Metastatic endometrioid adenocarcinoma of the ovary

Case contributed by Dr Alexandra Stanislavsky

Presentation

Abdominal mass.

Patient Data

Age: 65
Gender: Female

There is a large, complex cystic right adnexal mass which measured 19 x 11.5 x 15.6 cm (SI x AP x ML). It has multiple internal septations some of which are thick and irregular with papillary projections, as well as several enhancing and diffusion restricted solid mural components.  

There is extension of at least two solid components through the wall of the mass to produce polypoid growths on its external surface.  There are also multiple nodular metastatic deposits
within the anterior omental fat.  Small volume ascites in the right fossa, with several further small
peritoneal nodules.

The uterus is surgically absent.  Normal left ovary at the left posterolateral aspect of the mass and separate from it.  No normal right ovarian tissue identified.

There is a small umbilical fat containing hernia with adjacent enhancing and diffusion restricted material within the umbilicus in keeping with an umbilical metastasis.

No enlarged pelvic or para-aortic lymph nodes.  The upper abdominal MRI sequences are not included, however there were no further metastases in the upper abdomen.
 

Annotated images:

Case Discussion

This is a high grade, stage IV ovarian cystadenocarcinoma with local and distant metastases (including metastasis to the umbilicus - "Sister Mary Joseph nodule".  

Note the utility of DWI in highlighting the extent of tumoral, peritoneal and metastatic disease.

Final histology: endometrioid adenocarcinoma

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Case information

rID: 29104
Case created: 4th May 2014
Last edited: 21st Sep 2015
System: Gynaecology
Inclusion in quiz mode: Included

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