Complex Abdominal Mass with Uncertain Diagnosis in Young Female Patient

Case at a Glance

A 21-year-old female presents with two large abdominal masses discovered on MRI - a confirmed 16cm dermoid cyst and an undiagnosed 11cm mid-abdominal mass with concerning imaging characteristics including significant contrast enhancement and restricted diffusion.

Patient's Story

The patient, a 21-year-old female (BMI 24.2, height 5'2", weight 152 lbs), presented under NHS care with symptoms of severe constipation requiring 6-8 sachets of CosmoCol daily and intermittent abdominal pain. She was scheduled for surgical intervention following imaging studies that revealed concerning findings.

Initial Assessment

Physical examination revealed a young female in stable condition with complaints of chronic constipation and episodic abdominal pain. The patient required significant laxative therapy for bowel management and intermittent pain relief medication.

The Diagnostic Journey

MRI with contrast was performed, revealing two distinct masses. The lower mass (16cm) was definitively diagnosed as a dermoid cyst. However, the upper mass (11cm) in the mid-abdomen presented diagnostic challenges with the following characteristics: 157% enhancement post-contrast, soft tissue composition, patchy enhancement pattern, restricted diffusion on DWI, compression of small bowel without obvious connection, and no apparent connection to uterus or ovaries. The gynecologist initially suggested fibroma as the most likely diagnosis, though the imaging characteristics raised questions about this differential.

Final Diagnosis

Confirmed dermoid cyst (16cm, lower abdomen). The 11cm mid-abdominal mass remains under investigation with differential diagnosis including fibroma, gastrointestinal stromal tumor (GIST), solitary fibrous tumor, fibrothecoma, or thecoma. The imaging characteristics of significant enhancement and restricted diffusion are atypical for typical fibromas.

Treatment Plan

Surgical resection of both masses was planned. Pre-operative considerations included the possibility of GIST given the imaging characteristics, which would require specific surgical approach and potential bowel involvement assessment. Multidisciplinary consultation was recommended to optimize surgical planning.

Outcome and Follow-up

Patient scheduled for surgical intervention with plan for intraoperative assessment to determine exact origin and nature of the undiagnosed mass. Histopathological examination would provide definitive diagnosis and guide further management. Close post-operative monitoring planned given the size and uncertain nature of the masses.