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Adenocarcinoma of the Ovary

Ovary Adenocarcinoma


Presentation

  • AIM: To illustrate unusual patterns of isolated supradiaphragmatic presentation and relapse of papillary serous adenocarcinoma of the ovary.[ncbi.nlm.nih.gov]
  • Fifty percent of clear cell patients presented in Stage I versus 31% of serous patients.[ncbi.nlm.nih.gov]
  • Foci of high-grade squamous neoplastic proliferation, inflammation, and a paratubal cyst were also present on the pathology specimen.[ncbi.nlm.nih.gov]
  • CASE: A 51-year-old woman, with complete remission after optimal maximal debulking and chemotherapy for an International Federation of Gynecology and Obstetrics IIIc primary ovarian carcinoma, presented with nausea, vomiting, vertigo and headache 18 months[ncbi.nlm.nih.gov]
  • Endometriosis was mixed with the tumors or was present adjacent to the tumor. The endometriosis was composed of a layer of atypical epithelium (atypical endometriosis), and gradual merges between endometriosis and carcinoma were present in 3 cases.[ncbi.nlm.nih.gov]
Weight Loss
  • Advanced ovarian cancer often results in blockage of the intestines, causing severe nausea, vomiting, pain and weight loss. DIAGNOSIS Physical Examination A careful pelvic exam is performed with attention to the ovaries, uterus, bladder and rectum.[womenscancercenter.com]
Pleural Effusion
  • In advanced stages, the size and growth of the tumor can lead to: Abdominal pain and ascites Cancer cachexia Possible disruption of menstrual cycle Dyspnea due to malignant pleural effusion Abdominal or pelvic mass Complication: tumor can cause ovarian[amboss.com]
  • The cancer cells spread to the surface of the lungs and chest cavity, resulting in a collection of fluid around the lungs known as a pleural effusion. Ovarian cancer may also spread to the pelvic, aortic, groin and neck lymph nodes.[womenscancercenter.com]
Pelvic Mass
  • CT scan of the abdomen and pelvis revealed bilateral pelvic masses. A laparotomy revealed a papillary serous adenocarcinoma of ovarian primary and an infarcted spleen with capsular tumor metastases.[ncbi.nlm.nih.gov]
  • Patients with clear cell carcinoma presented more often with pelvic masses (84% vs 65%) and had larger (diameter greater than 10 cm) primary tumors (73% vs 29%).[ncbi.nlm.nih.gov]
  • CASE: A 39-year-old gravida 3 para 2 woman was diagnosed in October 2000 with a large pelvic mass. She underwent an exploratory laparotomy and a left salpingo-oophorectomy with multiple abdominal and pelvic biopsies.[ncbi.nlm.nih.gov]
  • In advanced stages, the size and growth of the tumor can lead to: Abdominal pain and ascites Cancer cachexia Possible disruption of menstrual cycle Dyspnea due to malignant pleural effusion Abdominal or pelvic mass Complication: tumor can cause ovarian[amboss.com]
  • The most common signs and symptoms of HCO are abdominal distension, abdominal pain and pelvic mass.[spandidos-publications.com]
Abdominal Pain
  • CASE: The patient, a 64-year-old, nulliparous postmenopausal Greek woman presented with a complaint of abdominal pain and abnormal uterine bleeding.[ncbi.nlm.nih.gov]
  • The most common signs and symptoms of HCO are abdominal distension, abdominal pain and pelvic mass.[spandidos-publications.com]
  • In these cases symptoms may include: Abdominal pain Trouble urinating or frequent urination Low back pain Pain with sexual intercourse Bad cramps with a woman’s periods Feeling full quickly after eating, or no appetite Nausea or vomiting.[cancer.coloradowomenshealth.com]
  • pain or swelling Elevated levels of the protein CA-125 According to the Ovarian Cancer National Alliance, most patients diagnosed with ovarian cancer develop a recurrence.[cancercenter.com]
  • In advanced stages, the size and growth of the tumor can lead to: Abdominal pain and ascites Cancer cachexia Possible disruption of menstrual cycle Dyspnea due to malignant pleural effusion Abdominal or pelvic mass Complication: tumor can cause ovarian[amboss.com]
Increased Abdominal Girth
  • abdominal girth over the past month.[medbullets.com]
  • abdominal girth (clothes no longer fit at the waist)![amboss.com]
  • abdominal girth Lethargy, fatigue or lack of energy Abdominal pain or swelling Elevated levels of the protein CA-125 According to the Ovarian Cancer National Alliance, most patients diagnosed with ovarian cancer develop a recurrence.[cancercenter.com]
  • Here, we report a case of a 55‑year‑old female who presented to the Second Xiangya Hospital, Changsha, China, with lower abdominal pain, abdominal distention and increasing abdominal girth.[spandidos-publications.com]
Abdominal Mass
  • Presenting symptoms are usually related to an enlarging abdominal mass. Clear cell carcinoma is the most common epithelial ovarian neoplasm to be associated with paraneoplastic hypercalcemia, and rarely hypercalcemia may be a presenting symptom.[path.upmc.edu]
  • Endoscopy and Biopsy A definitive diagnosis requires microscopic examination of part or all of the involved ovary or any other suspicious abdominal mass.[womenscancercenter.com]
Abdominal Distension
Amenorrhea
  • ., a low voice, facial hair); precocious puberty, early sexual maturity; amenorrhea, absence/stopping of the menstrual period; or postmenopausal bleeding. Publication Review By: Stanley J. Swierzewski, III, M.D.[healthcommunities.com]
Irregular Menstruation
Adnexal Mass
  • About 6–7% of all adnexal masses found during physical examination are actually metastatic ovarian tumors, frequently unsuspected by gynecologists. 2 – 4 The metastasis often masquerades as a primary ovarian tumor and may even be the initial manifestation[clinicalgate.com]

