The patient was initially referred from the gynecological department for the investigation of an incidental cystic-solid left abdominal mass seen on perinatal ultrasonography, for which she had the MRI shown here.

PATHOLOGY

Source of sample: colon - biopsy.
Microscopic description: fragments of colonic mucosa with adenocarcinoma.

Source of sample: left ovary.
Macroscopic description: mass weighing 304 g, measuring 11x10x7 cm. On sections - brown, pliable, cystic tissue with solid areas and thrombi.
Microscopic description - diagnosis: sections show moderately differentiated mucin-producing adenocarcinoma that stained positive for CDX-2 and SATB2 and negative for PAX-8, with extensive areas of necrosis.

Source of sample: left adnexa.
Macroscopic description: piece of brown, pliable tissue measuring 4x3x3 cm.
Microscopic description: sections from the ovary show one focus of adenocarcinoma with mucus production, m/p metastatic. The fallopian tube is without significant pathological changes.

Source of sample: omentum.
Macroscopic description: segment of omentum measuring 18x8x1.5 cm, edematous, without masses.
Microscopic description: fragment of omental tissue showing foci of adenocarcinoma.

The patient had a follow-up MRI that showed that the right ovarian cyst had grown and developed a multilocular appearance similar to that in the left ovary. Histopathology proved it to be metastatic adenocarcinoma as well.