Name Of the Patient : Mrs. Deepali Mehendale
Age: 43 Years.
Date: 13/04/1999
Address : 696,Sadashiv peth, Khalkar wada, Pune 30, Maharashtra, India
Diagnosis Known case of Ca Ovary
Biopsy Report: (20-04-1999) Clinically : Ca Ovary

Specimen :
1.Specimen of uterus, cervix and huge bilateral ovarian masses, obliterating the fallopian tubes Uterus and cervix are 8 x 5.5 x 4 cm. Cervix is parous and patulous. Cervical canal is dilated. Fallopian tubes are not seen. Both the ovaries are replaced by huge masses, 13.5x11.5 cm and 12x 10.5 cm.
Both are soft to firm, with friable, soft excrescences. On cutting both showed multiloculated thin walled, cysts containing seromucoid pale yellow secretions. Inner lining of the cysts showed small, tiny, soft, friable outgrowths.
2. Specimen of piece of Omentum,
6.5x3x3 cm. Pale yellow with areas of haemorrhages.

Histology :
1. Section shows chronis cervicitis. Endometrium is in proliferative phase. Ovarian masses from both sides shows seromucinous cyst-adenocarcinoma (Grade I).

Stroma shows mild Infiltration.

2. Sections from omenutum shows normal fat tissue. There is no infiltration by tumour cells.

Status of the Patient: A.Operated
B. No chemotherapy.
B. No Radiation
Treatment Given: Only on our Homoeopathic medicine after operation.
Follow Up Investigation: ULTRASOUND OF ABDOMEN AND PELVIS(01/04/1999)
Gross ascitcs is seen in all parts of abdomen. Ascitic fluid shows few internal echocs.

Bilateral ovarian masses are seen. The right mass is larger. Masses totally measure approximately 15x10x10 cms in size and show both cystic and solid contents with very irregular lobulated outline and multiple mural nodules along the inner walls of the cystic components.

Uterus is normal.

Liver, spleen Pancreas, both kidneys, Gall bladder aorta and IVC are normal.

No lymphadenopathy.

IMPRESSION
Bilateral large cystic and solid ovarian masses with gross ascites (Cyst adenocarcinoma of ovary is likely).

CT SCAN OF ABDOMEN AND PELVIS(
15-05-1999)

Patient is a known case of Ca ovary with history of surgical removal of uterus, cervix and both ovaries.

CT scan of abdomen and pelvis has been done with and without intravenous contrast. Bowel loops were opacified with dilute gastro graffin. Colon was opacified by per rectal administration of contrast. Direct contrast sections have been obtained for the abdomen and oral and post contrast sections have been obtained for the pelvis.

Study reveals irregular soft tissue density lesion measuring 3.6 x 6.7 cms in pelvis posterior to the bladder and anterior to the rectum abutting the bladder wall without and significant contrast enhancement/ necrotic components, likely to represent residual tumour.

Liver is normal in size and shows homogenous parenchymal density. No focal hepatic lesion or mass is noted. No subphrenic pathology is noted.

Gall bladder is well distended with smooth outline. There is no evidence of any radio opaque calculi. No intra luminal mass is seen.

Pancreas is seen in its entire length and is normal in size and configuration. No focal lesion, mass or pancreatitis is noted.

The spleen is normal in size and shows homogenous parenchyma.

Both the kidneys are normal in size, shape, location and show equal and prompt excretion of contrast medium. The pelvi-calyceal system and ureters are normal. No hydronephrosis or perinephric pathology is noted. No renal or supra renal mass is noted. The peri and para renal fat spaces are well maintained.

The aorta and the venacava appear normal. No evidence of pre or para-aortic lymphadenopathy is noted.

Opacified bowel loops appear normal.

No evidence of ascites is noted.
Opacified bowel loops appear normal.

No evidence of ascites is noted.

The contrast opacified urinary bladder shows normal outlines.

The pelvic musculature and the bony pelvic walls show normal outlines.

No evidence of obvious pelvic lymphadenopathy.

The contrast enhanced pelvis vascular structures appear normal.

