The diagnostic challenge of ovarian carcinoma in normal-sized ovaries: a report of two cases
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Soon Leong Yong
,
Safilah Dahian
Abstract
Normal-sized ovarian carcinoma syndrome (NOCS) is a rare condition characterised by malignancy identified in ovaries of normal size with abdominal metastasis. We report two cases of advanced ovarian carcinoma with ovaries of normal size. The first case was a 13-year-old adolescent with malignant ascites and bilateral normal sized multicystic ovaries detected on ultrasound. Serum cancer antigen 125 (CA 125) and lactate dehydrogenase were markedly raised. A computed tomography (CT) scan showed the presence of thick omental cake but no ovarian tumour. An ultrasound-guided biopsy of the omental cake was undertaken. A histopathological examination and immunohistochemical studies of omentum caking confirmed a diagnosis of high-grade serous carcinoma of ovarian in origin. Despite neoadjuvant chemotherapy, she deteriorated rapidly with acute renal failure and respiratory distress. She succumbed to her disease 10 weeks after diagnosis. The second case, a 69-year-old postmenopausal female presented with malignant ascites and ultrasound evaluation showed hydrometra and bilateral atrophic ovaries. CA 125 was significantly raised. A laparoscopic biopsy of the left ovary and endometrial sampling were performed. A diagnosis of synchronous primary high grade papillary serous ovarian cystadenocarcinoma and endometrial adenocarcinoma were revealed. Relapse occurred despite ongoing adjuvant chemotherapy. We concluded that a preoperative definitive diagnosis of NOCS is difficult. Strong clinical suspicion is needed when all the important causes of malignant ascites are excluded. Radiological-guided biopsy and laparoscopic biopsy are useful to achieve the diagnosis of NOCS.
Acknowledgements
The authors would like to thank the Director General of Health Malaysia for permission to publish this paper. The authors are also grateful to Dr. Zhong Wei Ong for his valuable contribution in preparation of the case images.
Author Statement
Research funding: Authors state no funding involved.
Conflict of interest: Authors state no conflict of interest.
Informed consent: Informed consent has been obtained from all individuals.
Ethical approval: This case report had been registered to National Medical Research Register (under Ministry of Health Malaysia) and Institutional Review Board (IRB) approval was obtained. The Research Identification Number given was NMRR-17-1524-37172.
Submission declaration: This case report was presented at the 25th Congress of the Obstetrical and Gynaecological Society of Malaysia, in Kuala Lumpur, Malaysia on 28 July 2017.
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©2018 Walter de Gruyter GmbH, Berlin/Boston
Articles in the same Issue
- Obituary
- Kjell Carlström (1940–2018)
- Original Articles
- Dehydroepiandrosterone and/or its metabolites: possible androgen receptor antagonistic effects on digitized mammographic breast density in normal breast tissue of postmenopausal women
- The influence of thyroid disorders on bone density and biochemical markers of bone metabolism
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- Opinion Paper
- Endometrial injury for patients with endometriosis and polycystic ovary syndrome undergoing medically assisted reproduction: current data and a protocol
- Case Report
- The diagnostic challenge of ovarian carcinoma in normal-sized ovaries: a report of two cases
Articles in the same Issue
- Obituary
- Kjell Carlström (1940–2018)
- Original Articles
- Dehydroepiandrosterone and/or its metabolites: possible androgen receptor antagonistic effects on digitized mammographic breast density in normal breast tissue of postmenopausal women
- The influence of thyroid disorders on bone density and biochemical markers of bone metabolism
- Evaluation in the predictive value of serum human epididymal protein 4 (HE4), cancer antigen 125 (CA 125) and a combination of both in detecting ovarian malignancy
- Opinion Paper
- Endometrial injury for patients with endometriosis and polycystic ovary syndrome undergoing medically assisted reproduction: current data and a protocol
- Case Report
- The diagnostic challenge of ovarian carcinoma in normal-sized ovaries: a report of two cases
