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Endometroid carcinoma of the ovary

Case contributed by Jini P Abraham
Diagnosis certain

Presentation

Presented with abdominal mass and pain for one month.

Patient Data

Age: 65 years
Gender: Female

MRI pelvis revealed a large lobulated altered signal intensity lesion along the posterior and right lateral wall of uterus, displacing the uterus anteriorly and towards the left side.

It is heterogenously hypointense on T2, isointense on T1 and hyperintense on IR images. No areas of diffusion restriction. Post contrast study shows intense homogenous enhancement. There are few areas within the lesion which are hyperintense on T1 fat saturated images – suggestive of hemorrhage. The lesion is indenting and compressing the urinary bladder anteriorly. Right ovary is not seen separately.

Differential diagnosis includes

  • uterine leiomyoma
  • solid ovarian tumor (fibroma or fibrothecoma)

Histopathological diagnosis – Sertoli cell variant of endometroid carcinoma of ovary.

Case Discussion

Ovarian tumors are most commonly misdiagnosed as uterine leiomyomas. A large pedunculated or exophytic subserosal myoma can sometimes be mistaken for an ovarian tumor. A stalk connecting the myoma with the uterus, two separate ovaries visualized and vascular signal voids between the uterus and mass can help differentiate a subserosal myoma from a primary adnexal tumor. Sometimes, it is difficult to visualize the stalk due to distortion by the huge size of the lesion.

Although CA-125 levels are helpful in differentiating between benign versus malignant ovarian neoplasm, a mildly elevated serum CA-125 is common in patients with uterine diseases as well.

Sertoliform variant of endometrioid carcinoma of ovary is a rare variant that resembles Sertoli and Sertoli-Leydig cell tumors on histology. These tumors arising from the uterus have also been reported.

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