Patient's question:
June 11, 2013Patient gender: Female; Age: 9 years. The patient has always been in good spirits, with normal appetite and sleep, and normal urination and defecation; no history of allergies or hereditary diseases. On June 10, 2013, the family noticed a swelling in the patient's abdomen, and on June 11, they took her to Y Hospital in the city for a color Doppler ultrasound (B) examination of the liver, gallbladder, spleen, pancreas, uterus, and adnexa.
Ultrasound findings: The anterior diameter of the left liver was 52 mm, the longitudinal diameter of the left liver was 62 mm, the oblique diameter of the right liver was 107 mm, PV was 8 mm, and the extrahepatic bile duct was 3 mm. The liver section showed normal morphology and size, with uniform liver parenchymal echo and clear vascular structures. No obvious abnormal mass echoes were seen in the liver. CDFI: No obvious abnormalities were seen in the liver blood flow.
Gallbladder: 54 x 17 mm, wall thickness 2 mm, smooth, with no abnormalities inside.
Spleen: Thickness 34 mm, normal morphology and size, fine and uniform echoes, with no obvious abnormal masses. CDFI blood flow: No obvious abnormalities in blood flow.
Pancreas: Not clearly displayed due to intestinal gas interference.
Uterus: Size 38 x 25 x 33 mm, regular contour, uniform echoes, endometrium 10 mm, with uneven echoes.
Both ovaries were unclear. A slightly stronger echo of 12 x 11 mm was seen at the fundus of the uterus, with unclear boundaries. CDFI: Increased blood flow in the uterine muscle wall. The slightly stronger echo showed no obvious blood flow.
A mixed echo with a size of approximately 182 x 141 mm was seen in the abdominal cavity, mainly low echo, unclear boundaries, irregular shape, with blood flow inside and around.
Interpretation: Space-occupying lesions in the abdomen, large amount of ascites, slightly stronger echo at the fundus of the uterus. Further examination is recommended.
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June 12, 2013
Following medical advice, the patient's family took her to the radiology department of Y Hospital on June 12, 2013, for magnetic resonance imaging (MRI) of the pelvis, DWI, and lower abdomen. Findings: A large elliptical mass shadow was seen in the abdominal cavity, measuring approximately 18.0 x 8.8 x 12.8 mm, with relatively clear boundaries. Multiple cystic changes were observed inside, with T1WI mainly showing isointense signals, scattered nodular high signals and cystic low signals, T2WI showing slightly high signals, DWI showing slightly high signals, and ADC map showing slightly low signals. Enhancement scan showed significant enhancement of the mass, with no enhancement in the cystic areas.
In the left adnexal region, an elliptical long T1 long T2 signal shadow measuring approximately 0.8 x 1.1 cm was seen, with clear boundaries, and no enhancement was observed after contrast enhancement. The size, morphology, and signals of the uterus were normal. The bladder was well-filled, with no wall thickening and no abnormal signals.
Large amounts of fluid signals were seen in the abdominal and pelvic cavities, with no enlarged lymph nodes. On June 13, 2013, the "Radiology Consultation Report" was obtained.
Diagnosis:
1. Space-occupying lesions with large amounts of abdominal and pelvic effusion, considered malignant: sarcoma? Neuroblastoma?
2. Cyst in the left uterine adnexa.
Y Hospital recommended immediate admission to the gynecology department, but the gynecology department of the hospital had no available beds at the time and asked the patient to wait for a bed.
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June 13, 2013 – June 26, 2013
On June 13, 2013, after receiving the "Radiology Consultation Report" from Y Hospital, the patient's parents were worried that hospitalization and surgery for a 9-year-old child might lead to adverse consequences. Starting from June 15, 2013, they began taking traditional Chinese medicine (TCM) for treatment. The TCM prescription followed the logic of "discharge fluid → soften masses → reduce swelling (tumor)" to first eliminate abdominal and pelvic effusion through urination and defecation. The prescription is as follows:
Composition Weight (g) Composition Weight (g) Composition Weight (g) Composition Weight (g)
Augustus 15g Banyan 10g White Mustard 20g Staghorn 5g
Fructus Linderae 15g Tangerine Peel 10g Alisma 10g Peony Root 10g
Poria 10g Radix Bupleuri 10g Kelp 10g Rhubarb 5g
Atractylodes 10g Astragalus 10g
The prescription was taken until June 22, 2013, followed by a 3-day break until June 26, 2013.
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June 27, 2013
To verify whether the TCM prescription truly had the effect of "discharging fluid," the patient's family took her back to Y Hospital on June 27, 2013, for a color Doppler ultrasound (B) examination of the ascites and mass, as well as blood and plasma tests. However, the vice chief physician of the gynecology department at Y Hospital did not understand the family's request for a " of ascites and mass." The first examination only included "uterus and adnexa" in two areas.
Ultrasound findings:
Uterus size: 44 x 26 x 42 mm, regular contour, uniform echoes, endometrium 6 mm.
Right ovary: 16 mm x 13 mm, no obvious abnormal echoes in the right adnexa.
Left ovary: 19 mm x 15 mm, with a 10 x 9 mm dark area inside (follicle?).
CDFI: Increased blood flow in the uterus.
Interpretation:
Increased blood flow in the uterus
Additionally, to review the "ascites and mass," the patient's family requested a " of ascites and mass" from the outpatient surgeon at Y Hospital. The results were as follows:
Ultrasound findings:
A mixed echo with a size of approximately 177 x 84 x 117 mm was seen in the abdominal cavity, mainly low echo, unclear boundaries, irregular shape, with an additional 66 x 37 mm dark area inside, which showed septations. CDFI: Blood flow was seen inside and around the mixed echo. A liquid dark area measuring 101 mm deep was detected in the lower abdomen, a liquid dark area measuring 24 mm deep was detected in the prehepatic region, and a liquid dark area measuring 77 mm deep was detected in the left upper abdomen.
Interpretation:
Space-occupying lesions in the abdomen
Large amount of ascites
Furthermore, blood and plasma tests were conducted. In the blood test, "Platelet count 373.000↑ (reference range 100-300)," lymphocyte ratio 0.199 ↓ (reference range 0.2-0.5), and platelet pressure value 0.360↑ (reference range 0.11-0.28). All other tests were normal.
In the plasma test, "CA125 Carbohydrate Antigen 125 392.000↑ (0-35)," and all other tests were normal.
After these results were obtained, the outpatient physician at Y Hospital did not provide any explanation of the patient's condition but simply advised admission. The patient's family felt extremely uneasy because they did not receive any explanation of the patient's condition from the outpatient physician.
Subsequently, through an introduction, the patient's family took her to E Hospital in the city for consultation. The vice president of the hospital carefully reviewed the MRI images from Y Hospital taken on June 12, 2013, and provided the family with an objective and patient explanation. He recommended that the patient be admitted for surgery, and the family immediately agreed to hospitalization and treatment.
Since June 27, 2013, was a Thursday, and weekends (June 29 and 30) were off for doctors, the vice president of E Hospital recommended that the patient be admitted on Monday (July 1, 2013) for further examinations and treatment. The family immediately agreed to this plan.
Doctor's answer:
Granulosa cell tumors have a relatively better prognosis compared to other types of ovarian cancer. However, whether chemotherapy is necessary depends on the doctor's assessment of the surgical condition and postoperative pathology, as well as a comprehensive judgment. It is recommended to follow the treatment approach recommended by your current surgical doctor. Treatment is generally conducted according to standard protocols and principles, so there is no need to worry.