What are the common symptoms of Polycystic Ovarian Syndrome. How does PCOS affect fertility. What are the risk factors associated with PCOS. How can women manage PCOS symptoms effectively.

Understanding Polycystic Ovarian Syndrome (PCOS)

Polycystic Ovarian Syndrome (PCOS) is a complex metabolic disorder affecting approximately 1 in 10 women of childbearing age. This condition creates a hormonal imbalance and can lead to various metabolic problems, impacting multiple aspects of a woman’s health and life. Despite its name, not all women with PCOS develop ovarian cysts.

PCOS is primarily diagnosed in women between the ages of 15 and 44, with many cases identified in women in their 20s and 30s who are experiencing fertility challenges. While the exact cause remains unknown, research suggests a combination of genetic and environmental factors may contribute to its development.

The Hormonal Connection

High levels of androgens and insulin in women with PCOS indicate a hormonal component to the condition. However, the precise mechanisms behind this hormonal imbalance are not yet fully understood. Managing PCOS often requires a multidisciplinary approach, involving fertility specialists, obstetricians, and gynecologists to address the various symptoms and associated health concerns.

Recognizing PCOS Symptoms

The symptoms of PCOS can manifest as early as puberty, with young women noticing irregular periods, weight gain, headaches, and pelvic pain. As the condition progresses, a wide range of symptoms may develop:

• Sleep disturbances (night sweats, insomnia, sleep apnea)
• Chronic fatigue
• Hirsutism (excess hair growth on face, chest, back, etc.)
• Hair thinning or male-pattern baldness
• Acne and other skin problems
• Unexplained weight gain
• Fertility issues
• Mood instability, depression, and anxiety
• Persistent pain (headaches, pelvic pain, abdominal pain)
• Irregular menstrual cycles
• Ovarian cysts (in some cases)

The Impact of PCOS on Fertility

PCOS is a leading cause of female infertility, affecting 70-80% of women with the condition. The primary factor contributing to infertility in PCOS patients is anovulation or irregular ovulation. However, not all women with PCOS are infertile, and some may conceive naturally without assistance.

Fertility Management Strategies

For women experiencing fertility problems due to PCOS, there are several approaches to improve their chances of conception:

1. Weight management
2. Medication to regulate ovulation
3. Assisted reproductive technologies
4. Lifestyle modifications
5. Hormonal therapies

Consulting with a gynecologist or obstetrician can provide valuable insights into natural fertility options and personalized strategies to enhance fertility in women with PCOS.

Risk Factors and Associated Health Concerns

While the exact risk factors for developing PCOS are not fully established, research has identified two primary factors:

• Family history (having a mother or sister with PCOS)
• Obesity

Additionally, women with PCOS often exhibit insulin resistance and higher-than-normal androgen levels. However, the causal relationship between these conditions and PCOS remains unclear.

Increased Health Risks

Women with PCOS are at a higher risk of developing several health conditions, including:

• Clinical obesity
• Fatty liver disease
• Cardiovascular disease
• Type 2 diabetes

The National Polycystic Ovarian Syndrome Association highlights that women with PCOS constitute the largest group at risk for cardiovascular disease and type 2 diabetes among women of reproductive age.

Managing PCOS: Treatments and Lifestyle Modifications

While there is no cure for PCOS, effective management of symptoms can significantly improve quality of life and reduce associated health risks. Treatment approaches typically focus on addressing individual symptoms and may include:

Medications

• Hormonal birth control to regulate menstrual cycles and reduce androgen levels
• Metformin to improve insulin sensitivity
• Anti-androgen medications to address hirsutism and acne
• Fertility medications for women trying to conceive

Lifestyle Changes

• Adopting a balanced, nutrient-rich diet
• Engaging in regular physical activity
• Stress management techniques
• Maintaining a healthy sleep routine

How can diet and exercise impact PCOS symptoms. A healthy lifestyle can significantly improve insulin sensitivity, regulate hormone levels, and aid in weight management. These changes can lead to more regular menstrual cycles, reduced androgen levels, and improved overall well-being.

