Left ovarian serous cystadenocarcinoma and right ovarian cystadenofibroma

Case contributed by Dr Ammar Ashraf

Presentation

Lower abdominal pain for 2 years, getting worse for 1 week, and associated with abdominal distension and anorexia. No weight loss, urinary symptoms or PV bleeding.

Patient Data

Age: 60 years
Gender: Female

Large well-defined heterogeneous multicystic right adnexal/ovarian mass lesion measuring approximately 10.5 x 11.6 x 8.3 cm. Mild internal vascularity is seen in it. No calcifications are seen in it. Left ovary was not confidently identified. 

Large, well-defined, complex right ovarian mass measuring 11.3 x 9.2 x 9.0 cm, having both enhancing solid soft tissue components and non-enhancing cystic spaces. Sizable complex left ovarian lesion measuring 7.5 x 7.0 x 4.3 cm, with prominent peripheral and internal calcifications. A small cyst measuring 1.0 x 1.0 cm, having peripheral calcifications, is seen in the cervix. Thickened and calcified peritoneum underlying the left anterior abdominal wall and left iliac fossa, and scattered focal calcifications along the peritoneal covering of the liver, spleen, stomach and small bowel, likely representing diffuse peritoneal metastases. A few bilateral enlarged external iliac lymph nodes. Enlarged liver (18 cm) with two well-defined, rounded focal lesions measuring 12 x 10 mm and 7 x 7 mm in segment 8 and 4A respectively, suspicious of hepatic metastases. No ascites.

Case Discussion

Laboratory investigations: CA 125=144 (≤35U/ml), CA 19.9=6 (≤37U/ml), CA 15-3=5.8 (≤31.3U/ml), CEA=2.1 (≤5ng/ml).

Following imaging and laboratory workup, the patient underwent surgery (total abdominal hysterectomy with bilateral salpingo-oophorectomy, peritoneal, omental and small intestine resection). 

Histopathology

Diagnosis: Primary tumor site: left ovary, ovarian surface involvement. Histologic type:  low-grade serous cystadenocarcinoma (psammocarcinoma). Extent of involvement of other tissues/organs: tumor involves both ovaries, both fallopian tubes, bilateral parametrial tissue, omentum, peritoneum and serosa of the small intestine. Pathologic staging (pTNM): pT3b, pNx, FIGO STAGE IIIB.

Additional pathologic findings: Mucinous cystadenofibroma of the right ovary (11 cm in greatest dimension). Atrophic endometrium.

Specimen integrity: intact right ovarian capsule and fragmented left ovary.

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