1Romeo P, et al. Int J Gynecol Cancer 2020;0:1–2. doi:10.1136/ijgc-2020-001473

Ultrasound, macroscopic and histological features of serous epithelial ovarian carcinomas

Paola Romeo, Damiano Arciuolo, Maria Cristina Moruzzi, Francesca Moro

Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy

Correspondence toDr Francesca Moro, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy; morofrancy@ gmail. com

Accepted 30 April 2020

To cite: Romeo P, Arciuolo D, Moruzzi MC, et al. Int J Gynecol Cancer Published Online First: [please include Day Month Year]. doi:10.1136/ijgc-2020-001473

Educational video lecture

© IGCS and ESGO 2020. No commercial re- use. See rights and permissions. Published by BMJ.

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INTERNATIONAL JOURNAL OF

GYNECOLOGICAL CANCER

Video 1

AbstrACtWe present a video showing two cases of serous epithelial ovarian carcinomas. The first video shows clinical, ultrasound, macroscopic, and histological features of a patient with high grade serous ovarian carcinoma. The second video presents clinical, ultrasound, macroscopic, and histological features of a patient with low grade serous ovarian carcinoma.

sUmmAry

The objective of Video 1 is to present two cases of serous epithelial ovarian carcinomas, examined at the Gynecologic Oncology Unit of the Fondazione Poli-clinico Universitario Agostino Gemelli, IRCCS, Rome, Italy.

The first case is a 51- year- old patient with a family history of breast cancer (mother), referred to our center for bilateral adnexal masses detected during ultrasound examination performed in another hospital for pelvic pain. Serum levels of oncolog-ical markers were: CA125 423.6 U/mL (0–35 U/mL), CA19.9 8 U/mL (0–37 U/mL), and CA15.3 15 U/mL (0–32.5 U/mL). Both transabdominal and trans-vaginal ultrasound examinations were performed at our center. Transvaginal ultrasound examination showed a right multilocular solid tumor measuring 56×55×50 mm, with anechoic cystic content, a left solid tumor 42×27×34 mm in size, with internal cystic areas and an external irregular wall, and pelvic carci-nomatosis. Both ovarian masses showed moderate

Maria Cristina Moruzzi1Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy

biography: Dott.ssa Maria Cristina Moruzzi is a gynecologist of Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, in Rome. She is particularly involved in clinical research in ovarian cancer and ultrasound.

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2 Romeo P, et al. Int J Gynecol Cancer 2020;0:1–2. doi:10.1136/ijgc-2020-001473

Educational video lecture

Figure 1 Ultrasound and surgical images of a 51- year- old patient with high grade serous ovarian carcinoma. During both ultrasound examination and laparoscopy it was possible to observe omental cake (A, B), the right ovarian mass (C, D), and the left ovarian mass (E, F).

vascularization at color Doppler examination. At transabdominal ultrasound examination, ascites, omental cake, and abdominal carcinomatosis were described (Figure  1). We applied the IOTA ADNEX model1 on the solid mass—the left ovarian lesion. IOTA ADNEX showed an increased risk of malignancy, with the highest relative risk for stage II–IV ovarian cancer (link to the IOTA ADNEX model calculator: https://www. iotagroup. org/ sites/ default/ files/ adnexmodel/ IOTA- ADNEXmodel. html). Moreover, the tumor was classified as O- RADS 5.2

At laparoscopy, ultrasound findings were confirmed. An intraop-erative frozen section of the right ovarian mass was positive for high grade serous ovarian carcinoma. A debulking surgery was performed with residual tumor 0. The macroscopic assessment of the ovarian masses confirmed bilateral solid cystic tumors.3 The final histology report was positive for high grade serous ovarian carcinoma.4 The patient underwent six cycles of adjuvant pacli-taxel/carboplatin chemotherapy.

The second case is a 20- year- old patient with no family history of cancer, referred to our center for adnexal masses detected during ultrasound examination performed at another hospital for amenorrhea and pelvic pain. Serum levels of oncological markers were: CA125 291 U/mL (0–35 U/mL), CA19.9 14 U/mL (0–37 U/mL), CA15.3 20 U/mL (0–32.5 U/mL), and carcinoembryonic antigen (CEA) 0.5 U/mL (0–5 ng/mL). Transvaginal ultrasound examination was performed at our center and it showed a right solid tumor 66×42×65 mm in size with exophytic tissue on the surface, heter-ogenous echostructure, irregular external walls, hyperechoic foci, multiple papillary projections, and shadowing. These are typical features of low grade serous ovarian carcinoma, as previously

described in the literature.5 The left adnexum presented a left multi-locular solid tumor 62×56×78 mm in size, with low- level cystic content, and multiple papillary projections. At color Doppler exam-ination, the right mass showed moderate vascularization, whereas the left one showed minimal vascularization. We applied the IOTA ADNEX model1 on the solid mass—the right ovarian lesion. IOTA ADNEX showed an increased risk of malignancy, with the highest relative risk for stage II–IV ovarian cancer (link to the IOTA ADNEX model calculator: https://www. iotagroup. org/ sites/ default/ files/ adnexmodel/ IOTA- ADNEXmodel. html). Moreover, the tumor was classified as O- RADS 5.2

Laparoscopy confirmed bilateral ovarian masses and multiple peritoneal nodules. A right salpingo- oophorectomy, peritoneal biopsies, and peritoneal washing were performed. The macro-scopic assessment of the right mass confirmed a solid tumor with exophytic tissue.3 The final histology report of the right adnexum confirmed a right low- grade serous ovarian carcinoma with micro-invasive foci.4 Peritoneal washing was positive for atypical cells and peritoneal biopsies were negative for atypia. Then, a second operation with debulking surgery was performed and the residual tumor was 0. The final histology report was positive for low grade serous ovarian carcinoma FIGO (International Federation of Gyne-cology and Obstetrics) stage IIIC, so the patient underwent six cycles of adjuvant paclitaxel/carboplatin chemotherapy, after which the possibility of maintenance hormonal therapy was discussed.

Contributors All the authors contributed in collecting clinical, ultrasound, macroscopic and histological materials and in the production of the video.

Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not- for- profit sectors.

Competing interests None declared.

Patient consent for publication Not required.

Provenance and peer review Not commissioned; externally peer reviewed.

OrCID iDFrancesca Moro http:// orcid. org/ 0000- 0002- 5070- 7245

reFerenCes 1 Van Calster B, Van Hoorde K, Valentin L, et al. Evaluating the risk of

ovarian cancer before surgery using the ADNEX model to differentiate between benign, borderline, early and advanced stage invasive, and secondary metastatic tumours: prospective multicentre diagnostic study. BMJ 2014;349:g5920.

2 Andreotti RF, Timmerman D, Strachowski LM, et al. O- RADS US risk stratification and management system: a consensus guideline from the ACR Ovarian- Adnexal Reporting and Data System Committee. Radiology 2020;294:168–85.

3 Longacre TA, Wells M. Serous tumors. In: Kurman RJ, Carcangiu ML, Herrington CS, et al, eds. WHO classification of tumours of female reproductive organs. Lyon, France: IARC Press, 2014: 15–24.

4 Vang R, Shih I- M, Kurman RJ. Ovarian low- grade and high- grade serous carcinoma: pathogenesis, clinicopathologic and molecular biologic features, and diagnostic problems. Adv Anat Pathol 2009;16:267–82.

5 Moro F, Baima Poma C, Zannoni GF, et al. Imaging in gynecological disease (12): clinical and ultrasound features of invasive and non- invasive malignant serous ovarian tumors. Ultrasound Obstet Gynecol 2017;50:788–99.

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