Published
Absceso pélvico que se confunde con tumor maligno de ovario en una mujer posmenopáusica. Reporte de caso
Pelvic abscess mistaken for malignant ovarian tumor in a postmenopausal woman. Case report
DOI:
https://doi.org/10.15446/cr.v7n1.87199Keywords:
Absceso, Neoplasias Ováricas, Fibroma, Posmenopausia, Informes de Caso (es)Abscess, Fibroma, Ovarian Neoplasms, Postmenopausal, Case Reports (en)
Introducción. Los abscesos tubo ováricos son poco frecuentes en la posmenopausia y se asocian con patologías ginecológicas benignas como endometriosis, pólipo endometrial o leiomioma uterino, y con patologías malignas como adenocarcinoma de endometrio, tumores malignos epiteliales y no epiteliales de ovario, carcinoma escamocelular de cérvix y adenocarcinoma de colon. Su presentación representa un reto diagnóstico y terapéutico para el médico.
Presentación del caso. Paciente femenina de 72 años, quien consultó por cuadro clínico de tres días de evolución consistente en dolor y distensión abdominal asociados a fiebre y síntomas urinarios irritativos y retención urinaria. Los exámenes de ingreso mostraron leucocitosis con neutrofilia y CA-125 en 222 U/mL. El ultrasonido y la resonancia magnética evidenciaron una masa retrouterina solido-quística de 15 cm. Ante sospecha de tumor versus absceso tubo-ovárico, se realizó biopsia dirigida por tomografía mediante la cual se encontró material purulento fétido. Se practicó laparotomía que confirmó masa pélvica retrouterina sólido quística con contenido purulento, adherencias y compromiso inflamatorio de las trompas uterinas. El resultado de patología informó fibroma ovárico y absceso tubo ovárico. La paciente evolucionó satisfactoriamente en el posoperatorio y en los controles posteriores.
Conclusiones. El caso reportado ilustra cómo, en ocasiones, un posible diagnóstico de carcinomatosis por cáncer de ovario puede ser realmente una patología benigna (absceso tubo ovárico) que responde bien a un tratamiento médico-quirúrgico. Las imágenes diagnósticas y los marcadores tumorales son de gran ayuda para diferenciar una patología ovárica maligna de un proceso benigno.
Introduction: Tubo-ovarian abscesses are rare in postmenopausal women. They have been associated with benign gynecological conditions such as endometriosis, uterine polyp or leiomyoma, and malignant diseases such as endometrial adenocarcinoma, epithelial and non-epithelial malignant ovarian tumors, squamous cell carcinoma of the cervix, and adenocarcinoma of the colon. Their presentation represents a diagnostic and therapeutic challenge for clinicians.
Case report: A 72-year-old female patient was admitted with a 3-day history of abdominal pain and distension, fever, irritative urinary symptoms and urinary retention. Lab tests on admission showed elevated white blood cells and neutrophils count, and CA-125 at 222 U/mL. Ultrasound and magnetic resonance imaging revealed a solid retrouterine cystic mass of 15 cm. Suspecting tumor versus tubo-ovarian abscess, a tomography-directed biopsy was performed, finding foul-smelling purulent material. An exploratory laparotomy was performed with intraoperative findings of solid-cystic retrouterine pelvic mass with purulent content, adhesions, and inflammatory involvement of the uterine tubes. Pathology reported ovarian fibroma and tubo-ovarian abscess. The patient evolved satisfactorily in the postoperative period and in the subsequent follow-up appointments.
Conclusions: The reported case illustrates how a possibility of ovarian cancer with peritoneal carcinomatosis can actually be a benign condition (tubo-ovarian abscess) that responds well to medical-surgical treatment. Diagnostic imaging and tumor markers are helpful in differentiating a malignant ovarian disease from a benign process.
References
Kim SH, Kim SH, Yang DM, Kim KA. Unusual causes of tubo-ovarian abscess: CT and MR imaging findings. Radiographics. 2004;24(6):1575-89. https://doi.org/dqxgzx
Osborne NG. Tubo-ovarian abscess: Pathogenesis and management. J Natl Med Assoc. 1986;78(10):937-51.
