Differential diagnostics of abdominal tumours: Case report

Abstract

Only physical methods of examination in the form of inspection, palpation, percussion and auscultation are not sufficient for the early detection of tumours of the abdomen, and it is necessary to apply contemporary imaging techniques. This paper presents a patient with abdominal tumour and explains the problem in differentiating the origin of the tumour despite modern diagnostic procedures. Case report: A female person, aging 60, was sent to the Department of Surgery for the bloated stomach, poor appetite and occasional heartburn. During the examination of the abdomen, the doctor observed a palpable flank mass measuring about 15x15cm, clearly circumscribed, of firm consistency and subjective light mobility in the abdomen; the abdomen above the chest level, hard palpation, insensitive to pain. After the laboratory testing which showed an increase in leukocytes (WBC 14.4) and a significant decrease in hemoglobin (HGB 67) and erythrocytes (2.14), with calm tumour markers CA19-98.00, CEA 2.11, the patient was subjected to ultrasonic testing whereby the presence of heterogeneous, predominantly hypoechoic mass in the abdomen was confirmed. Considering that with this method it was not possible to differentiate the origin of the tumour, the patient was sent to the CT of the abdomen whereby the presence of heterodensitysoft-tissue formation in the ventral abdomen from the height of kidneys to small pelvis was confirmed and it raised the suspicion of genital origin of the tumour which was why the patient was referred to a gynaecologist. The gynaecological examination did not determine the origin of the tumour and then we searched for the level of tumour marker CA-125 in order to prove the possible genital origin of tumour, namely the ovary. According to the findings of immunohistochemistry, the level of CA-125 was 149, which was almost four times higher than normal findings. After consultations with the anaesthesiologist, a surgical intervention was scheduled. The patient was operated under general endotracheal anaesthesia, where the exploration of the abdomen found that the tumour was of ovarian origin. Ex tempore histopathologic findings indicated a benign change. The ovary with the associated tumour was removed completely. The patient was successfully recovering at the Department of Surgery with adequate treatment and care. Definitive histopathological findings confirmed the existence of ovarian cancer. Conclusion: In spite of modern diagnostic methods (X-rays, ultrasound and CT examinations), the origin of the tumour was discovered with surgical intervention. In addition to educating the population for early reporting to the doctor at the first signs and symptoms of a disease, it is necessary to improve the existing and discover new methods of examination by means of which we will easily decide whether a patient will be treated with medications, radiological therapy or chemotherapy or they should opt for surgical procedures.