The Psychological Impact of PCOS

The physical symptoms of PCOS can have a profound effect on a woman’s mental health and self-esteem. Many women with PCOS report experiencing:

• Depression
• Anxiety
• Poor body image
• Low self-esteem
• Social isolation

How can women with PCOS address mental health concerns. Seeking support from mental health professionals, joining support groups, and practicing self-care can help manage the psychological impact of PCOS. Cognitive-behavioral therapy and mindfulness techniques have shown promise in improving mood and coping skills for women with PCOS.

PCOS and Long-term Health Considerations

Managing PCOS is not just about addressing immediate symptoms; it’s also crucial for long-term health. Women with PCOS should be vigilant about:

• Regular health screenings for diabetes and cardiovascular disease
• Monitoring bone density, as PCOS can increase the risk of osteoporosis
• Maintaining a healthy weight to reduce the risk of obesity-related complications
• Addressing fertility concerns early if planning to conceive

What role does early intervention play in managing PCOS. Early diagnosis and treatment of PCOS can help prevent or minimize long-term health complications. Regular check-ups and open communication with healthcare providers are essential for effective management of the condition.

Emerging Research and Future Treatments

The field of PCOS research is continuously evolving, with new insights into the condition’s underlying mechanisms and potential treatments emerging. Some areas of current research include:

• Genetic factors contributing to PCOS
• The role of environmental toxins in PCOS development
• Novel pharmaceutical approaches to managing symptoms
• The impact of gut microbiome on PCOS
• Personalized medicine approaches for PCOS management

How might future treatments improve outcomes for women with PCOS. Advances in research may lead to more targeted therapies, improved diagnostic tools, and better understanding of PCOS prevention strategies. These developments could significantly enhance the quality of life for women with PCOS and reduce associated health risks.

Polycystic Ovarian Syndrome is a complex condition that affects millions of women worldwide. While it presents numerous challenges, with proper management and support, women with PCOS can lead healthy, fulfilling lives. By staying informed about the latest research and treatment options, working closely with healthcare providers, and adopting healthy lifestyle habits, women with PCOS can effectively manage their symptoms and minimize long-term health risks.

As awareness of PCOS continues to grow, so does the hope for improved diagnostic tools, more effective treatments, and potentially, preventive strategies. The journey of living with PCOS may be challenging, but with the right resources and support, women can navigate this condition successfully and thrive.

Polycystic Ovarian Syndrome (PCOS): Symptoms, Treatments, & More

Are you one of the five million U.S. women with Polycystic Ovarian Syndrome (PCOS)?

About 1 in 10 women of childbearing age have this condition, which creates a hormonal imbalance and other metabolic problems.

PCOS can affect many aspects of a woman’s health and life, including weight, hair, skin, energy, sleep, mood, reproductive health, and fertility. Although the “cystic” part of the condition’s name implies that all women with PCOS have ovarian cysts, some women have cysts and some don’t.

What is PCOS?

PCOS is a metabolic disorder that has a strong effect on the endocrine and reproductive systems and contributes to cardiac disease and obesity. It is most commonly diagnosed in women age 15 to 44, including women in their 20s and 30s who are struggling to become pregnant.

Although the exact cause of PCOS is not yet known, research indicates that it may be a combination of genetic and environmental factors. High levels of androgens and insulin in women with PCOS suggest that the cause is hormonal, but it is unclear how and why certain women develop this imbalance.

Women with PCOS may need the help of an array of clinicians to manage their condition and cope with their symptoms. These include a fertility specialist and an obstetrician/gynecologist.

What are the Symptoms of PCOS?

The earliest symptoms of PCOS are typically experienced during puberty when young women notice irregular periods, weight gain, headaches, and pelvic pain with or without their period.