Krival TC, Cooksey C, Propst AM. Tubo-Ovarian Abscess: diagnosis, medical and surgical management. Comp Ther. 2004;30(2):93-100. https://doi.org/bc5swp
Lareau SM, Beigi RH. Pelvic Inflammatory Disease and Tubo-ovarian Abscess. Infect Dis Clin North Am. 2008;22(4):693-708. https://doi.org/dcvqww
Blumenfeld Z, Toledano C, Eitan A, Barzilai A, Brandes JM. Tubo-ovarian Abscess in the Postmenopausal Woman. World J Surg. 1982;6(5):634-6. https://doi.org/d8h6fd
Lipscomb GH, Ling FW. Tubo-Ovarian abscess in postmenopausal patients. South Med J. 1992;85(7):696-9. https://doi.org/dfg4bm
Chen MJ, Yang JH, Yang YS, Ho HN. Increased occurrence of tubo-ovarian abscesses in women with stage III and IV endometriosis. Fertil Steril. 2004;82(2):498-9. https://doi.org/fr92fq
Yoshida M, Katsuragawa H, Miyamoto U, Ohnishi S, Katsura Y. Estrogen-producing ovarian adenocarcinoma with large abscess formation. Gynecol Obstet Invest. 1993;35(4):245-8. https://doi.org/bjbphb
Khan NA, Maajeeni EH. Tubo-ovarian abscess in a postmenopausal woman with underlying ovarian carcinoma. Saudi Med J. 2005;26(6):1010-1.
Wetchler SJ, Dunn LJ. Ovarian abscess. Report of a case and review of the literature. Obstet Gynecol Surv. 1985;40(7):476-85. https://doi.org/fs8zh9
Gockley AA, Manning-Geist BL, Boatin AA, Gu X, Cohen S. Tubo-ovarian abscesses in postmenopausal women: Clinical presentation and outcomes. Maturitas. 2019;125:20-6. https://doi.org/ftmd
Muto MG. Management of an adnexal mass. UpToDate. 2020 [cited 2020 Aug 20]. Available from: https://bit.ly/2N0ggDu.
Centers for Disease Control and Prevention (CDC). 2015 Sexually Transmitted Diseases Treatment Guidelines. Atlanta: CDC; 2015 [cited 2020 Jun 1] Available from: https://bit.ly/3k0YRGZ
Chappell CA, Wiesenfeld HC. Pathogenesis, diagnosis, and management of severe pelvic inflammatory disease and tuboovarian abscess. Clin Obstet Gynecol. 2012;55(4):893-903. https://doi.org/ftmf
Rosen M, Breitkopf D, Waud K. Tubo-Ovarian Abscess Management options for women who desire fertility. Obstet Gynecol Surv. 2009;64(10):681-9. https://doi.org/bdqm93
Farid H, Lau TC, Karmon AE, Styer AK. Clinical Characteristics Associated with Antibiotic Treatment Failure for Tuboovarian Abscesses. Infect Dis Obstet Gynecol. 2016;2016:5120293. https://doi.org/ftmg
Protopapas AG, Diakomanolis ES, Milingos SD, Rodolakis AJ, Markaki SN, Vlachos GD, et al. Tubo-ovarian abscesses in postmenopausal women: Gynecological malignancy until proven otherwise? Eur J Obstet Gynecol Reprod Biol. 2004;114(2):203-9. https://doi.org/drsbh2
Krurman RJ, Carcangiu ML, Herrington CS, Young RH, editors. WHO Classification of Tumours of Female Reproductive Organs. 4 th ed. Geneva: World Health Organization; 2014.
