Macroscopic diagnosis of an ovarian adenocarcinoma with peritoneal metastasis and intestinal obstruction

Image Description

We present the case of a 41-years-old female who presented to the emergency room with diffuse abdominal pain, bloating and vomiting. After the clinical and paraclinical investigations, we concluded to the diagnosis of intestinal obstruction due to an abdominal tumor of inconclusive etiology and decided for emergency surgery. Intraoperatively, we identified multiple peritoneal tumors located both in the supramesocolic and inframesocolic abdominal compartments; the diaphragm was covered with nodules that ranged in diameter from 1 cm to 10 cm (Fig. 1-2). Extemporaneous investigations confirmed the diagnosis of ovarian epithelial adenocarcinoma. The tumors were structured as solid or cystic masses with irregular surfaces that bled easily at manipulation. In the case of peritoneal metastasis in ovarian adenocarcinoma, the peritoneum has the same embryologic origin as the ovary; therefore, tumors at this level can develop as primary tumors. In these cases, optimal cytoreduction must be obtained (residual tumors below 1cm). Macroscopic observations can be used to suspect an ovarian adenocarcinoma but extemporaneous investigations are mandatory to confirm this diagnosis.