46-kg abdominal tumor misdiagnosed as obesity: Unveiling healthcare bias due to obesity stigma.

KEY CLINICAL MESSAGE

Obesity results in higher risk of some cancers while obesity stigma affect patient's quality of care. In this case report, a 46 kg ovary mass was misdiagnosed as severe obesity. Obesity stigma awareness and a sustained effort from healthcare professionals are required to deliver adequate patient care to patients with obesity.

ABSTRACT

Obesity is a disease associated with an increased risk of cardiovascular diseases, diabetes, musculoskeletal disorders, and some cancers. Obesity stigma affect patients and healthcare professionals leading to mistrust, poor adherence, noncompliance to screening, and misdiagnosis. We reported a case report of a patient sent to our referral center for surgical evaluation of long-standing severe obesity (BMI 59). Physical examination was significant for abdominal obesity with a hard consistency, but no cushingoid dysmorphism or lipodystrophy. No abdominal pain, pelvic pain, vaginal bleeding, or change in bowel movements were present. Tumor markers were normal except for an elevated Ca 19.9. Imaging showed a large, intraperitoneal abdominal mass with no metastatic disease. The patient underwent surgery to remove a 46-kg complex ovarian cystic mass (circumference: 160 cm, diameter: 67 cm), full of liquid and with six nodular areas. The mass was entirely extracted with an intact capsule. The cystic mass resulted in a well-differentiated intestinal-type adenocarcinoma with microinvasive foci, an endophytic borderline area (sec. WHO 2014), and mucinous-cystic areas with no atypia. The patient had postoperative bilateral basal pleural effusion resolved with conservative treatment and was discharged at home on postoperative day 12 with an uneventful 90-day postoperative follow-up. In the present case report, a 46 kg ovary mass was misdiagnosed as severe obesity, and the patient was referred for bariatric evaluation. Unveiling biases related to obesity stigma is the first step to ensuring better patient care. Obesity stigma awareness and a sustained effort from healthcare professionals are required to deliver adequate patient care to patients with obesity.