Many of my surgical consults are for abdominal pain. Often the pain is related to a surgical problem, but sometimes it is not. Sometimes the reason for the pain is easy to surmise, but other times, it takes more investigation to determine the problem. Often I will use ultrasound to help me determine if surgery will help bring healing or not.
One young woman came in with abdominal pain in the lower abdomen. The pain was very localized and associated with a mass that could be palpated through the abdominal wall. The mass moved slightly when pushed, but then returned to its original position. On ultrasound, I could see that there was a mass next to her uterus that was distinct from the surrounding structures. The mass was not solid, but had a mix of fluid and solid-like material inside. Even one place inside the mass looked almost like bone.
I made the diagnosis of “ovarian cyst with torsion.” This means that the ovary has developed a large cyst / mass on it. The ovary is connected to the uterus by its blood supply and the Fallopian tubes, but otherwise floats freely in the abdomen. If the ovary grows large, it may become twisted on the stalk which holds its blood supply and it becomes strangulated . This strangulation (as you can imagine) elicits the pain.
In the operating room, I found that one of her ovaries was very large, twisted on its blood supply and had turned purple and lifeless. I removed it and closed her. I saw no other abnormalities.
Afterwards, I opened up the mass on a back table. There were sacs of fluid, both thick and thin. A large hairball was also present. The most peculiar finding, however, was a small bone that looked almost like a small vertebrae! This was a dermoid cyst – or more technically labeled, a benign mature cystic teratoma.
- Benign = no cancer
- Mature = Forming actually tissues like hair, skin, muscle, bone, etc
- Cystic = part of the mass was fluid within a capsule
- Teratoma = A tumor derived from the cells which form sperm and eggs.
The diagnosis was later confirmed by histopathology evaluation.