Presentation
Abdominal mass.
Patient Data
There is a large cystic-solid multiloculated right adnexal mass which measured 19 x 11.5 x 15.6 cm (SI x AP x ML). It has multiple internal septations some of which are thick and irregular with papillary projections, as well as several enhancing and diffusion restricted solid mural components.
There is extension of at least two solid components through the wall of the mass to produce polypoid growths on its external surface. There are also multiple nodular metastatic deposits
Annotated sagittal T2 image highlighting multiple malignant features of this complex tumor, including solid components (thick arrows) and papillary projections (arrowheads) in a cystic mass. Ascites and peritoneal nodules are present (thin arrows) representing peritoneal metastatic involvement. Note also hemorrhagic locule within the mass with a fluid-fluid level (asterisk)
Annotated DWI image shows the utility of this sequence in highlighting the malignant components within the tumor (asterisk), direct extracapsular extension (thick arrow), peritoneal nodules (thin arrow) and distant metastasis - in this case, within the umbilicus (arrowhead).
Case Discussion
This is a high grade, stage IV ovarian cystadenocarcinoma with local and distant metastases (including metastasis to the umbilicus - "Sister Mary Joseph nodule".
Note the utility of DWI in highlighting the extent of tumoral, peritoneal and metastatic disease.
Final histology: endometrioid adenocarcinoma
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