Endometrioid adenocarcinoma

Case contributed by Dr Morlie L Wang

Presentation

Right-sided abdominal pain. On exam, the patient had acute abdomen and mass palpated (26-week size).

Patient Data

Age: 30 years
Gender: Female
CT

A large pelvi-abdominal complex mass lesion is seen with enhancing soft tissue components and septations. It is inclined to right side with prominent feeding vessels from right adnexa that show partial twist. Mild free ascites.

Case Discussion

Final "expert" pathology of right adnexal mass: endometrioid adenocarcinoma of the ovary, grade I, resembling Sertoli-stromal tumor.  The carcinoma arises in the background of a borderline endometrioid cystadenofibroma. The capsule is free of involvement by carcinoma. The fallopian tube had no specific pathological change.

Note: Originally, it was felt that this tumor represented a Sertoli-Leydig tumor, intermediate type with an endometrioid component. This was favored over a pure endometrioid carcinoma due to the young age of the patient. However, due to the prominence of an endometrioid component and uncertainty regarding the clinical significance of this finding the case was sent for expert of opinion.

Expert opinion: endometrioid adenocarcinoma resembling Sertoli-stromal cell tumor with well-moderate differentiation. No unequivocal invasion.

Gross description: A portion of the surface of the ovary has a dusty appearance. The rest of the external surface is pinkish to purplish tan and smooth. Sections reveal a largely solid surface with multiple cysts. The largest cyst measures 8 cm and is filled with a large amount of blood clots. Other cysts are filled with hemorrhagic fluid.  A second large cyst also about 8 cm at the opposite pole from the hemorrhagic cyst contains necrotic material. Many of the cysts have a nodular inner lining with foci of papillary projections. 

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