ABSTRACT

Tuboovarian abscesses (TOAs) are considered to be a problem during a woman’s reproductive ages, and the diagnosis appears to be infrequent in postmenopausal women. It has been reported that 34% of patients hospitalized with a diagnosis of acute genital tract infections in reproductive ages develop TOA. It seems to be a serious problem to be solved that TOA may be related to a concomitant gynecological malignancy in a postmenopausal woman. In this case report we aimed to present a case of serous ovarian carcinoma presenting with postmenopousal tubo-ovarian abscess. A-63 year old postmenopausal patient was admitted to our gynecological outpatient clinic with a history of 3 months ongoing lower abdominal pain. The patient has been in menopause for 18 years. Her medical history was unremarkable with no previous surgery and systemic disease, except hypertension. Her initial gynecological pelvic examination presented right adnexal fullness. A transvaginal ultrasound scan revealed fluid collection of 39x21 mm in the uterine cavity and a 3.5 cm right adnexal cystic formation suspicious for TOA without any other pathology of the genitourinary system. Endocervical curettage and probe curettage were performed under general anesthesia. Unfortunately, pathological findings did not provide enough material for diagnosis. Because of the persistence of fluid collection and an adnexal mass, the patient was hospitalized and an antibiotic regimen of gentamicin and clindamycin intravenously was started. On the third day of antibiotic therapy, exploratory laparoscopic operation was planned and drainage and abscess wall sampling was performed. The pathological result revealed malign epithelial tumor and no microorganism was defined on abscess culture. Because of pathological result, tumoral debulking and staging surgery was performed. The patient was diagnosed as having a FIGO (International Federation of Gynecology and Obstetrics) stage IIIC tumor, and received six cycles of paclitaxel and carboplatin regimen after surgery. Patients presenting with postmenopausal TOA should be investigated in detail to exclude a concomitant gynecological or any other pelvic malignancy. In order to obviate any delay in the diagnosis and treatment, medical treatment alone or conservative treatment should be avoided.