Epithelial ovarian cancers account for over 85% of ovarian malignancies and the majority of these are diagnosed in advanced stages. The less frequent diagnosis of early stage malignancies is often the result of ultrasonographic findings. Long term follow up to elucidate the natural history of adnexal masses that, by ultrasound guidelines are benign, is an approach for asymptomatic patients who choose follow up rather than surgical removal. We present a rare case involving a catalogue of images depicting the gradual development of a serous adenocarcinoma.METHODS:
A 59 year old woman presented to gynecologic oncology for evaluation. She had initially been evaluated in 2010 by her primary gynecologist for postmenopausal bleeding, with negative endometrial biopsies. An ultrasound was performed, demonstrating a simple cyst. She was followed with serial ultrasounds and tumor markers every six months. The patient opted for conservative management, and during the fifth year of imaging, septations and solid components gradually appeared. The patient was referred to gynecologic oncology when CA-125 became elevated as well. She underwent a robotic hysterectomy, bilateral salpingo-oophorectomy, and staging procedure. Pathology revealed a high grade serous adenocarcinoma arising in a borderline serous tumor, involving the surface of both ovaries without evidence of metastases to lymph nodes. Postoperative course was uncomplicated.CONCLUSION:
In this case, serial ultrasonographic images provide a rare opportunity to visually observe the gradual progression of an ovarian cystadenocarcinoma from a benign-appearing simple cyst to a multi-loculated complex cyst.