Ruptured clear cell carcinoma of the ovary presenting as acute abdomen

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Highlights

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This is the first report of spontaneous rupture of clear cell ovarian carcinoma.

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Ruptured tumors should remain in the differential diagnosis of acute abdomen.

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Stage 1 due to rupture has a better prognosis than ascites and surface involvement.

Here we present the first documented case of a ruptured ovarian clear cell carcinoma presenting as an acute abdomen.

Case

......The patient is a 54 year old G1P1001, postmenopausal woman who presented to the emergency department complaining of severe abdominal pain for the past 24 h. She reported that the pain was diffuse and constant; review of systems was otherwise negative. Past gynecological history was remarkable for endometriosis. Past medical, surgical, family, and social histories were non-contributory. On presentation, her vital signs were remarkable for tachycardia with a pulse of 105. The remainder of her vital signs was within normal limits. On physical exam, her abdomen was distended, diffusely tender, dull to percussion, and positive for both rebound and guarding........

 

.......This case is novel in that spontaneous rupture of a clear cell ovarian tumor had occurred, and the patient presented with peritoneal signs and an acute abdomen, which is a surgical emergency. Gynecologists often see patients with ovarian malignancies presenting subacutely with constitutional and abdominal and pelvic signs and symptoms in an outpatient setting. However, epithelial ovarian carcinomas, and in particular ovarian clear cell cancer, ought to remain in the differential diagnosis in patients presenting with an acute abdomen with imaging suspicious for malignancy.