

U1.6ltrasound Size : 15.2X16.6X10.5cm

Utrasound

Ultrasound Septum thickness : 0.4cm

Ultrasound Imp:Lt. ovarian cystic mass. Imp:Lt. ovarian cystic mass. R/O Cystic teratoma. R/O Cystic teratoma. R/O cystadenama. R/O cystadenama. Rec) Tumor marker and CT. Rec) Tumor marker and CT.

MRI Pelvic cavity 내에 17 X 18 cm sized multiseptated cystic mass 가 있으며 Pelvic cavity 내에 17 X 18 cm sized multiseptated cystic mass 가 있으며 definite solid portion 은 없음. definite solid portion 은 없음. Left ovarian epithelial tumor 의 가능성이 큼. Left ovarian epithelial tumor 의 가능성이 큼. Pelvic cavity 내에 scanty amount ascites 가 있으며 physiologic amount 로 생각됨. Pelvic cavity 내에 scanty amount ascites 가 있으며 physiologic amount 로 생각됨. Spleen 은 12cm 정도임. Spleen 은 12cm 정도임. 그외 abdominal solid organs 에 특이소견 없음. 그외 abdominal solid organs 에 특이소견 없음. 의미있게 커진 lymph node 없음. 의미있게 커진 lymph node 없음. 1. R/O Left ovarian epithelial tumor, benign > malignancy. 1. R/O Left ovarian epithelial tumor, benign > malignancy. 2. Scanty amount of ascites in pelvic cavity. 2. Scanty amount of ascites in pelvic cavity. --> Physiologic amount. --> Physiologic amount. 3. Borderline splenomegaly. 3. Borderline splenomegaly.

Lab. 1/21 CEA : 1.37ng/ml 1/21 CEA : 1.37ng/ml 2/13 Ca-125 :17.2U/ml 2/13 Ca-125 :17.2U/ml

Operation Preop Dx. - pelvic mass Preop Dx. - pelvic mass Name of operation – LSO Name of operation – LSO anesthesia - G/A anesthesia - G/A opreative findinds and procedures opreative findinds and procedures low midline incision with previosu scar revision low midline incision with previosu scar revision subcue, fascia. peritoneum were opened and no adhesion in abd. cavity subcue, fascia. peritoneum were opened and no adhesion in abd. cavity no ascites and washing cytology done no ascites and washing cytology done pelvic mass origin of LO was 3mo, sized and cystic pelvic mass origin of LO was 3mo, sized and cystic LSO and send to Frozen : mucinous cystadenoma LSO and send to Frozen : mucinous cystadenoma bleeding control bleeding control peritoneum, fascia, subcue were sutured layer by layer peritoneum, fascia, subcue were sutured layer by layer EBL : 200 EBL : 200 biopsy : LSO biopsy : LSO

외과병리 검사보고서 GROSS : GROSS : 동결절편 검사를 위하여 받은 검체는 신선 상태의 난소와 부착된 나팔관이었다. 동결절편 검사를 위하여 받은 검체는 신선 상태의 난소와 부착된 나팔관이었다. 난소의 크기는 20.0x20.0x11.5cm 이었고, 무게는 2,025.0gm 이었다. 난소의 크기는 20.0x20.0x11.5cm 이었고, 무게는 2,025.0gm 이었다. 나팔관의 길이는 9.0cm, 외직경 0.7cm 이었다. 나팔관의 길이는 9.0cm, 외직경 0.7cm 이었다. 난소의 겉면은 회백색으로 매끈하였다. 난소의 겉면은 회백색으로 매끈하였다. 난소는 multilocular 한 cyst 로 대치되어 있었으며, cyst 내부에는 황색의 난소는 multilocular 한 cyst 로 대치되어 있었으며, cyst 내부에는 황색의 mucinous fluid 가 가득 차 있었다. mucinous fluid 가 가득 차 있었다. 벽의 두께는 0.1cm 이하로 얇았으며, 내면에 고형성 부분은 관찰되지 않았다. 벽의 두께는 0.1cm 이하로 얇았으며, 내면에 고형성 부분은 관찰되지 않았다. 대표적 절편을 동결절편 검사하였다. 대표적 절편을 동결절편 검사하였다. Frozen Diagnosis : Frozen Diagnosis : F1) Ovary and salpinx, left, salpingo-oophorectomy ; F1) Ovary and salpinx, left, salpingo-oophorectomy ; Mucinous cystadenoma (2 월 14 일, MJK/GZZ) Mucinous cystadenoma (2 월 14 일, MJK/GZZ) DIAGNOSIS : DIAGNOSIS : Ovary and salpinx, left, salpingo-oophorectomy ; Ovary and salpinx, left, salpingo-oophorectomy ; 1. Mucinous cystadenoma, 20.0x20.0cm 1. Mucinous cystadenoma, 20.0x20.0cm 2. Salpinx, no pathologic abnormality 2. Salpinx, no pathologic abnormality

Sonographic DDx of pelvic mass CysticComplexSolid Completely cystic Physiologic ovarian cysts Physiologic ovarian cysts cystadenomas cystadenomas Hydrosalpinx Hydrosalpinx Endometrioma Endometrioma Paraovarian cyst Paraovarian cyst Hydatid cyst of Morgagni Hydatid cyst of Morgagni Predominantly cystic Cystadenomas Cystadenomas Tubo-ovarian abscess Tubo-ovarian abscess Cystic teratoma Cystic teratomaUterineLeiomyoma(sarcoma) Endometeial Endometeial carcinoma, sarcoma carcinoma, sarcoma Multiple Endomeriomas Endomeriomas Multiple follicular cysts Multiple follicular cysts Predominantly solid Cystadenoma(carcinoma) Germ cell tumor Extrautrine Solid ovarian tumor Septated Cystadenoma(carcinoma) Cystadenoma(carcinoma) Mucinous Mucinous Serous Serous Papillary Papillary

Mucinous Cystadenoma 20% of all benign ovarian neoplasms 20% of all benign ovarian neoplasms 3rd to 5th Decades 3rd to 5th Decades 5% Bilateral 5% Bilateral Cystic Multiloculated Cystic Multiloculated Average size 15-30cm Average size 15-30cm Smooth external surface Smooth external surface Lined by single layer of columnar cells Lined by single layer of columnar cells Can rupture ---> Pseudomyxoma Peritonei Can rupture ---> Pseudomyxoma Peritonei –thick, gelatinous, mucinous material in peritoneum

DDX Mucinous cystadenoma Serouscystadenoma septum More thicker, numerous Thin, unilocular echogenecity Fine, gravity dependent echoes Anechoic mass marginSmoothSmooth ascitesNoNo sizelarge