Polycystic Ovarian Syndrome symptoms for women of all ages typically include:

• Sleeplessness. Women with PCOS are more likely to have night sweats, insomnia, and sleep apnea, which is a condition where the person stops breathing for short periods of time while sleeping.
• Fatigue. Low energy is a common symptom and is often related to poor sleep quality from PCOS.
• Hirsutism. This is the medical term for excess hair growth. Women with PCOS often develop hairy areas on the abdomen, feet, chest, back, arms, upper lip, chin, and cheeks.
• Thinning hair. While excess hair growth is the problem on other parts of the body, on the top of the head the hair tends to thin in women with PCOS. They may develop something similar to male pattern baldness, or baldness on the top-front of the head.
• Acne. Skin problems are common in women with PCOS. This includes acne, darkened skin, and skin tags.
• Weight gain. About 50-percent of women with PCOS have weight gain that is difficult to combat, even with a traditional exercise and diet regimen.
• Fertility issues. PCOS is one of the top causes of female infertility but not all women with PCOS are infertile and some conceive naturally with no assistance.
• Mood instability. When you have PCOS, you are more likely to experience fluctuation in moods, depression, and anxiety. For some women, this worsens around the time of their period.
• Pain. Women with this condition often report persistent PCOS pain in various parts of their bodies, including headaches, pelvic pain, and abdominal pain.
• Period irregularity. Periods may arrive irregularly or alternate between a very heavy flow and a lighter flow, or spotting. Bleeding could also be heavy month after month.
• Cysts. Some women, but not all, develop cysts on their ovaries with PCOS. These cysts are an accumulation of immature follicles; and the number of cysts tends to decrease with age.

PCOS and Infertility

PCOS infertility is quite common due to the related condition of anovulation (or irregular ovulation). The prevalence of infertility in women with PCOS is about 70- to 80-percent.

Women who experience fertility problems due to PCOS shouldn’t give up hope. By managing PCOS symptoms, women can often improve their fertility. This may involve a health plan that includes weight loss, medication, and/or medical procedures.

Your gynecologist or obstetrician can also support you with additional information about natural fertility options that can help you boost your fertility and increase the odds of becoming pregnant.

PCOS Risk Factors

It is difficult to pin down precisely what puts someone at a higher risk of PCOS, but research indicates that there are two primary risk factors: having a mother or sister with PCOS and being obese.

Two additional characteristics are common in women with PCOS: insulin resistance and higher-than-normal androgens. However, there is not a clear cause-and-effect relationship between these conditions and PCOS.

Women with PCOS are also more likely to develop other health conditions, including clinical obesity, fatty liver disease, cardiac disease, and diabetes. According to the National Polycystic Ovarian Syndrome Association, women with PCOS constitute the largest group of women at risk for cardiovascular disease and type 2 diabetes.

PCOS Testing and Treatment Options

It is important to understand that there is no single PCOS test. To diagnose it, your doctor will likely perform a variety of tests that indicate PCOS may be present, which could include testing your:

• Blood pressure
• Glucose tolerance
• Cholesterol
• Triglyceride levels
• Hormones

In terms of PCOS treatment, you may receive a recommendation for a Polycystic Ovarian Syndrome diet that could involve calorie reduction, limiting carbohydrates and sugar, and/or increasing your intake of protein and green leafy vegetables. Many women find, and some studies show, that a PCOS diet relieves symptoms and prevents the condition from worsening.

In addition, your provider may recommend screening you for depression, anxiety, sleep apnea, and other sleep disorders. This will help you understand how the condition is affecting your mental and physical well-being.

There are certain medications your provider might prescribe for Polycystic Ovarian Syndrome treatment, including hormonal birth control, anti-androgens, and Metformin. However, some of these are not recommended for women intending to become pregnant, so always discuss your plans with your doctor.

