Rare Dual-Tumor Surgery Successfully Performed at Kailash Hospital Noida

Managing multiple tumors simultaneously in a single patient presents unique diagnostic and surgical challenges. Such cases require meticulous preoperative evaluation, accurate pathological diagnosis, and comprehensive surgical planning to ensure the best possible outcomes. At Kailash Hospital, Noida, Dr. Manish Sahni, Consultant Surgical Oncologist, successfully treated a 60-year-old woman diagnosed with two distinct tumors occurring at different anatomical sites—a rare clinical scenario that required a highly coordinated surgical approach.

Presentation of Symptoms (if any)

The patient presented with:

• Persistent abdominal discomfort for two months
• Progressive abdominal bloating and fullness

On clinical examination:

• A firm, partially mobile lower abdominal mass was palpable
• The lower limit of the abdominal lump could not be clearly appreciated
• A separate soft, fluctuant swelling measuring approximately 15 × 15 cm was noted over the right upper back near the scapular region, becoming more prominent during arm abduction

The presence of two distinct masses raised concerns about multiple underlying pathologies requiring detailed investigation.

Diagnosis

Comprehensive diagnostic evaluation was performed.

CECT Abdomen Findings

• A large heterogeneously enhancing solid-cystic complex mass measuring approximately 18 × 15 cm
• Originating from the left adnexal (ovarian) region

MRI Back Findings

• A lobulated 15 × 15 cm intermuscular lipomatous lesion
• Located between the latissimus dorsi and trapezius muscles
• Contained multiple internal septations

Biopsy Findings

• Biopsy of the back swelling suggested a lipomatous lesion

Tumor Markers

• Serum CEA
• CA 19-9
• CA-125

All were within normal limits despite the presence of a large ovarian mass.

Condition Overview

This case was particularly rare because the patient harbored two separate tumors simultaneously:

1. A large ovarian neoplasm arising from the left adnexa.
2. A giant lipomatous mesenchymal tumor in the upper back.

What made the case even more unusual was that the ovarian tumor was ultimately diagnosed as a mucinous ovarian tumor with intraepithelial carcinoma, a condition that requires extensive surgical staging despite often presenting with normal tumor markers.

The coexistence of these two distinct tumors in different regions of the body is uncommon and emphasizes the importance of thorough evaluation before surgery. Missing either lesion could have led to incomplete treatment and compromised outcomes.

Treatment Plan

Following optimization and pre-anesthetic assessment, the patient underwent a comprehensive surgical procedure.

Management of Ovarian Tumor

An exploratory laparotomy was performed with removal of the large adnexal mass.

Frozen Section Analysis

• Revealed a borderline mucinous tumor with moderate atypia

Based on these findings, complete oncological staging surgery was carried out, including:

• Total Abdominal Hysterectomy (TAH)
• Unilateral Salpingo-Oophorectomy (USO)
• Peritoneal fluid cytology
• Multiple peritoneal biopsies
• Bilateral pelvic lymph node sampling
• Infracolic omentectomy
• Appendicectomy
• Cholecystectomy (performed due to associated gallstones)

Management of Back Tumor

Simultaneously, a wide local excision of the large right upper back swelling was performed to achieve complete removal.

Outcome and Follow-Up

The patient tolerated the extensive procedure remarkably well.

Key postoperative highlights included:

• Uneventful recovery
• Early mobilization
• No major postoperative complications
• Discharge on Postoperative Day 5

Final histopathological examination revealed:

Ovarian Tumor

• Mucinous ovarian tumor with intraepithelial carcinoma
• Peritoneal fluid demonstrated atypical cells
• Pelvic lymph nodes were negative
• No evidence of disease elsewhere in the abdomen

Back Tumor

• Consistent with lipomatous mesenchymal neoplasia

The absence of nodal involvement and lack of metastatic disease elsewhere indicated a favorable prognosis following complete surgical management.

Conclusion

This rare case highlights the importance of meticulous preoperative assessment and multidisciplinary oncological care. The simultaneous presence of a large ovarian neoplasm and a giant lipomatous mesenchymal tumor in the same patient posed significant diagnostic and therapeutic challenges.

The successful management of both tumors in a single surgical setting demonstrates the value of comprehensive evaluation, intraoperative pathology support, and expert surgical oncology care. Under the leadership of Dr. Manish Sahni, the patient achieved an excellent postoperative outcome and a favorable oncological prognosis.