Metastatic endometrioid adenocarcinoma of the ovary

Case contributed by Dr Alexandra Stanislavsky


Abdominal mass.

Patient Data

Age: 65 years
Gender: Female

There is a large cystic-solid multiloculated 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 sagittal T2 image highlighting multiple malignant features of this complex tumor, including solid components (thick arrows) and papillary projections (arrowheads) in a cystic mass. Ascites and peritoneal nodules are present (thin arrows) representing peritoneal metastatic involvement.  Note also hemorrhagic locule within the mass with a fluid-fluid level (asterisk)

Annotated DWI image shows the utility of this sequence in highlighting the malignant components within the tumor (asterisk), direct extracapsular extension (thick arrow), peritoneal nodules (thin arrow) and distant metastasis - in this case, within the umbilicus (arrowhead).

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
Published: 17th May 2014
Last edited: 28th Jul 2020
Inclusion in quiz mode: Included