Presentation
History of partial right nephrectomy at 2016, for follow up.
Patient Data
FU study after 1 mth after partial Rt nephrectomy 3-2017
Clear surgical bed. Normal features of the right renal scar. No evidence of residual or recurrent masses. Apart from tiny renal simple cortical cysts bilaterally.
fundal interstitial fibroid with calcifications noted.
Pelvic bilateral parauterine solid masses with punctate coarse calcifications (which at this study were reported as subserous fibroids).
Rounded soft tissue lesion is noted at the anterior perirectal fat abutting anterior wall of the rectum (missed to be reported at this study).
2nd FU 1-2019 before hysterosalpingectomy
Progressive size of the bilateral adnexal parauterine masses, suspicious for bilateral ovarian malignancy.
Progressive size of the rounded soft tissue lesion at the anterior preirectal fat.
Stationary satisfactory follow up of partial right nephrectomy.
Minimal pelvic ascites.
Bilateral fatty canal of Nuck hernias.
Pathology report
Gross:
- S.T.A.H with B.S.O showing bilateral hemorrhagic ovarian cysts largest 14 x 13 cm, circumscribed and encapsulated. On section, endophytic solid and cystic papillary growth
- the uterus is 10 x 9 cm showing hypertrophic endometrium and multiple fibroids, largest 8 cm
- aspirated ascitic fluid turbid yellow
Microscopic:
- bilateral ovarian malignant serous cystic tumor consisting of endophytic growth, formed of tubal epithelium, overlying fibrovascular cores
- in patrs, there are fine branching papillae, showing pseudostratification of surface epithelium and mitosis. Large one shows capsular infiltration with microvascular permeations
- uterus shows multiple leiomyomata with endometrial cystic glandular hyperplasia
- omentum shows focal metastatic deposits
- the ascitic fluid shows clusters of malignant cells
Conclusion:
S.T.A.H with B.S.O + omentectomy + ascitic fluid Biopsy:
- bilateral ovarian serous cystadenocarcinoma G.2. with omental deposits and malignant ascites
- uterus endometrial cystic glandular hyperplasia with multiple cellular leiomyomata
Multiple mesenteric mass lesions are noted (omental metastases), seen at:
- under the right lateral abdominal wall, averaging 7 x 7 x 7 cm with heterogeneous enhancement and necrotic core. An adjacent anterior smaller omental nodule is noted averaging 1.5 x 1.8 cm
- at right iliac fossa, averaging 7.2 x 7.5 x 7.1 cm in dimensions with adjacent few other omental masses, largest averaging 3 x 2.5 cm
- at left lumbar region measuring 1.3 x 1.2 cm
- at the pelvis averaging 3.7 x 2.8 cm
- just lateral to right nephrectomy renal scar averaging 2 x 1.6 cm
- adjacent to mid-ascending colon averaging 1.8 x 1 cm
An enhancing subcutaneous nodule is noted at the surgical scar just above the level of umbilicus measuring 1.2 x 0.7 cm, mostly surgical scar implantation metastasis.
Minimal pelvic ascites.
Average size of the cervical stump. No masses noted.
IVC filter is noted.
Case Discussion
This case shows bilateral ovarian malignancy that was missed before under the effect of a follow up of another malignancy postoperatively. It was pathologically proved to be ovarian serous cystadenocarcinomas. They can occur bilaterally, most commonly appear as bilateral ovarian solid masses. Calcifications may occur in minority of cases.