Raj Mamtha S, Pittala Karthik, Wallace Sean J, Wojcik Randolph
Department of Surgery, Division of Plastic & Reconstructive Surgery, Yale New Haven Health, New Haven, USA.
Division of Plastic & Reconstructive Surgery, Lehigh Valley Health Network, Allentown, USA.
Cureus. 2023 Feb 27;15(2):e35542. doi: 10.7759/cureus.35542. eCollection 2023 Feb.
Ovarian cancer is a feared diagnosis for women and clinicians alike. Ovarian mucinous adenocarcinoma is a unique subset of ovarian cancer. As a primary tumor, massive ovarian masses, and more specifically mucinous adenocarcinomas, have been infrequently reported in the medical literature. Team approaches to massive tumor extirpations are essential, as patients often require the expertise of various subspecialists including, but not limited to, gynecologic-oncologists, general surgeons, and plastic and reconstructive surgeons. Here we present a case of a 71-year-old woman with a massive, incapacitating pelvic mass, later found to be a primary ovarian mucinous adenocarcinoma. Once medically optimized, a multi-service team approach was utilized for tumor extirpation and abdominal wall reconstruction. Involved surgical services included Gynecologic-Oncology, General Surgery, and Plastic and Reconstructive Surgery. Exploratory laparotomy for tumor extirpation, hysterectomy, bilateral salpingo-oophorectomy, omentectomy, peritoneal stripping, bilateral inguinal lymphadenectomy, and appendectomy was performed. Extensively thin, devascularized, and attenuated abdominal wall fascia that was adherent to the tumor was removed. The abdominal wall defect was reconstructed and reinforced with inlay and overlays of biologic monofilament mesh. Inverted-T of the vertical and horizontal skin components was performed in a tailor-tacking fashion, assuring the maintenance and protection of the abdominal skin flap vascularity through utilizing the Huger Zones of perfusion. Pathology revealed a stage IA grade 2 mucinous adenocarcinoma of the ovary without evidence of metastasis. No adjuvant therapies were required. The tumor's weight was 140 pounds, and its dimensions were 63 x 41 x 40 cm. It is our hope that presenting this experience will raise awareness of this spectrum of diseases and allow for earlier diagnoses and treatments, as well as exemplify the virtues of a team-based approach in the successful extirpation and subsequent reconstruction of the abdominal wall and skin.
卵巢癌无论对女性患者还是临床医生来说都是令人恐惧的诊断结果。卵巢黏液性腺癌是卵巢癌中一个独特的亚型。作为一种原发性肿瘤，巨大的卵巢肿块，尤其是黏液性腺癌，在医学文献中的报道并不常见。对于巨大肿瘤切除手术，团队协作的方法至关重要，因为患者通常需要包括但不限于妇科肿瘤学家、普通外科医生以及整形和重建外科医生等各专科医生的专业知识。在此，我们报告一例71岁女性患者，其盆腔有巨大的、导致身体功能丧失的肿块，后来被确诊为原发性卵巢黏液性腺癌。在患者病情达到医学上的最佳状态后，采用了多学科团队协作的方法进行肿瘤切除和腹壁重建。参与手术的科室包括妇科肿瘤、普通外科以及整形和重建外科。进行了剖腹探查以切除肿瘤、子宫切除、双侧输卵管卵巢切除、大网膜切除、腹膜剥离、双侧腹股沟淋巴结清扫以及阑尾切除。切除了与肿瘤粘连的广泛变薄、缺血且萎缩的腹壁筋膜。腹壁缺损通过生物单丝网片的嵌入和覆盖进行重建和加固。采用裁缝针法进行垂直和水平皮肤成分的倒T形缝合，通过利用休格灌注区确保腹部皮瓣血管的维持和保护。病理检查显示为卵巢IA期2级黏液性腺癌，无转移迹象。无需辅助治疗。肿瘤重量为140磅，尺寸为63×41×40厘米。我们希望分享这一病例能提高对这类疾病的认识，实现更早的诊断和治疗，并体现团队协作方法在成功切除肿瘤以及随后腹壁和皮肤重建中的优势。
