Endoscopic ultrasound-guided fine needle aspiration of ovarian mass and omental deposits

Abstract

Background:In spite of the modest size of the ovaries, they are frequently the site of many physiological and pathological lesions. Ovarian fine needle aspiration cytology (FNAC) can help in differentiation of ovarian lesions. It is usually performed under ultrasonography or computed tomography (CT) guidance. We report a case of endoscopic ultrasound (EUS)-guided FNAC of ovarian mass from the rectum.Case Report:A 65-year-old hypertensive woman with a history of bypass surgery presented with abdominal distension for 1 month and weight loss. CT (abdomen) revealed gastric wall thickening, omental thickening, ascites, and left adnexal mass measuring 4.5 cm × 5 cm. Carcinoembryonic antigen and cancer antigen 125 were elevated. Gastroscopy was normal. Being a poor surgical candidate, EUS was planned to define the primary diagnosis. EUS from stomach revealed hyperechoic omental deposits whose FNAC was performed with a 22-gauge needle. EUS performed from upper rectum revealed hypoechoic ovarian mass. FNAC was performed with the 22-gauge needle. Ovarian and omental FNAC (H and E stain) revealed scattered atypical epithelial cells. Immunohistochemistry confirmed the diagnosis of primary mucinous ovarian cancer. The patient underwent neoadjuvant chemotherapy.Discussion:We present a novel technique of EUS-guided FNAC of ovarian mass from rectum. After reviewing the literature, this appears to be the first case where EUS-guided FNAC was utilized from rectum for diagnosis of ovarian massConclusions:This case demonstrates the potential use of EUS in ovarian lesions. Adequate samples for immunohistochemistry are possible with EUS-FNA. Imaging is better because of proximity to ovary and use of high frequency probes. Further studies are required to explore the use of EUS in adnexal masses.