Presentation
Off and on abdominal pain for 2 years, getting worse over the last two weeks.
Patient Data
A large complex cystic lesion measuring about 13 x 18 x 19 cm is noted in the lower central abdomen extending into the pelvis. Multiple septations and a soft tissue component measuring 5.5 x 6.2 cm are seen in it. A well-defined cystic lesion measuring 3.8 x 6.9 cm is seen in the left adnexa. No septations or soft tissue component is seen in it. No significant vascularity is seen in both lesions on color Doppler ultrasound examination.
A well defined, sizable, complex lesion having both solid and cystic components measuring 13 x 17 x 19 cm, is seen in the midline pelvis, likely arising from the right ovary. The lesion shows punctate calcifications and multiple enhancing septations as well as enhancing solid component. The lesion is displacing the uterus posteriorly, indenting the urinary bladder dome, is in close contact with small bowel loops and mildly compressing the right pelvic ureter. A well-defined cystic lesion measuring about 4.5 x 5.5 x 6.5 cm is seen in the left adnexa. A mural calcification is seen in it. No septations, soft tissue component or any enhancement is seen in it. No ascites, lymphadenopathy or pneumoperitoneum is seen. Mild right hydroureteronephrosis secondary to the mass effect over the right pelvic ureter. Mild left hydronephrosis with abrupt transition at pelviureteric junction, suggestive of partial pelviureteric junction obstruction. Morphology of the remaining abdominal viscera is unremarkable.
Histopathology report (gross,microscopy and immunohistochemical staining) and different tumor markers.
Case Discussion
Bilateral ovarian lesions; the lesion seen on the right side is larger and have complex features whereas the the lesion seen on the left side is smaller and appears benign.
Ovarian epithelial tumors can be benign, borderline, or malignant tumors. Borderline tumors (BTs) are a distinct pathologic entity, representing an intermediate phase between the benign and malignant tumors and are characterized by nuclear atypia and increased epithelial proliferation but no frank stromal invasion 1,2. BTs account for 10–20% of all ovarian neoplasms and have six histologic subtypes: serous, mucinous, seromucinous, endometrioid, clear cell, and Brenner 1,2. Serous or mucinous subtypes together account for > 90% of these neoplasms 1. BTs are commonly seen in younger females (reproductive age), in contrast to the ovarian malignancies, which are most commonly seen in the postmenopausal women 1. Seromucinous BTs are an uncommon subtype of borderline tumors. Their clinical and imaging features are quite similar to those of serous BTs, such as papillary morphology, frequent bilaterality (20–40%), and peritoneal implants (20%) 1,2. They are also frequently associated with endometriosis 1,2.
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