Impression : Study reveals irregular soft tissue density region measuring about 3.6 x6.7 cm in Pelvis, posterior to the bladder and anterior to the rectum. abbuting the bladder wall without any significant contrast enhancement, necrotic components, likely to represent residual tumour.

Ultrasonography of abdomen and Pelvis ( 22-06-1999)

Known case of Ca ovary operated.

Liver is normal in size and echotexture. Hepatic portal and venous systems are normal. No focal hepatic lesion is seen. No evidence of intra hepatic biliary dilatation seen. No subphrenic pathology noted.

Gall bladder is well distended with smooth outline and normal walls. There is no calculus or sludge.

Common bile Duct measures 3 mms. Portal vein measures 10 mms.

Pancreas is seen in its entire length and appears normal. No evidence of any pancreatic lesion seen.

Spleen is normal in size and shows homogenous parenchymal texture. No focal splenic lesion noted.

Right kidney measures 90x30 mms, left kidney measures 92x36 mms. Both kidneys are normal in size, shape, location, and echoanatomy. No evidence of any hydronephrosis, calculus or perinephric pathology noted.

Aorta and inferior vena cava are seen in their entire length and appear normal. No evidence of any pre and para aortic lymphadenopathy.

Urinary bladder is well distended with normal walls.

No evidence of ascitis or pleural effusion is noted.

Uterus and ovarics are not seen due to previous hysterectomy.
(Bowel related masses may not be detected due to limitations of USG).
Impression
: Essentially within normal limits. No Mass is detectable in a Pelvic Sonography.

CT Scan of ABDOMEN PELVIS(22-12-1999)

Previous CT scan report has been reviewed.
Follow -up CT scan of abdomen and pelvis has been done with and without intravenous contrast. Bowel loops were opacified with dilute gastro graffin.
Liver, gall bladder, pancreas and spleen appear normal.
Both kidneys appear normal in size, shape and location. No renal or supra renal mass is noted. Perinephric fat planes. are well maintained. 
The aorta, venacava and pelvic lymphadenopathy is noted.
No evidence of ascites is noted.
No abdominal or pelvic lymphadenopathy is noted.
Small bowel loops adherent to undersurface of anterior abdominal wall at surgical site/lower abdomen with a small incisional hermia.
Impression : No Residual or recurent mass lesion, ascites, lymphadenopathy, omental thickening is noted.

Ultrasonography of abdomen and Pelvis ( 1-02-2003)
Known case of Ca ovary (Operated).
Liver is normal in size and shows hyperechoic echotexture suggestive of fatty infiltration. Intrahepatic biliary and portal radicals are normal. No focal lesion.

Portal Vein = 1mms.                     CBD = 3mms.

Gall Bladder is well distended with normal walls. There is no calculus or sludge.

Pancreas is seen in its entirety and shows normal echoanatomy. Pancreatic duct is undilated.

Spleen is normal size and echotexture. No focal lesion.

Right Kidney measures: 88 x 33mms.      Left Kidney measures:  98 x 35mms.

Both Kidneys are normal in size, shape, position and echotexture. Corticomedullary differentiation is well maintained. There is no calculus or hydronephrosis.  

Both Ureters are undilated.

Aorta, IVC and Paraaortic regions are normal.

No acites or lymphadenopathy.

Urinary Bladder is well distended with normal walls.

Uterus and Ovaries are nor seen due to Hysterectomy. Vault is normal. No pelvic mass.

Impression : Fatty infiltration of liver.
Rest of the abdomen and pelvis is within normal limits.

  Date Ca-125 Units Normal range
10/05/1999 43.40 U/ml less than 35.0
26/06/1999 4.40 U/ml less than 35.0
27/07/1999 0.04 U/ml less than 35.0
25/02/2000 8.62 U/ml less than 35.0
18/9/2000 7.9 U/ml less than 20.0
11/5/2001 11.70 U/ml less than 20.0
28/2/2002 14.50 U/ml less than 20.0
13/1/2003 13.48 U/ml less than 35.0
Comment : As per the result of CT Scan and sonography and blood investigation - tumour marker i.e. Ca-125 and clinically too, patient is completely under control till today(10/04/2003).
Cancer Patients by Appointment               


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