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Ultrasound, macroscopic and histological features of serous epithelial ovarian carcinomas
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  1. Paola Romeo,
  2. Damiano Arciuolo,
  3. Maria Cristina Moruzzi

    Dott.ssa Maria Cristina Moruzzi is a gynecologist of Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, in Rome. She is particularly involved in clinical research in ovarian cancer and ultrasound.


    and
  4. Francesca Moro
  1. Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
  1. Correspondence to Dr Francesca Moro, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy; morofrancy{at}gmail.com

Abstract

We present a video showing two cases of serous epithelial ovarian carcinomas. The first video shows clinical, ultrasound, macroscopic, and histological features of a patient with high grade serous ovarian carcinoma. The second video presents clinical, ultrasound, macroscopic, and histological features of a patient with low grade serous ovarian carcinoma.

  • ovarian neoplasms
  • pathology
  • gynecology
  • ovarian cancer
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Summary

The objective of this video 1 is to present two cases of serous epithelial ovarian carcinomas, examined at the Gynecologic Oncology Unit of the Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy.

Video 1.

The first case is a 51-year-old patient with a family history of breast cancer (mother), referred to our center for bilateral adnexal masses detected during ultrasound examination performed in another hospital for pelvic pain. Serum levels of oncological markers were: CA125 423.6 U/mL (0–35 U/mL), CA19.9 8 U/mL (0–37 U/mL), and CA15.3 15 U/mL (0–32.5 U/mL). Both transabdominal and transvaginal ultrasound examinations were performed at our center. Transvaginal ultrasound examination showed a right multilocular solid tumor measuring 56×55×50 mm, with anechoic cystic content, a left solid tumor 42×27×34 mm in size, with internal cystic areas and an external irregular wall, and pelvic carcinomatosis. Both ovarian masses showed moderate vascularization at color Doppler examination. At transabdominal ultrasound examination, ascites, omental cake, and abdominal carcinomatosis were described (Figure 1). We applied the IOTA ADNEX model1 on the solid mass—the left ovarian lesion. IOTA ADNEX showed an increased risk of malignancy, with the highest relative risk for stage II–IV ovarian cancer (link to the IOTA ADNEX model calculator: https://www.iotagroup.org/sites/default/files/adnexmodel/IOTA-ADNEXmodel.html). Moreover, the tumor was classified as O-RADS 5.2

Figure 1

Ultrasound and surgical images of a 51-year-old patient with high grade serous ovarian carcinoma. During both ultrasound examination and laparoscopy it was possible to observe omental cake (A, B), the right ovarian mass (C, D), and the left ovarian mass (E, F).

At laparoscopy, ultrasound findings were confirmed. An intraoperative frozen section of the right ovarian mass was positive for high grade serous ovarian carcinoma. A debulking surgery was performed with residual tumor 0. The macroscopic assessment of the ovarian masses confirmed bilateral solid cystic tumors.3 The final histology report was positive for high grade serous ovarian carcinoma.4 The patient underwent six cycles of adjuvant paclitaxel/carboplatin chemotherapy.

The second case is a 20-year-old patient with no family history of cancer, referred to our center for adnexal masses detected during ultrasound examination performed at another hospital for amenorrhea and pelvic pain. Serum levels of oncological markers were: CA125 291 U/mL (0–35 U/mL), CA19.9 14 U/mL (0–37 U/mL), CA15.3 20 U/mL (0–32.5 U/mL), and carcinoembryonic antigen (CEA) 0.5 U/mL (0–5 ng/mL). Transvaginal ultrasound examination was performed at our center and it showed a right solid tumor 66×42×65 mm in size with exophytic tissue on the surface, heterogenous echostructure, irregular external walls, hyperechoic foci, multiple papillary projections, and shadowing. These are typical features of low grade serous ovarian carcinoma, as previously described in the literature.5 The left adnexum presented a left multilocular solid tumor 62×56×78 mm in size, with low-level cystic content, and multiple papillary projections. At color Doppler examination, the right mass showed moderate vascularization, whereas the left one showed minimal vascularization. We applied the IOTA ADNEX model1 on the solid mass—the right ovarian lesion. IOTA ADNEX showed an increased risk of malignancy, with the highest relative risk for stage II–IV ovarian cancer (link to the IOTA ADNEX model calculator: https://www.iotagroup.org/sites/default/files/adnexmodel/IOTA-ADNEXmodel.html). Moreover, the tumor was classified as O-RADS 5.2

Laparoscopy confirmed bilateral ovarian masses and multiple peritoneal nodules. A right salpingo-oophorectomy, peritoneal biopsies, and peritoneal washing were performed. The macroscopic assessment of the right mass confirmed a solid tumor with exophytic tissue.3 The final histology report of the right adnexum confirmed a right low-grade serous ovarian carcinoma with microinvasive foci.4 Peritoneal washing was positive for atypical cells and peritoneal biopsies were negative for atypia. Then, a second operation with debulking surgery was performed and the residual tumor was 0. The final histology report was positive for low grade serous ovarian carcinoma FIGO (International Federation of Gynecology and Obstetrics) stage IIIC, so the patient underwent six cycles of adjuvant paclitaxel/carboplatin chemotherapy, after which the possibility of maintenance hormonal therapy was discussed.

Dott.ssa Maria Cristina Moruzzi is a gynecologist of Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, in Rome. She is particularly involved in clinical research in ovarian cancer and ultrasound.


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Footnotes

  • Contributors All the authors contributed in collecting clinical, ultrasound, macroscopic and histological materials and in the production of the video.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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