Shen Y, Liang Y, Cheng X, Lu W, Xie X, Wan X. Ovarian fibroma/fibrothecoma with elevated serum CA125 level: A cohort of 66 cases. Medicine (Baltimore). 2018;97(34):e11926. https://doi.org/ftv5
Cho YJ, Lee HS, Kim JM, Lee SY, Song T, Seong SJ, et al. Ovarian-sparing local mass excision for ovarian fibroma/fibrothecoma in premenopausal women. Eur J Obstet Gynecol Reprod Biol. 2015;185:78-82. https://doi.org/f62rqv
Buamah P. Benign Conditions Associated With Raised Serum CA-125 Concentration. J Surg Oncol. 2000;75(4):264-5. https://doi.org/b84v7q
Dochez V, Caillon H, Vaucel E, Dimet J, Winer N, Ducarme G. Biomarkers and algorithms for diagnosis of ovarian cancer: CA125, HE4, RMI and ROMA, a review. J Ovarian Res. 2019;12(1):28. https://doi.org/ggdxs6
Khoiwal K, Bahadur A, Kumari R, Bhattacharya N, Rao S, Chaturvedi J. Assessment of Diagnostic Value of Serum Ca-125 and Risk of Malignancy Index Scoring in the Evaluation of Adnexal Masses. J Midlife Health. 2019;10(4):192-6. https://doi.org/ftv6
Kumar V, Rajan S, Gupta S, Akhtar N, Sharma S, Sinha P, et al. Diagnostic Value of Risk of Malignancy Algorithm (ROMA) in Adnexal Masses. J Obstet Gynaecol India. 2020;70(3):214-9. https://doi.org/ftv7
Fredericks TI, Goodrich ST, Ueland FR, Smith A, Bulloock RG, Bonato V, et al. Combining a second generation multivariate index assay with ovarian imaging improves the preoperative assessment of an adnexal mass. J Surg Oncol. 2019;2(3):2-9. https://doi.org/ftv8
Van Calster B, Van Hoorde K, Froyman W, Kaijser L, Wynants L, Landolfo C, et al. Practical guidance for applying the ADNEX model from the IOTA group to discriminate between different subtypes of adnexal tumors. Facts Views Vis Obgyn. 2015;7(1):32-41.
Timmerman D, Valentin L, Bourne TH, Collins WP, Verrelst H, Vergote I. Terms, definitions and measurements to describe the sonographic features of adnexal tumors: a consensus opinion from the International Ovarian Tumor Analysis (IOTA) Group. Ultrasound Obstet Gynecol. 2000;16(5):500-5. https://doi.org/cd86x9
Froyman W, Timmerman D. Methods of Assessing Ovarian Masses: International Ovarian Tumor Analysis Approach. Obstet Gynecol Clin North Am. 2019;46(4):625-41. https://doi.org/ftv9
Van Calster B, Valentin L, Froyman W, Landolfo C, Ceusters J, Testa AC, et al. Validation of models to diagnose ovarian cancer in patients managed surgically or conservatively: multicentre cohort study. BMJ. 2020;370:m2614. https://doi.org/ftwc
Andreotti RF, Timmerman D, Strachowski LM, Froyman W, Benacerraf BR, Bennett GL, et al. O-RADS US Risk Stratification and Management System: A Consensus Guideline from the ACR Ovarian-Adnexal Reporting and Data System Committee. Radiology. 2020;294(1):168-85. https://doi.org/ftwd
Iyer VR, Lee SI. MRI, CT, and PET/CT for ovarian cancer detection and adnexal lesion characterization. AJR Am J Roentgenol. 2010;194(2):311-21. https://doi.org/fm9zrz
Rockall AG. Diffusion weighted MRI in ovarian cancer. Curr Opin Oncol. 2014;26(5):529-35. https://doi.org/f6dhbr
Dimensions
PlumX
Article abstract page views
Downloads
How to Cite
License
Copyright (c) 2021 Case reports
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors, upon submitting their manuscripts, will retain their copyright. The Journal has the right to use, reproduce, disseminate, distribute, and publish the articles in any form or medium.
Uniform Disclosure Form for possible Conflicts of Interest, the assignment of rights and responsibility must be delivered together with the original.
Those authors who have publications with this journal accept the following terms:
The authors will keep their copyright and guarantee the journal the right of first publication of their work, which will be simultaneously subject to the Creative Commons Recognition License that allows third parties to share the work whenever its author is indicated and his first publication this journal
The authors may adopt other non-exclusive licensing agreements for the distribution of the published version of the work (eg, deposit it in an institutional telematic file or publish it in a monographic volume) whenever the initial publication in this journal is indicated.
Authors are allowed and advised to disseminate their work through the Internet (eg in institutional telematic files or on their website) before and during the submission process, which can produce interesting exchanges and increase citations of the published work. (See The effect of open access).
