Residency Program - Case of the Month

Clinical history:

The patient is a 39-year-old female with a 5-month history of persistent abdominal pain and cramping. A colonoscopy was performed and found no abnormalities. On pelvic exam, no masses were appreciated but an endometrial biopsy was positive for endometrial polyp, negative for malignancy. A subsequent dilation and curettage revealed multiple polypoid lesions that were subsequently diagnosed as endometrioid adenocarcinoma, FIGO Grade I, with superficial myometrial invasion. Approximately three weeks later an exploratory laparotomy and total abdominal hysterectomy with bilateral salpingoophorectomy was performed. As the exploratory laparotomy commenced, a complex left ovarian mass was identified, thus the left fallopian tube and ovary were sent for frozen section diagnosis. The uterus, right fallopian tube and ovary were later sent for frozen section analysis as well. Additional specimens were then obtained for staging purposes. Of note, the patient is status post right hemicolectomy for an ileocecal valve mass, diagnosed 9 years prior.

Gross description:

The left ovary measured 6.0 x 5.0 x 4.0 cm and, with the attached fallopian tube, weighed 59.0 grams. The outer surface of the ovary was somewhat lobular but smooth. Serial sectioning revealed a 5.0 cm intraparenchymal nodule with tan-yellow granular cut surfaces and areas of hemorrhage and necrosis.

The 112 gram uterus measured 9.5 cm from superior to inferior, 3.2 cm from cornu to cornu and 3.8 cm from anterior to posterior. The serosal surface was unremarkable with no areas of ulceration, induration or excrescences. The uterus was opened to reveal a fungating, slightly papillated mass predominantly involving the anterior endometrium with focal involvement of the right posterior fundus. The mass measured 2.5 cm in greatest surface dimension and did not grossly appear to involve the myometrium. The right tube and ovary were grossly normal.

Microscopic photographs:

Ovary
Uterus

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