Workup

  • Despite a previous negative cancer workup, a transvaginal ultrasound scan, performed for antral follicle count as part of the initial ovarian reserve assessment, revealed a synchronous ovarian adenocarcinoma.[ncbi.nlm.nih.gov]
Ovarian Mass
  • CT scan of the pelvis showed a left-sided ovarian mass later diagnosed as serous adenocarcinoma of the ovary. She underwent surgery and histology of the mass showed poorly-differentiated serous adenocarcinoma.[ncbi.nlm.nih.gov]
  • The initial assessment demonstrates that the patient has a right-sided hydrothorax, ascites, and a large ovarian mass. Surgery is performed to remove the ovarian mass, and the patient's ascites and pleural effusion resolve promptly.[medbullets.com]
  • mass, she will be treated by the Division of Gynecology at Boston Children's Hospital.[childrenshospital.org]
  • In a few cases, the ovarian mass is the presenting feature.[e-immunohistochemistry.info]
  • Consistent with previous studies, POMCs appear to develop from benign and borderline POMTs, which tend to be the largest ovarian masses overall and usually involve only one ovary; MOMCs are often much smaller and bilateral.[jcp.bmj.com]
Pleural Effusion
  • In advanced stages, the size and growth of the tumor can lead to: Abdominal pain and ascites Cancer cachexia Possible disruption of menstrual cycle Dyspnea due to malignant pleural effusion Abdominal or pelvic mass Complication: tumor can cause ovarian[amboss.com]
  • The cancer cells spread to the surface of the lungs and chest cavity, resulting in a collection of fluid around the lungs known as a pleural effusion. Ovarian cancer may also spread to the pelvic, aortic, groin and neck lymph nodes.[womenscancercenter.com]

Treatment

  • Maytansine thus appears inactive in the treatment of adenocarcinoma of the ovary at the dose and schedule tested.[ncbi.nlm.nih.gov]
  • METHODS: Two hundred twenty-five patients were diagnosed with mucinous adenocarcinoma at individual institutes and underwent primary treatment between 1998 and 2003.[ncbi.nlm.nih.gov]
  • Abstract Cis-dichlorodiammineplatinum(II) was used in the treatment of 34 patients with advanced adenocarcinoma of the ovary who were resistant to conventional chemotherapy.[ncbi.nlm.nih.gov]
  • Thus, radiotherapy may be effective for treatment of clear cell adenocarcinoma of the ovary. Copyright 2002 S. Karger AG, Basel[ncbi.nlm.nih.gov]
  • Treatment The type of treatment depends on the stage of the disease. First-line treatment is surgical management, followed by chemotherapy then radiotherapy. Surgical management Surgical management is done by open surgery.[myvmc.com]

