A “student” case of ovarian tumor

Capros H., MD, PhD,

Department of Obstetrics
and gynecology,
State Medical University of Moldova Malignant ovarian cancer by Gretchen
Andrew, 1988
Addressed by GP for ultrasonography: assessment of a
subumbilical mass.

Interrogatory.
81 year old female patient
A constant sense of abdominal fullness for about 2 month
Abdominopelvic cramping
Fatigue
Patient history:
Hypertension
Hypercholesterolemia
Claustrophobia
GP3 ( A1D3)

Postmenopausal bleeding en septembre 2020.

Speculum examination: cervical polyp.
Ultrasound - endometrial thickness of 17mm.
Normal for intermediate menopause PAP smear.
Hysteroscopic report : Hysterometry at 13 cm.
Large and soft uterus. Florid endometrium on the
superior plane of the cavity.

Pathology report ( 2020):

Endometrial curettage - glandulocystic polypoid

hyperplasia of the endometrium without atypia ( a
dozen biopsy fragments measuring 0.2 to 1.3 cm)

Cervical polyp without signs of malignancy ( 3

fragments from 1.2 to 1.6 cm.
Ultrasonography 2022

Transabdominal and transvaginal

ultrasound examination showed a
left unilocular solid tumor 146×120
×53 mm, with anechoic content and
papillary projections. The largest
papillary projection was 87×46 mm
with intensive vascularization.
Ultrasonography

Enlarged uterus ( 86× 52× 61)

with endometrial thickness of
9.7mm.
Serum level of oncological markers:

CA 125 : 11351. 0 ( < 35 U/ml)

CA 19.9 : 9460 ( < 27 U/ml)
CA 15.3 : 77 ( < 32 U/ml)
CAE : 8.47 ( 0.15-3.80 ng/ml)
Alfa- fetoprotein : 9.4 ( 0.6-2.6 Ui/ml)
HE 4 : 4110
ROMA : 99
Imaging results
Normal appearance of the
liver, the lung bases without
suspicious nodules. Absence
of pleural effusion, pericardial
effusion.
A mixed fluid and solid
abdomino - pelvic mass,
probably developed at the
expense of the left ovary, the
abdominal and pelvic seat.
It contains a septate solid
portion that measures
approximately 109 mm in
cross-sectional diameter and
a hypervascularized non-
calcified solid portion.
Note the presence of primitive
iliac adennomegaly, internal
iliac, right external iliac of 13
mm, left external iliac,
obturator. Multiple bilateral
inguinal lymph nodes.
The uterus is anteverted,
anteflexed 101 mm in height,
the endometrium is visible
and measures 8 mm. Blade of
ascites visible between the
mass and the uterine fundus.
Intraoperative findings:
mass envirom 20 mm of long axis
of suspicious appearance, of mixed
tissue and lichide nature
Waiting for pathology…

Another workup for postmenopausal

bleeding????

1. Clayton NL, Jaaback KS, Hirschowitz L. Primary fallopian tube carcinoma - the experience of a UK cancer centre a
nd a review of the literature. J Obstet Gynaecol 2005; 25:694.
2. Hippisley-Cox J, Coupland C. Identifying women with suspected ovarian cancer in primary care: derivation and vali
dation of algorithm. BMJ 2011; 344:d8009.
3. Hamilton W, Peters TJ, Bankhead C, Sharp D. Risk of ovarian cancer in women with symptoms in primary care: po
pulation based case-control study. BMJ 2009; 339:b2998.
Thank You.