The risk of malignancy index (RMI) in diagnosis of ovarian malignancy: A case report
DOI: https://doi.org/10.33024/minh.v8i1.664
Ovarian cancer, advanced-stage, risk of malignancy index
Abstract
Background: Ovarian cancer is among the deadliest gynecological cancers, with nearly 70% of cases identified at an advanced stage. It is the fourth most common cause of cancer-related deaths in women. While early detection significantly improves ovarian cancer outcomes, the disease often presents no symptoms in its early stages, resulting in delayed diagnosis and worsened prognosis. Achieving an accurate initial diagnosis in women with ovarian cancer is essential for ensuring early, correct treatment and reducing the risk of overtreatment. Clinically, various methods are available to assess ovarian malignancy risk, including the Risk of Malignancy Index (RMI).
Purpose: To demonstrate the use of the RMI score to differentiate between benign and malignant ovarian tumors.
Method: The case of Mrs. LKS, a 34-year-old woman who had experienced abdominal distension and related symptoms for one year, was analyzed in detail. The patient underwent multiple diagnostic evaluations, including a physical exam, ultrasound, abdominal CT scan, and histopathological analysis. The RMI, a well-established malignancy risk assessment tool, was employed. The initial evaluation of ovarian malignancy risk primarily considered ultrasound results, menopausal status, and serum CA-125 levels, with an RMI score above 200 indicating a high risk of ovarian cancer. Surgical procedures performed included a total hysterectomy, omentectomy, appendectomy, and ascitic fluid drainage.
Results: The patient’s main issue was a gradually worsening abdominal distension over the past year, accompanied by lower abdominal pain, nausea, and significant weight loss. Physical examination and imaging revealed a heterogeneous cystic mass in the abdomen, suggesting a malignant ovarian cyst, along with the presence of ascites. The RMI score exceeded 200, indicating a high risk of ovarian malignancy. The patient underwent a laparotomy, which included a total hysterectomy, omentectomy, and appendectomy, leading to a postoperative diagnosis of stage III B ovarian cancer. Despite the intervention, the prognosis remained poor (dubia ad malam) due to the advanced stage at diagnosis.
Conclusion: The RMI calculation serves as a valuable and reliable method for guiding diagnostic, management, and treatment decisions for patients with benign and malignant ovarian masses.
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References
Alanbay, İ., Akturk, E., Coksuer, H., Ercan, M., Karaşahin, E., Dede, M., & Baser, İ. (2012). Comparison of risk of malignancy index (RMI), CA125, CA 19-9, ultrasound score, and menopausal status in borderline ovarian tumor. Gynecological Endocrinology, 28(6), 478-482.
Burbos, N., & Duncan, T. J. (2010). Management of a pelvic mass. Obstetrics, Gynaecology & Reproductive Medicine, 20(11), 335-340.
Geomini, P., Kruitwagen, R., Bremer, G. L., Cnossen, J., & Mol, B. W. (2009). The accuracy of risk scores in predicting ovarian malignancy: a systematic review. Obstetrics & Gynecology, 113(2 Part 1), 384-394.
Harris, R., Whittemore, A. S., Itnyre, J., & Collaborative Ovarian Cancer Group. (1992). Characteristics relating to ovarian cancer risk: collaborative analysis of 12 US case-control studies: III. Epithelial tumors of low malignant potential in white women. American Journal of Epidemiology, 136(10), 1204-1211.
Hoffman, B. L., Schorge, J. O., Schaffer, J. I., Halvorson, L. M., Bradshaw, K. D., & Cunningham, F. G. (2012). Epithelial ovarian cancer. Williams Gynecology. 2nd ed., McGraw-Hill, 853-878.
Huwidi, A., Abobrege, A., Assidi, M., Buhmeida, A., & Ermiah, E. (2022). Diagnostic value of risk of malignancy index in the clinical evaluation of ovarian mass. Molecular and Clinical Oncology, 17(1), 118.
Jacobs, I. J. (1991). Ca 125 in the physiology and pathology of the female reproductive tract: With particular reference to the diagnosis of ovarian cancer. University of London, University College Hospital Medical School (United Kingdom).
Jayson, G. C., Kohn, E. C., Kitchener, H. C., & Ledermann, J. A. (2014). Ovarian cancer. The lancet, 384(9951), 1376-1388.
Lheureux, S., Gourley, C., Vergote, I., & Oza, A. M. (2019). Epithelial ovarian cancer. The Lancet, 393(10177), 1240-1253.
Liberto, J. M., Chen, S. Y., Shih, I. M., Wang, T. H., Wang, T. L., & Pisanic, T. R. (2022). Current and emerging methods for ovarian cancer screening and diagnostics: a comprehensive review. Cancers, 14(12), 2885.
Lodha, A. (2016). Evaluation of a Risk of Malignancy Index Based on Serum CA125, Ultrasound Findings and Menopausal Status in the Pre-Operative Diagnosis of Pelvic Masses (Master's thesis, Rajiv Gandhi University of Health Sciences (India)).
Majmudar, T., & Abdel-Rahman, H. (2008). Pelvic mass–diagnosis and management. Obstetrics, Gynaecology & Reproductive Medicine, 18(7), 193-198.
National Institute for Health and Care Excellence. (2023). Ovarian cancer: recognition and initial management. NICE Clinical Guideline. United Kingdom. Accessed from: https://www.nice.org.uk/guidance/cg122
Patel, M. D. (2006). Practical approach to the adnexal mass. Radiologic Clinics, 44(6), 879-899.
Rein, B. J., Gupta, S., Dada, R., Safi, J., Michener, C., & Agarwal, A. (2011). Potential markers for detection and monitoring of ovarian cancer. Journal of Oncology, 2011(1), 475983.
Rooth, C. (2013). Ovarian cancer: risk factors, treatment and management. British journal of nursing, 22(Sup17), S23-S30.
Rout, S., Midha, D., Mukherjee, G., & Bhaumik, J. (2024). Diagnostic Dilemmas in Ovarian Cancer. Indian Journal of Gynecologic Oncology, 22(1), 3.
Sundar, S., Neal, R. D., & Kehoe, S. (2015). Diagnosis of ovarian cancer. Bmj, 351.
Tingulstad, S., Hagen, B., Skjeldestad, F. E., Onsrud, M., Kiserud, T., Halvorsen, T., & Nustad, K. (1996). Evaluation of a risk of malignancy index based on serum CA125, ultrasound findings and menopausal status in the pre‐operative diagnosis of pelvic masses. BJOG: An International Journal of Obstetrics & Gynaecology, 103(8), 826-831.
Yamamoto, Y., Yamada, R., Oguri, H., Maeda, N., & Fukaya, T. (2009). Comparison of four malignancy risk indices in the preoperative evaluation of patients with pelvic masses. European Journal of Obstetrics & Gynecology and Reproductive Biology, 144(2), 163-167.
Zhang, S., Yu, S., Hou, W., Li, X., Ning, C., Wu, Y., & Sun, L. (2019). Diagnostic extended usefulness of RMI: comparison of four risk of malignancy index in preoperative differentiation of borderline ovarian tumors and benign ovarian tumors. Journal of ovarian research, 12, 1-9.
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