Female, 64 years old, felt abdominal distension for 2 months, and was transferred from internal medicine for consultation.

The patient felt abdominal distension, abdominal enlargement and loss of appetite for 2 months. She has been menopausal for 5 years without vaginal bleeding or drainage. G3P2。 He was healthy in the past and denied the history of gynecology. Physical examination has ruled out heart, liver, kidney, tuberculosis and digestive system diseases.

Physical examination: emaciation, small superficial lymph nodes, abdominal swelling, voiced sounds (+), gynecological examination: vulva (-), vagina (-), cervix and uterus are all atrophied, and the left adnexal area can reach a mass with a diameter of 6cm, which is solid, irregular in shape, adhered to surrounding tissues without tenderness. The mass of the left attachment area is slightly smaller, and its properties are the same as those of the left. Trinity examination: there are scattered nodules in uterosacral ligament without tenderness.

Analysis steps:

Initial diagnosis: ovarian cancer.

Diagnostic basis: The patient felt abdominal distension, abdominal enlargement and loss of appetite for 2 months. Thin and sick. There is ascites, mobile dullness (+), gynecological examination: both appendages can touch solid and irregular masses, adhere to surrounding tissues, and have no tenderness. Three-in-one examination showed scattered nodules in uterosacral ligament without tenderness.

Differential diagnosis:

1. Endometriosis: The adnexal mass is irregular in shape and adheres to the surrounding tissues, and there are scattered nodules in the uterosacral ligament. However, the patient has been menopausal for 5 years, and the uterosacral ligaments are scattered in nodules without tenderness.

2. Tuberculous peritonitis: Medical examination has ruled out diseases of heart, liver, kidney, tuberculosis and digestive system. Chest X-ray and B-ultrasound are helpful for diagnosis. Finally, the diagnosis can be made by exploratory laparotomy and biopsy.

3. Ovarian metastases may have double adnexal masses and ascites. Routine stool examination and digestive endoscopy are feasible to exclude digestive system tumors. The final diagnosis can be made by pathological examination.

Further inspection

1.b-ultrasound examination

2. Detection of serum CA 125.

3. Ascites to check tumor cells

4. Routine test before operation.

Verb (abbreviation of verb) therapeutic principle

Abdominal exploration was performed immediately after diagnosis to reduce tumor cells. Postoperative adjuvant chemotherapy.