부산대학교 도서관

Background: Abdomino-pelvic masses with ascites, peritoneal disease, pleural effusion, and elevated serum CA-125 levels in a patient raises the clinical suspicion of advanced ovarian cancer. However, disseminated tuberculosis and echinococcosis are benign conditions that can mimic an ovarian malignancy. This article presents an unusual case of double benign pathology of an ovarian fibroma and disseminated pelvic hydatid disease that appeared to be advanced ovarian cancer. Case: A 57-year-old postmenopausal woman of Peruvian origin presented with a history of abdominal pain, distension, and chronic cough. On examination, she was noted to be cachectic and had ascites. A chest X-ray showed the presence of pleural effusion. Her serum CA-125 level was elevated. Computed tomography (CT) scans of her thorax, abdomen, and pelvis confirmed the right-sided pleural effusion and revealed the presence of adnexal masses, a calcified parenchymal liver mass, and an omental cake. Initial decision was to start on neoadjuvant chemotherapy in view of the clinical suspicion of advanced ovarian cancer. However, an omental biopsy and a cytologic assessment of her ascitic fluid was negative for cancer. The patient underwent a laparotomy with resection of all macroscopic disease. Histopathology testing showed a left ovarian fibroma. The right ovarian cyst, omental, and other peritoneal nodules all contained hydatid disease. There was no evidence of malignancy. She received albendazole. Results: At her 6-month follow up abdominal ultrasound scan, there was no evidence of disease recurrence and the calcified liver lesion had reduced in size. Conclusions: This highly unusual case highlights the need for histologic and/or cytologic confirmation of malignancy before considering neoadjuvant therapy. With increasing global travel, nonendemic diseases also need to be considered in the differential diagnosis and, thus, eliciting a history regarding foreign travel is important. (J GYNECOL SURG 31:362) [ABSTRACT FROM AUTHOR]