In December 2023, client went to PCP due to sudden weight loss and trouble eating. Felt full right away. In January 2024, PCP ordered an MRI of abdomen and pelvic area which was completed on February 1, 2024.
Upon receiving the results, the doctor said that it could be a colon tumor. (it was between the uterus and the rectum). This doctor felt it was gynecologic, so he referred to OB/GYN.
In March 2024, client presented to OB/GYN and he did a physical as well as an intravaginal ultrasound exam. After this exam, the OB/GYN said it was like a soft ball between the rectum and the uterus, but not to be concerned because it was benign. He told her to just eat more and that everything was fine. He did not order a biopsy of the mass. She was very relieved and went about her business.
On July 12, 2024, client had meniscus surgery in Orlando. She recalls her legs and feet getting very swollen but was told not to worry because she wasn't experiencing chest pain. She showed the showed the anesthesiologist and the nurse. The swelling continued after the surgery and the orthopedic recommended compression socks.
In August 2024, she presented to the ER for shortness of breath. She was admitted for congestive heart failure. At the hospital they found that she had an incompetent heart valve. They said that there was nothing that they could do about it. They said that she would likely be dead by December. She left the hospital thinking she was terminal.
"Then miracle after miracle happened." She had a cardiologist who was a friend who got her into a hospital in Atlanta on August 28, 2024. A cardiologist found a second valve that not closing. PET scan showed carcinoid syndrome which was determined to be the cause of her heart failure. The mass that was discovered in March 2024 was actually cancerous.
On December 3, 2024, she had an MVR done. ON 1/8/25, she had an AVR done. She is still dealing with some shortness of breath & treats with a cardiologist for heart failure caused by the cancer.
On April 14, 2025, she had her ovaries and left tube removed. Subsequent PET scan show she is CA free.
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Do you believe there might have been medical error?
With weight loss, anorexia and pelvic mass, a pelvic exam and ultrasound is likely inadequate workup to conclude the mass as being benign. A formal ultrasound to evaluate for vascularity of the mass, short-interval follow up, or other additional workup would be more appropriate. While a mass could be uterine fibroid, additional clinical symptoms should have led to increased index of suspicion and workup.
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
While carcinoid tumors tend to be indolent, serotonin secretion may have led to the cardiac valvular disease. If the diagnosis had been made earlier with more workup when she presented in March 2024, the valvular disease may not have occurred
What makes you a good expert for this case?
I am a gynecologic oncologist in practice (in private practice as well as academic medical center settings) for 12 years and have worked up and managed several patients with carcinoid tumors. I have drafted expert opinions and given depositions as expert witness for medical liability cases in the past.
How often do you encounter cases similar to this one in your practice?
1-2 cases a year over the past 12 years
Do you believe there might have been medical error?
Based upon the information in the narrative, it seems like surgical intervention would have been prudent and likely would have led to an identification of the nature of the mass. This may have prevented the subsequent developments.
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
Same responses as above. Based upon the information in the narrative, it seems like surgical intervention would have been prudent and likely would have led to an identification of the nature of the mass. This may have prevented the subsequent developments.
What makes you a good expert for this case?
I am a board certified Gyn Oncologist with more than 3 decades of clinical experience.
How often do you encounter cases similar to this one in your practice?
Such tumors are uncommon. I currently care for 2 patients with this type of tumor and have seen others.
Do you believe there might have been medical error?
A Gyn mass in a 78 year old woman must always be taken seriously. Ultrasound cannot distinguish a benign from malignant tumor. I am assuming from this presentation that the ovary contained a carcinoid tumor. If so, removal of the ovary in a timely fashion would have prevented the cardiac manifestation of carcinoid syndrome.
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
As above, delay in removal of the mass led to release of vasoactive substances from the tumor that affected her heart.
What makes you a good expert for this case?
35 years experience as a Gyn oncologist dealing with ovarian tumors including primary carcinoid of the ovary.
How often do you encounter cases similar to this one in your practice?
These are rare tumors. I have probably dealt with about 20 over my career. However I have dealt with hundreds and hundreds of ovarian tumors in postmenopausal women.
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