Unveiling a Large Pelvic Mass in a Middle-Aged Woman: The Consequences of Neglected Gynecological Care

Pelvic masses in women can originate from both gynecological and non-gynecological sources, necessitating careful evaluation to ensure appropriate treatment. Gynecological masses can range from functional ovarian cysts and tubo-ovarian abscesses to malignant and benign tumors. This case report presents a mucinous borderline ovarian tumor (BOT), a rare type of ovarian neoplasm. This case highlights a 48-year-old G6P6006 White female with a history of asthma, presenting to the emergency department with a 10-day history of constipation and a month-long history of abdominal distention, which caused shortness of breath when supine. The patient had no recent primary care or gynecological follow-up. Physical examination revealed abdominal distension with absent bowel sounds and multiple hemangiomas, but no peritoneal signs. Initial laboratory studies were within normal limits, except for an elevated cancer antigen 19.9 (CA 19.9) level of 736.5. Imaging studies, including ultrasound and CT, identified a large complex adnexal mass measuring 28 x 21.5 x 15.4 cm. Given the suspicion of a gynecologic malignancy, the patient underwent a total abdominal hysterectomy with bilateral oophorosalpingectomy and an appendectomy. The mass, which was completely excised, was identified as a mucinous BOT measuring 32 cm at its largest diameter. Intraoperative pathology and peritoneal washings were negative for malignancy. Postoperatively, the patient met all recovery milestones and was discharged on day three, with a successful follow-up for staple removal. This case emphasizes the importance of timely access to healthcare in managing large ovarian tumors and potentially preventing malignant transformation. Improved access to healthcare services, particularly through insurance coverage, can enhance early detection and allow for comprehensive cancer care, thus improving survival outcomes. The case also highlights the lack of routine screening for many gynecological tumors, underscoring the need for improved healthcare access and awareness, which could facilitate earlier intervention and better patient outcomes. Early diagnosis and management of mucinous BOTs can significantly improve prognosis. Addressing healthcare access barriers remains crucial in reducing the risk of late-stage presentations and ensuring effective treatment for women with gynecological malignancies.