Residency Program - Case of the Month

Clinical history:

The patient is a 64 year-old female with a past medical history of cervical cancer s/p vaginal hysterectomy, hemorrhagic cyst s/p right oopherectomy, hypertension, and recurrent pulmonary emboli. She presented with abdominal pain for two weeks. Computed tomography (CT) showed a multi-cystic pelvic mass.  An exploratory laparatomy was performed revealing a 12 cm tense cystic mass in the pelvis that was adherent to the left pelvic side wall and vaginal cuff. A left salpingo-oopherectomy was performed. Intraoperative frozen section of the mass revealed suspicion for an ovarian malignancy, thus staging (bladder peritoneum, left pelvic side wall biopsy, cul-de-sac biopsy, left pelvic sidewall lymph node and left periaortic lymph node) and an appendectomy were completed.

Gross description:

Left fallopian tube and ovary: Received fresh was a 454 gram multiloculated cystic ovary (13.2 x 13.4 x 3.8 cm) with a fimbriated fallopian tube (3.9 x 0.4 x 0.3 cm) segment attached to the outer surface. Cut surfaces of the cystic structure reveal a cyst wall 1.5 cm in maximum thickness. The cystic lining contains pink-purple excrescences partially covered with tan-brown soft material.

Appendix: Received fresh was a vermiform appendix (3.7 cm long x 1.0 cm diameter) with a bent tip. The cut surface of the tip was glistening yellow. The serosa was pink and hyperemic.

Microscopic images (Ovary):

Figure 1: Ovary	Figure 2: Ovary	Figure 3: Ovary

Microscopic images (Appendix):

Fig. 4: Appendix	Fig. 5: Appendix	Fig. 6: Appendix	Fig. 7: Appendix
Fig. 8: Appendix	Fig. 9: Appendix	Fig. 10: Appendix	Fig. 11: Appendix, Chromagranin
Fig. 12: Appendix, CEA	Fig. 13: Appendix, CK-20	Fig. 14: Appendix, MUC-2

Immunohistochemistry workup

ANSWER