Presentation
Abdominal distension. Ca 125 104. BHCG 13. AFP 0.7 (normal)
Patient Data
There is a 16.5 x 11.3 x 9.5 cm solid, heterogeneous mass in the pelvis which demonstrates marked internal vascularity on ultrasound (IOTA color score 4). Lobulated contour and lobulated internal echogenicities are noted. No calcification within the mass. No acoustic shadows. No cystic components.
The uterus is anteverted and separate to the mass, as is the right ovary which was identified and measured 3.7 x 2.6 x 2.4 cm. The endometrium appeared thickened, measuring 22mm.
Structurally normal righ ovary with follicles present. The left ovary could not be separately identified.
No free fluid in the pelvis.
Pelvic findings confirmed at CT.
Enlarged para-aortic lymph nodes present.
No evidence of metastases to upper abdominal viscera, peritoneum, or the visualized lung bases.
MRI confirms the presence of a large solid enhancing mass occupying the mid abdomen and pelvis. Note the presence of multiple lobulations comprising the mass. Prominent vascular flow voids present.
Para-aortic lymphadenopathy as seen on CT.
Case Discussion
Risk stratification:
Based on IOTA simple rules this is likely malignant.
There are 2 "M" features present - irregular solid tumor (M1) and very strong blood flow (M5). No "B" features.
Based on the ADNEX model, the risk of malignancy is 52%.
O-RADS Category 5; high risk - >50%; recommend management by a gynae-oncologist.
Histology:
Ovarian dysgerminoma.
Intact capsule. Widespread lymphovascular invasion.
Discussion:
Large, solid mass in an adolescent female patient. Note the lobulated internal architecture of this lesion, which is typical for this entity.
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