When to See Your Doctor About PCOS

Talk to your provider to discuss PCOS if:

• You have never been diagnosed, but you are concerned with your current symptoms
• You have irregular periods or do not get periods on your own
• You are obese and/or have weight gain that is difficult to manage
• You have a PCOS diagnosis and are having trouble managing your condition

Be sure to talk to your OB-GYN provider about any PCOS symptoms that have arisen or have begun to worsen: headaches, cramps, fatigue, thinning hair, excess hair, acne, weight gain, moodiness, heavy or irregular periods, or trouble conceiving.

Early detection is vital with PCOS because intervention can help prevent damage to your heart, liver, pancreas, reproductive system, mental wellness, and more. With the help of your Moreland OB-GYN provider, y

ou can manage PCOS symptoms with a personalized plan that’s tailored specifically to your needs.

Moreland OB-GYN Associates, S.C. is dedicated to the needs of their patients. At Moreland OB-GYN, we promote overall excellence in women’s health care. Our compassionate providers understand the difficulties that women face in their daily health, whether it is unexplainable pain or unusual symptoms, we are here to listen and provide our expert care.

For more information about PCOS, request an appointment with Moreland OB-GYN

Ovarian Cysts – Common Symptoms and treatment options

Ovarian Cysts – Common symptoms and some treatment options

An ovarian cyst is a sac or pouch filled with fluid or other tissue that forms on the ovary. Ovarian cysts are very common in women during their reproductive years. There are multiple types of ovarian cysts and most are…

Posted on:

December 1, 2014

Last updated on:

December 1, 2014

Written by:

Adeeti Gupta

Categorized in:
Healthy Links

An ovarian cyst is a sac or pouch filled with fluid or other tissue that forms on the ovary. Ovarian cysts are very common in women during their reproductive years. There are multiple types of ovarian cysts and most are noncancerous. The most common type of cyst is a functional cyst, which may form on a monthly basis as a result of ovulation. These cysts will almost always disappear on their own in about 6-8 weeks. These cysts most commonly do not cause any symptoms, and if any, they are very mild.

Sometimes, however, they may continue to get bigger and start collecting fluid or blood inside them. If they get really big (more than 7-8 cm) then there may be a risk for rupture (burst cyst) or torsion (twisting around the base of the cyst). In that case, you may suffer from severe sharp shooting pain in the abdomen associated with nausea, vomiting, sweating etc.

The pain may be constant or may be intermittent. Sometimes, the pain is so severe that you need to go to the emergency room. In the ER, you will be checked out by a sonogram and blood tests to see if you are losing blood. In most situations, if your blood pressure and heart rate is stable, you will be observed for a few hours and then discharged to follow up with your doctor. Your gynecologist may prescribe birth control pills to prevent the cyst from coming back in the next menstrual cycle.

Polycystic ovaries are also a commonly seen finding. Women with polycystic ovaries may present with symptoms of irregular periods. They may also have a tendency to gain weight, have excessive hair growth and have a pre-disposition to developing diabetes during pregnancy or later on in life. For women who are not ovulating, the ovaries may be enlarged and contain a large number of small cysts. About 4-7% of all women may present with polycystic ovaries.

Polycystic ovarian syndrome (PCOS) is a more complex condition, which includes hormonal imbalance and other symptoms. Your gynecologist can help you diagnose and manage the condition on an ongoing basis.

Another common type of cyst is an “endometrioma, or “chocolate cyst”. These types of cysts result from endometriosis. With endometriosis, endometrial tissue that is usually seen in the uterus grows outside the uterus, in places such as the ovaries. These cysts form as the tissue bleeds with each menstrual cycle, therefore filling the cyst with dark, reddish brown blood. Endometriosis is a complex condition with varying severity and presenting symptoms (Watch out for a more detailed blog coming up on endometriosis!).

Many women are not even aware that they have a cyst and don’t experience any symptoms. If they do experience symptoms of endometriosis, they may include abdominal or pelvic pain. More concerning signs may include bloating, constipation, extreme abdominal or pelvic pain, early satiety, nausea or vomiting.

