Diagnose is Complex adnexal mass
Path states Adenocarcinoma
Operative report below:
The patient was taken to the operating room and was placed on the operating room table, general anesthesia with endotracheal intubation was started, she was prepped and draped in a normal sterile fashion and Foley catheter was inserted, perioperative antibiotics were given, after surgical timeout a low mid line incision was made from the symphysis pubis towards the umbilicus, subcutaneous tissue was divided, fascia was incised in the mid line and fascial incision was extended superiorly and inferiorly, peritoneum was incised and peritoneal incision was extended superiorly and inferiorly, intraperitoneal cavity was inspected carefully, there was a large cystic and solid mass arising from the left ovary, this mass was adherent to the bladder peritoneum and cul-de-sac peritoneum, it was very friable at the site of adhesion’s to the bladder and there was extensive area of bladder peritoneal metastases, there was no evidence of gross involvement of omentum or other upper abdominal structures, small bowel and large bowel appeared normal, rectum and sigmoid also appeared normal, stomach, liver, pancreas and spleen were palpated and appeared normal there was no palpable retro peritoneal lymphadenopathy. Samples of bladder peritoneal metastases were removed an submitted to the pathology lab and frozen section report was consistent with an undifferentiated malignancy of likely sex cord stromal type, right ovary and tube appeared normal, Peritoneum lateral to the infundibulopelvic ligament was incised the ureter was identified in the retro peritoneal space, infundibulopelvic ligament was secured cut and ligated, and the ovary and tube with attached mass was removed with the attached peritoneum, similar procedure was completed on the opposite side, bladder peritoneal involvement was removed, at the end there was no evidence of visible residual disease, hemostasis was assured, dependent omentectomy was performed, the gastroepiploic vessels on the dependent portion of omentum was ligated using a LigaSure device and removed. Then the fascia was reappoximated using the loop #1 PDS in running fashion, the skin was re-approximated using a stapler. Sponge needle counts and instrument counts were correct at the end of the operation.