Prognosis

  • CONCLUSIONS: Univariate analysis suggests that metastatic disease to the appendix and failure to perform complete staging including appendectomy are related to a worsened prognosis.[ncbi.nlm.nih.gov]
  • CONCLUSIONS: Adenosine triphosphate-binding cassette superfamily F2 protein was highly expressed in CCC of the ovary, but expression was not related to age, clinical stage, chemoresponse, or prognosis.[ncbi.nlm.nih.gov]
  • In contrast, patients with mucinous invasive adenocarcinoma receiving suboptimal operation showed a significantly worse prognosis (survival rate: 27.8% vs. 61.5%).[ncbi.nlm.nih.gov]
  • INTRODUCTION: Advanced clear cell adenocarcinoma of the ovary is a histologic type with an extremely poor prognosis. No reports have been published concerning useful drugs for salvage chemotherapy for this type of cancer.[ncbi.nlm.nih.gov]
  • The lesions arising from endometriomas tended to be the cystic type on MRI and have a good prognosis. Preexisting endometrioma in this entity rarely showed "shading" on T2-weighted images.[ncbi.nlm.nih.gov]

Etiology

  • The etiology and pathogenesis of this phenomenon remains unclear. The authors' aim was to present a case of synchronous squamous cell carcinoma of the endometrium and endometrioid adenocarcinoma of the ovary and review current literature.[ncbi.nlm.nih.gov]
  • Etiology Risk factors Genetic predisposition BRCA1 / BRCA2 mutation HNPCC syndrome Peutz-Jeghers syndrome Hormonal imbalance and menstrual cycle Elevated number of lifetime ovulations (the contraceptive pill appears to have a protective effect) Infertility[amboss.com]

Epidemiology

  • References: [1] [2] [3] Epidemiological data refers to the US, unless otherwise specified.[amboss.com]
  • *SEER Surveillance, Epidemiology, and End Results[cancer.org]
  • Epidemiology About 7% of all ovarian tumours are metastatic, predominantly from the gastrointestinal tract. Conversely, about 3.4% of women with colorectal carcinoma develop ovarian metastases 2.[e-immunohistochemistry.info]
  • Ovarian preservation in young patients with stage I cervical adenocarcinoma: a surveillance, epidemiology, and end results study. International Journal of Gynecological Cancer. 24(8):1513-20, 2014 Oct. Abstract .[rcog.org.uk]
  • Below is the relative five-year survival rate for epithelial ovarian cancer: Below is the relative five-year survival rate for ovarian stromal tumors: Below is the relative five-year survival rate for ovarian germ cell tumors: The Surveillance, Epidemiology[healthline.com]
Sex distribution
Age distribution

Prevention

  • CONCLUSION: In an atypical presentation in patients with metastatic ovarian carcinoma, thorough investigations should be done to rule out or confirm brain metastasis, which can be aggressively managed to prevent serious consequences and improve outcome[ncbi.nlm.nih.gov]
  • Strategies for ovarian cancer prevention. Obstet Gynecol Clin North Am. 2007;34(4):667-86. [ Abstract ] Salehi F, Dunfield L, Phillips KP, et al. Risk factors for ovarian cancer: An overview with emphasis on hormonal factors.[myvmc.com]
  • Preventive Services Task Force Reaffirmation Recommendation Statement. USPSTF [On-line information].Available online at October 2012.[labtestsonline.it]
  • […] removal of pelvic and para-aortic lymph nodes and omentum Chemotherapy combination of platinum (i.e. carboplatin) and non-platinum (i.e. paclitaxel) regimen Radiation reserved for palliation or localized persistent disease after chemotherapy Prognosis, Prevention[medbullets.com]

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