Ovarian cysts may be found during a routine pelvic exam. If one is found, your provider will likely do an ultrasound of the uterus and ovaries to look closer at the cyst. You will also need sonogram if are experiencing abdominal pain or any other symptoms to rule out any other conditions in the lower abdomen that may be causing pain.
The treatment depends on the size and type of cyst found on ultrasound and your symptoms. With small functional cysts that are not causing the patient symptoms, watching and waiting is the usual course.

If the cysts are bothersome and growing, some treatment options may be birth control pills, which will help new cysts from forming. Your gynecologist may recommend removal by laparoscopic surgery if the cyst is getting bigger, painful or looks concerning on certain ultrasound findings.

Adeeti Gupta MD, FACOG

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GIANT OVARIAN TUMOR. TACTICS OF MANAGEMENT

Case study

G.F. Smirnova, A.D. Kirichenko, T.I. Fetisova, O.L. Lopatin, A.A. Egorov

Kemerovo Regional Clinical Oncological Dispensary,
650036, Russia, Kemerovo, st. Volgogradskaya, 35.
Tel. reception: (8-382) 54-14-98, fax: (8-382) 54-17-21,
Kemerovo State Medical Academy, Kemerovo.

Information about the authors :
Smirnova Galina Fedorovna – Oncologist OO-4, Kemerovo Regional Clinical Oncology Center, Kemerovo, 650065, Builders Boulevard, 16 “b” -46. Phone: 8-960-909-64-93, e-mail: [email protected];
Kirichenko Alexander Dmitrievich – Head of Department OO-4, Kemerovo Regional Clinical Oncology Center, Kemerovo, Russia;
Fetisova Tatyana Ivanovna – Ph.D. honey. Sci., Oncologist OO-4, Kemerovo Regional Clinical Oncology Dispensary, Associate Professor, Department of Obstetrics and Gynecology No. 2, Kemerovo State Medical Academy, Kemerovo, Russia;
Lopatin Oleg Leonidovich – Oncologist OO-4, Kemerovo Regional Clinical Oncology Center, Kemerovo, Russia;
Egorov Anatoly Alekseevich – Chief Physician, Kemerovo Regional Clinical Oncology Center, Kemerovo, Russia.

A rare case of a giant ovarian tumor is presented.

Keywords : giant ovarian tumor, ascites, liver cirrhosis, surgical access .

The gigantic ovarian tumor. Tactics of cure
G.F. Smirnova, A.D. Kirichenko, T.I. Fetisova, O. L. Lopatin, A.A. Egorov

Regional Clinical Oncological Clinic
(35, Volgogradskaya Street, 650036 – Kemerovo, e-mail: [email protected]),
The Kemerovo state medical academy.

Key words : gigantic ovarian tumor, ascites, cirrhosis of the liver, surgical approach .

Clinical symptoms of ovarian tumors registered in patients before treatment are divided into two groups – subjective and objective.

Subjective symptoms include: pain in the abdomen of a diverse nature, dysfunction of the gastrointestinal tract, ranging from mild discomfort, a tendency to constipation and to intestinal obstruction of varying severity, disorders of the urinary tract in the form of difficulty urinating, a decrease in daily diuresis and general symptoms – weakness, sweating, weight loss, malaise, feeling unwell, fatigue, dizziness, disability, fever, sleep disturbance, feeling of heaviness and pressure in the lower abdomen, recurrent or constant dull aching pain, a feeling of fullness in the abdomen, violation defecation, poor sleep and appetite.

Objective symptoms include an increase in the abdomen due to the accumulation of free fluid in the abdominal cavity (ascites) or due to the active growth of tumor masses.

No matter what time period (from 1-4 months to much later) the patient goes to the doctor, there is a greater number of symptoms in patients with advanced stages of the disease compared to patients with early stages.

