A 62-year-old nulligravida woman presented with a 10-month history of progressive abdominal distension and diffuse abdominal pain associated with a 25-kg weight gain. Results of upper endoscopy and colonoscopy performed 1 week prior to presentation were normal. She reported dyspnea on exertion but had no fevers or chills, nausea or vomiting, hematochezia, or change in the caliber or consistency of her stools. On physical examination, she had normal vital signs, no abnormalities on pelvic and rectal examination, and a large abdominal mass extending from the epigastrium to the pelvis. Laboratory testing showed a normal complete blood cell count, erythrocyte sedimentation rate, and comprehensive metabolic panel and normal levels of serum carcinoembryonic antigen (CEA), cancer antigen 125 (CA-125), and cancer antigen 19-9 (CA19-9). Computed tomography (CT) of her chest, abdomen, and pelvis revealed a large mass occupying the entire abdominal cavity (Figure 1).
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Mucinous ovarian carcinoma
D. Laparotomy with removal of mass
The key to the correct diagnosis is recognizing that a unilateral abdominal mass larger than 10 cm is characteristic of a primary ovarian neoplasm, for which complete surgical resection is the recommended treatment. A needle biopsy (choice A) may not provide adequate tissue to make an accurate diagnosis. Percutaneous drainage (choice B) is not recommended because this procedure may cause spillage of malignant cells into the abdomen. Diagnostic laparoscopy (choice C) would not remove the abdominal mass.
Mucinous ovarian tumors are categorized as benign, borderline, or malignant (mucinous ovarian carcinoma).1 Mucinous ovarian tumors are typically unilateral, multicystic, and large, with a mean size of 10 cm if benign; 16 cm if borderline, and 20 cm if malignant.2
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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.
Corresponding Author: Luigi Marano, MD, PhD, Unit of General Surgery and Surgical Oncology, Department of Medicine, Surgery and Neurosciences, University of Siena, Strada delle Scotte, 4, 53100 Siena, Italy (firstname.lastname@example.org).
Published Online: December 19, 2022. doi:10.1001/jama.2022.23320
Conflict of Interest Disclosures: None reported.
Additional Contributions: We thank the patient for providing permission to share her information.
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