Pelvic mass.

Chief Complaint A 62 y/o female presents with Hematochezia along with lower abdominal pain and nausea. History Patient is hypertensive. She had surgery for appendix. Examination Examination shows a palpable mass. Colonoscopy was normal. CT scan shows a 15×17 cm pelvic mass. CA-120 of 155 U/ml, a CEA of 2.5 ng/ml and serum inhibin B levels of 1,385 pg/ml. Diagnosis What is it? Lymphome? Sarcoma Treatment Please give your valuable opinion on tmt.

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It looks like a case of MUCINOUS AND GRANULOSA CELL OVARIAN TUMOR because 1.S.Inhibin levels are significantly raised and inhibin levels are more reliable than CA 125 levels in these OVARIAN tumors 2.CA - 125 is raised 3.CT scan showing a a big pelvic mass in a female goes in favour of OVARIAN mass Yes D/D is Sarcoma Lymphoma . A CT guided F.N.A.C or biopsy will be diagnostic Treatment depends upon the biopsy report. Surgical excision remains the mainstay of treatment

To finalize the diagnosis FNAC to be done, although looks to be lymphoma

Thanks Dr. Kute Ankush, Dr. Dinesh Gupta
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? OVARIAN PATHOLOGY.. LYMPHOMA.. SARCOMA.. NEED'S.. HPE STUDY..

Tnx Dr Vipin Bihari Jain sir
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Looks like lymphoma

Do PET scan
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Considering her age , CT scan reports looks like MALIGNANT & best management is Staging laparotomy AND to decide further extensive dissection at same time,then HPR , followed by chemotherapy/Radiotherapy as per operative findings, HPR.

Inhibin b elevated in granulosa cell tumors or epithelial ovarian tumors. CT guided biopsy will reveal diagnosis and immunohistochemistry. Treatment options r surgery fby chemotherapy or interval chemotherapy.

Likely to be Granulosa cell tumour or mucous adenoma in which CA125 and Inhibin B are elevated . CT guided biopsy PETCT to assess spread. Treatment depending on findings

Do CECT Abdopelvis and FNAC. Explain pt about the condition

High inhibin level indicate ovarian germ cell tumor

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