34yr old premenopausal women who is mother of 3 child delivered normal comes to us with c/o heavy menstrual bleeding since 3 month no any h/o preceded amenorrhea no any h/o bowel bladder disturbance , no any h/o weight loss , fever. No any significant past personal and family history. There was no any lymphadenopathy. Breast examination was normal. On examination inspection abdomen was distended below umbilicus , suface was smooth no overlying vein temperature was normal, on plapation smooth mass was felt which upper border is not felt clearly mass was not freely mobile. Pregnancy was ruled out. On ps examination cervix was displaced posteriorly cx is healthy nd having multiparous os, right and anterior forniceal fullness was there.on pv examination ut size could not be made out , lower border of mass felt through right fornix and anterior fornix on pr no any mass felt in pod.
We have done usg s/o 20×17cm mass with solid cystic area with thick septation from which overy could not be seel separately.
Ct scan was done s/o 20cm mass with solid cystic area both ovaries not seen separately with peritoneal thickening ? Metastasis, with paraaortic LN 1.6 cm enlarged suggestive of ovarian malignancy
We have done ca 125, CEA, BHCG , AFP , INHIBIN all are negative.