Adnexal Mass with an Unknown Histology

Abstract

Background: Ovarian malignancy is a common malignancy in women. Most malignancies are adenocarcinoma. However, adnexal metastases from squamous cell carcinoma (SCC) of the cervix are uncommon. Case: We present a 53-year-old nulliparous postmenopausal woman who presented with pain in abdomen, adnexal mass, and high CA125 levels. On local examination, vagina and cervix were apparently healthy with retroverted uterus of normal size, and bilateral (B/L) forniceal thickening was present. Pouch of Douglas and rectal mucosa were free. Clinicoradiologic diagnosis was an ovarian malignancy. Results: Intraoperatively, ∼150 mL mucinous ascites and omental caking with subcentimeter deposits on right subhepatic peritoneum were noted. Uterus was apparently normal and B/L adnexal masses with stretched and dilated B/L tubes were seen, ovaries could not be visualized separately (right = 6 × 5 cm, left = 7 × 4 cm). B/L pelvic lymph nodes were grossly enlarged with pelvic peritoneal deposits. A total abdominal hysterectomy with B/L pelvic lymph node dissection with total omentectomy with excision of pelvic and subhepatic peritoneal deposits with appendicectomy was done and a Sugarbaker's completeness cytoreduction score 0 (CC-0) was achieved. Final histopathologic examination postsurgery revealed disseminated SCC of the cervix. Conclusions: Before confirming a diagnosis of primary SCC of the ovary, a consideration of possible origin from a cervical tumor should be made, unless overt features of primary neoplasia are immediately obvious.