The size of the tumor masses prevails in patients at late stages compared with patients at early stages. The mobility of tumor masses is greater in the early stages, even with different sizes of tumor masses. Only giant tumors (i.e. more than 30 cm in diameter) have little displacement due to their size. The main and most frequent complaints are pains of varying intensity in the lower abdomen or in the lumbar region (59.4%), in the sacrum. In most cases, the pain is dull, aching and pulling, sometimes sharp, paroxysmal. Acute pain occurs due to complete or partial torsion of the tumor stem and necrosis of the tumor site. The dysuric phenomena caused by pressure of a tumor on a bladder are frequent.

The second most common symptom can be considered a menstrual disorder (29.8%) that occurs within 1-12 months. before the appearance of a palpable tumor and expressed in the form of menometrorrhagia, algomenorrhea.

Violation of the menstrual cycle by the type of menorrhagia is more often observed with a mixed nature of benign epithelial tumors (28.5%), algomenorrhea – with endometrioid (36.3%), amenorrhea and irregular menstruation – with serous (16.3%) and mucinous ( 33.3%) tumors. Bleeding in deep menopause in the presence of other symptoms of hyperestrogenism (youthful appearance of the patient, engorgement of the mammary glands, the presence of glandular cystic hyperplasia of the endometrium, etc.) are characteristic of Brenner’s epithelial tumor.

The third most common symptom – an increase in the size of the abdomen – is observed in every fifth patient with benign epithelial tumors (especially with mucinous cystadenoma) and in the vast majority of cases occurs due to the growth of the primary tumor. In patients with malignant epithelial tumors, an increase in the abdomen is most often due to ascites. The abdomen acquires a spherical shape, which is preserved when the position of the body changes.

Among other symptoms, every sixth patient has a bowel or bladder dysfunction and every tenth patient has dyspeptic disorders.

Approximately 20% of women with asymptomatic tumors do not complain.

Vaginal findings depend on the shape and size of the tumor. The uterus, as a rule, is located anteriorly, and the cyst is located on the side or behind the uterus. The tumor can be palpated as a round or ovoid formation of various sizes. The diagnosis is established on the basis of anamnesis, clinical course of the disease, bimanual or ultrasound data. Papillary cystomas can exist for a long time without visible changes. Often the tumor is almost asymptomatic, patients do not suspect the presence of a tumor for a long time and do not seek medical help. In some cases, patients go to the doctor about a rapid increase in the abdomen. Palpation of the abdomen is painless. Unfortunately, this sign is not always evaluated correctly. Often, the symptoms of the disease are due to the mechanical effect of the tumor on the surrounding tissues and adjacent organs. These are dull aching pains mainly in the lower abdomen, less often in the epigastric region or in the hypochondrium. The pains are constant, but they can also stop for a certain period.

Clinical practice of malignant ovarian tumors also lacks pathognomonic signs. In the early stages of the disease, the clinic is very poor, complaints are not specific. The development of the process proceeds without any violations of the general state of health or the functions of the genital organs. Difficulty breathing due to the appearance of effusion in the abdominal cavity and pleura. The menstrual cycle is disturbed by the type of dysfunctional uterine bleeding. Decreases the amount of urine produced. Constipation occurs.

