Presentation
Abdominal swelling and loss of appetite. Ultrasound to rule out ovarian carcinoma, and endometrial thickness.
Patient Data
Complex and diffusely hetero-echogenic tumoral enlargement of the right and left ovaries, both composed of solid and cystic parts and both predominantly matted/showing a kissing tendency at their para-medial areas, is noted. The right ovary measures approximately 556 ml, while the left ovarian counterpart measures approximately 853 ml in volume. Color Doppler mapping shows subtle vascularity within the lobulated ovarian lesions.
Within the pelvic floor, a lobulated, large (8.6 x 5.44 cm) hypoechoic and hypovascular solid material seats and displaces the uterus superiorly. The anteverted and non-gravid uterus is normal and measures 30.2 ml in volume with no focal myometrial, endometrial, or cervical lesions. The endometrial stripe thickness of 0.42 cm noted is within normal limits.
Moderately clear ascites fill the potential intra-abdominal spaces and exhibit septations on the right lumbar region. Small, multiple enlarged para-aortic lymph nodes are noted. Again, a small-sized (3.33 x 2.3 cm) hypoechoic and lobulated solid lesion is noted at the left liver lobe inferno-medially at the level of the superior caudate lobe parenchyma, which could be hepatic metastasis. The gallbladder shows a thin-walled outline, albeit with multilobular intra-luminal hypoechogenic soft-solid material.
Case Discussion
A major differential of bilateral ovarian malignant processes with pelvic sidewalls and para-aortic lymphadenopathy, septated ascites, tumefactive biliary sludge, and a likely hepatic metastasis (FIGO class IV).
Key:
Ovarian FIGO staging:
Stage I: Tumor limited to the ovaries.
Stage IA: Tumor limited to one ovary, no ascites.
Stage IB: Tumor limited to both ovaries, no ascites.
Stage IC: Stage IA or IB with ascites.
Stage II: Tumor involves one or both ovaries with pelvic involvement.
Stage IIA: Extension/implants to the fallopian tubes or uterus, no
ascites.
Stage IIB: Extension to other pelvic tissues; no ascites.
Stage IIC: Stage IIA or IIB with ascites.
Stage III: Tumor involves one or both ovaries with peritoneal metastases outside the pelvis or retroperitoneal lymphadenopathy.
Stage IIIA: Tumor grossly limited to the pelvis.
Stage IIIB: Peritoneal metastases beyond the pelvis (<2 cm).
Stage IIIC: Abdominal implants (>2cm) and/or retroperitoneal lymphadenopathy.
Stage IV: Distant metastasis, including the liver parenchyma 1-4.
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