Ovarian borderline serous tumor with desmoplastic non-invasive implants
Presentation
3-month history of lower abdominal pain and bloating. CA-125: 314; other tumor markers normal.
Patient Data
Large volume ascites extending to the upper abdomen.
The right ovary is normal in size and appearance but is encased by a large solid lobulated mass with marked vascularity (IOTA color score 4). The mass measures 13 x 11 x 12 cm which encases the right ovary within the middle.
There was a normal appearance of the uterus and left ovary (not shown).
Case Discussion
Irregular solid 13 cm adnexal tumor with marked vascularity is highly suspicious for malignancy, and the elevated Ca 125 further supports this. Pattern of ovarian encasement suggests possible tubal origin.
Risk stratification:
IOTA simple rules: M1, M2 and M5 malignant features present (irregular solid, ascites and color score 4, respectively). No B features.
ADNEX: 96% chance of malignancy
O-RADS: Category 5 - highly suspicious - recommend referral to a gynae-oncologist.
Histology:
Right adnexal borderline serous tumor.
Non-invasive desmoplastic implants are present along the pelvic side wall, uterine and left tubal serosal surfaces and witihn an umbilical nodule.
No lymphovascular invasion.
Peritoneal washings consistent with neoplastic cells of gynecological tract origin.