The diagnosis of ovarian tumors is based on the identification of various sizes and forms of tumor formation in the small pelvis, painless, moderately or limitedly displaced, with a bumpy or smooth surface, having a dense or tight elastic consistency. The asymptomatic development of the tumor process in the ovaries in the early stages of the disease forces clinicians to develop more advanced methods for their recognition and identify the so-called high-risk group of patients. The severity of pain depends on the individual characteristics of the woman, her threshold of pain sensitivity and possible degenerative changes in the tumor. Active early detection of ovarian cancer can be carried out on the basis of anamnesis and data from a routine gynecological examination. The consistency of malignant ovarian tumors, according to palpation data, is heterogeneous, cystic with areas of solidization, the surface is bumpy. When you try to move the tumor, pain is felt. The mobility of tumors is often limited due to their adhesion to adjacent organs. In the later stages of the disease, an enlarged and infiltrated greater omentum is palpated, metastases are found in the navel, supraclavicular region, along the peritoneum of the posterior uterine rectal cavity. Diagnosis of ovarian cancer, as well as malignant tumors of other organs, is based on a combination of history, palpation examination and the results of various additional methods. If an ovarian tumor is suspected, it is imperative to conduct an ultrasound tomography, which is the second stage of the study after the gynecological one. Echoscopic devices with vaginal sensors make it possible to determine the shape, size, localization of tumors and tumor-like formations of the small pelvis with a high degree of accuracy, as well as to get an idea of ​​their structure. Ovarian cancer can be suspected by erratic echoes, as well as the presence of many echo-negative shadows of a rounded shape. Detected by ultrasound and ascites up to 1 liter. With the help of computed tomography, it is often possible to determine the localization and size of the tumor formation, and sometimes to evaluate its internal structure.

To avoid gross errors in the choice of tactics for the treatment of patients with low-displacement tumors in the pelvis, one should remember the need to exclude a non-organ retroperitoneal tumor from them. Inorganic tumors such as lipomas located retroperitoneally, even with small sizes, can simulate ovarian tumors. In their recognition, the importance of computed tomography is invaluable, which allows not only to establish the retroperitoneal location of the tumor and localize its location, but also to clarify the extent, connection with adjacent anatomical structures and show the possibility of surgical removal of such a tumor. Among the additional research methods, a cytological examination of smears from the sediment of ascitic and pleural fluid, as well as lavages obtained by puncture of the Douglas space, is mandatory.

Colossal cyst (Slavic).

Kedrova cites in her dissertation a number of cases of large tumors of the ovary and points to the amazingly rapid growth of these tumors. Colossal ovarian tumors have been repeatedly reported in Russian literature, weighing many pounds (Gruzdev, Orlov, Cherevkov, Ulyanovsky, Demyanov, Stuchinsky and many others) and most often defined as glandular cystoadenomas. Cases are described when the weight and size of these cysts exceeded the weight and size of the body of their carrier. So, Franz reports a cyst weighing 80 kg, Spon from America reports a case of a cyst weighing 328 US pounds (1 US pound is 453.59grams or 0.45359 kg. (Skrobansky K.) [4].

Giant ovarian cyst in a 40-year-old Chinese woman.

Abdominal circumference – 156 cm. The patient sat all the time for 4 years, mostly with her legs turned up. I noticed an increase in the volume of the abdomen 10 years ago. [5].

A woman with a huge ovarian tumor. Sharp weight loss. Abdominal circumference 160 cm (Shteckel V.) [5].

Steckel V.: The size of the tumors can be varied, with a certain patience of the patient, it can reach gigantic proportions. But such giant tumors are becoming less and less common, and at present we already call much smaller tumors huge: the case of Kerer, where the weight of the tumor containing 26 liters of fluid was 33.3 kg, the case of Katz with a tumor of 29kg in weight and with a content of 25 liters of fluid, and the body weight after the operation was 34.9 kg. [5].

Patient N., 49 years old. , who lives in the city of Berezovsky and works as a salesperson by profession, applied to OKOD on 05.05.2010. Sent from the place of residence with a preliminary diagnosis: Ovarian tumor.

From the patient’s anamnesis: the menstrual cycle was established from the age of 15, regular. Last menstruation – 04/13/2010. Pregnancies – 2, ended in urgent independent childbirth, b / o, m / a-0. I did not use contraception during my sexual life. Denies gynecological diseases. Somatic diseases: Hypertension-11. CHSN-1. FC-11. Obesity-1U (during life). Oncoanamnesis is not burdened.

The patient began to notice an increase in the volume of the abdomen from X1.2009, associated this fact with obesity, and independently from X1.2009 to 02.2010 took drugs to reduce body weight (Xenical, Lindax). There were no menstrual irregularities. She applied for medical help only on 02.2010. At the appointment with the therapist 02/16/2010 complained of an increase in the volume of the abdomen, swelling of the legs, severe shortness of breath, a decrease in overall performance, an increase in body weight up to 155.5 kg.

