Residency Program - Case of the Month

Clinical History:

An 83-year-old female G2P2 with a past medical history of hypertension, hyperlipidemia, hypothyroidism and enterococcus endocarditis in 2013 presented in February 2014 with mid-abdominal pains. She was primarily diagnosed with gallstones.  In March 2014, she returned to the hospital with abdominal pains. A CT scan showed a large cystic pelvic mass. This was confirmed with a pelvic ultrasound which showed a large cystic pelvic mass measuring 11.6 X 7.0 X 8.6 cm. The mass had cystic and septated components with no significant free fluid. She fell at home and this added to the abdominal pains. She had been experiencing weight loss and decreased appetite without nausea and vomiting.  She underwent exploratory laparotomy, total abdominal hysterectomy and bilateral salpingo-oopherectomy with omentectomy and para-aortic lymph node dissection.

Gross:

The right tube and ovary were received which showed a solid and cystic soft tissue mass (110 gram, 9.7 x 7.0 x 3.4 cm) with attached dilated tortuous fallopian tube segment  (8.2 cm in length x 1.7 cm in diameter).  The ovary measures 7.3 x 7.1 x 3.2 cm. The outer surface is smooth and pink-tan.  The cystic component is previously ruptured with a thin wall that measures <0.1 cm.  The solid portion of the mass is sectioned to reveal fleshy tan cut surfaces with focal areas of necrosis.  The fimbriated end is firm and the dilated lumen is filled with a brown serous fluid.

Immunohistochemistry:

Representative Sections of the Ovary:

Image 1		Image 2		Image 3
Image 4		Image 5

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