Abstract:

Objective: To explore the characteristics of clinical cases misdiagnosed as gynecological tumors and to improve the knowledge and diagnostic ability of pelvic non-genital system tumors. Methods: A retrospective analysis of the case data of 58 patients admitted between August 2009 and March 2022 in the Beijing Obstetrics and Gynecology Hospital of Capital Medical University who were misdiagnosed as gynecological tumors, all of which were confirmed to be non-genital tumors by intraoperative exploration and pathology, including 24 cases of retroperitoneal tumors, 15 cases of appendiceal tumors and 19 cases of intestinal or mesenteric tumors. The clinical features, imaging manifestations, surgical methods and pathological diagnosis were analyzed. Results: Twenty-four patients with retroperitoneal tumors were preoperatively misdiagnosed as adnexal masses in 18 cases (75.0%), as uterine fibroids or broad ligament fibroids in 5 cases (20.8%), and as inflammatory pelvic masses in 1 case (4.2%). The clinical manifestations were abdominal pain or lower abdominal cramping in 6 cases (25.0%), frequent urination in 2 cases (8.3%), dyspareunia with sacrococcygeal discomfort in 1 case (4.2%), and no obvious symptoms in 15 cases (62.5%). Ultrasound or pelvic magnetic resonance imaging (MRI) did not suggest the possibility of retroperitoneal masses, and only one patient had pelvic and abdominal CT enhancement that did not exclude the possibility of retroperitoneal masses. In 15 patients with appendiceal tumors, all patients were misdiagnosed as adnexal tumors before surgery. The clinical manifestations were abdominal pain or lower abdominal distension in 6 cases (40.0%), and no obvious symptoms in 9 cases (60.0%). None of the patients had ultrasound suggesting a possible source of the appendiceal mass, and 3 patients had CT or MRI suggesting possible tumors of appendicular origin. 19 patients with intestinal or mesenteric tumors were misdiagnosed as having an adnexal mass in 18 cases (94.7%), a case (5.3%) was misdiagnosed as subserous myoma. The clinical manifestations were abdominal pain or lower abdominal distension in 8 cases (42.1%), and no obvious symptoms in 11 cases (57.9%). A patient had ultrasound suggesting that mesenteric cysts were not excluded, and neither CT nor MRI suggested the possibility of intestinal or mesenteric masses. Conclusions: Retroperitoneal tumors, appendiceal tumors and intestinal or mesenteric tumors are mostly suggested as pelvic masses by preoperative imaging, most of them have no specific clinical symptoms, and it is difficult to differentiate them from gynecological tumors. The gynecologists should pay attention to the above tumors, and carefully indentify patients with adnexal tumors to avoid misdiagnosis.

Key words: Diagnostic errors, Pelvic neoplasms, Retroperitoneal neoplasms, Appendiceal neoplasms, Intestinal neoplasms, Mesenteric tumors