The therapist made a preliminary diagnosis: Cirrhosis of the liver. Ascites. Ultrasound of the abdominal cavity (16.02.2010) was performed. Conclusion: Diffuse changes in the liver (cysts), focal changes in the right lobe of the liver. Hepatomegaly. Splenomegaly. Signs of portal hypertension. Structural changes in both kidneys. Signs of ascites. Diuretic drugs (veroshpiron, furosemide) were prescribed for 2 weeks, at the end of this treatment, the patient noted a deterioration in health, increased dyspnea, back pain, and an increase in the volume of the abdomen. Due to an unclear diagnosis and the lack of the expected effect from the use of diuretics, a patient with a diagnosis of liver cirrhosis, portal hypertension was referred to the hepatological center in Kemerovo. An additional examination was carried out in the hepatological center, based on the results of which the conclusion was made: There are no data for liver cirrhosis (no portal hypertension according to ultrasound and FGDS, liver tests unchanged), ovarian tumor. Consulted by an oncogynecologist and with a diagnosis of Giant ovarian tumor 05/05/2010 hospitalized in the gynecological department OKOD. During hospitalization, the patient moved independently with difficulty, could not be in a horizontal position on her back. Severe swelling of the legs was noted. The abdomen was sharply enlarged in size, at the highest point up to 161 cm. Abdominal skin with secondary changes (infiltration, hyperkeratosis, multiple striae, etc.), mainly in the hypogastrium (see photo No. 1).

06.02.2010 In order to verify the diagnosis and alleviate the patient’s condition, a point of intimate growth of the tumor to the anterior abdominal wall was found under ultrasound control. Puncture biopsy of the tumor was performed. 30 liters of thick mucus-like liquid were evacuated (see photo #2). Cytological examination of the fluid: No. 2807-2818 dated 05/11/2010: Mucus. The patient’s well-being and condition improved, which made it possible to conduct an additional examination: FGS, FCS, R-n OGK – there is no pathology.

On May 14, 2010, patient N. underwent laparotomy under ETN. The team was faced with the task of finding a rational optimal access to the abdominal cavity. The reference points were the points of bone formations: crista iliaca anterior superior, which were significantly higher than the point of the navel due to overstretching of the anterior abdominal wall and hanging down in the form of an apron. During laparotomy, an upper median incision was chosen above the navel for 20 cm along the length along the protruding part of the tumor. The size shows increased infiltration of the anterior abdominal wall, pronounced lymphorrhea of ​​the subcutaneous tissue. A tumor capsule is placed in the surgical wound, growing in places to the peritoneum of the anterior abdominal wall. The tumor is multi-chamber, with an uneven surface, of gigantic size, originating from the right ovaries, filling the entire abdominal cavity (50×70 cm). The content of the tumor is a mucinous liquid, brown in color. The tumor was removed and sent for urgent histological examination. Histological result: low-grade cystadenoma. Final answer after posting. During the revision of the abdominal organs: the liver is smooth, l/nodes are not enlarged. Intestine, b/omentum are not changed. Uterus up to 8 weeks, dense. The left appendages are not enlarged.

The operation was performed in the scope of extirpation of the uterus with appendages with resection of the b/omentum. Postoperative period without complications. Final histological result: No. 5073-5106r dated May 21, 2010: Mucinous cystadenocarcinoma of the right ovary. Fallopian tubes, cervix – the usual structure. Leiomyoma of the uterine body up to 1 cm in D. Atrophic endometrium. Tecomatosis of the left ovary. B / stuffing box – the usual structure.

The total weight of the removed ovarian tumor was 53 kg.

Photo No. 1 (during hospitalization, view on the side while lying).

Photo №2, 3 (during hospitalization).