EP25.03: Ultrasound features of a jejunal adenocarcinoma with ovarian metastasis: a case report

Abstract

Electronic poster abstractsearly pregnancy, a left ovarian mass was incidentally detected at another department, which was considered to be a dermoid cyst. On admission we performed a pelvic ultrasound examination, which demonstrated a multicystic ovarian mass with low-impedance circulation, which structure was typical for ovarian cancer. Pelvic magnetic resonance imaging (MRI) showed a bizarre mass in the left ovary, whose morphology and structure raised the suspicion of malignancy.Supporting information can be found in the online version of this abstract EP25.03 Ultrasound features of a jejunal adenocarcinoma with ovarian metastasis: a case report B. Grandal, L. Blanch, N. Rams Obstetrics and Gynecology, Hospital de la Santa Creu i Sant Pau, Barcelona, SpainThere are difficulties in differentiating between primary and secondary ovarian cancer.The ovary is a common site of dissemination from malignant tumours; 5 to 20% of ovarian masses are metastases from primary tumours in other organs, most originated from the gastrointestinal tract or the breast. Ovarian metastases of jejunal adenocarcinoma are a rare phenomenon and information on them is very limited.A 39-year-old woman with unremarkable past medical history was consulted for abdominal pain and dyspareunia. The pelvic examination revealed an increase in size of both ovaries. The transvaginal ultrasound showed solid multilocular cysts with anechoic fluid in both ovaries, colour score of 3, measurements 59x65x119 mm and 82x44x73 mm respectively, and no ascites. Serum levels of Ca 125, HE-4, LDH and CEA were elevated. Computed tomography revealed solid-cystic tumours in the pelvis and some images suspicious for hepatic dissemination and peritoneal implants. A diagnostic laparotomy for presumed primary ovarian cancer revealed a tumour in the jejunum compatible with adenocarcinoma and metastases in the epiplon, peritoneum, ovaries and liver. Conclusion: We present a case of a metastatic ovarian tumour from a primary small bowel adenocarcinoma, which is extremely rare. Review of the literature reveals less than 10 reported cases. Preoperative differentiation of primary and metastatic ovarian tumours is difficult. Testa et al. reported sonographic morphology pertaining to the origin of the primary tumour. As jejunum tumours are hardly frequent, it is impossible to develop a pattern-recognition for jejunal-to-ovary adenocarcinoma metastases. The ultrasound characteristics of our case are similar to those described in the ovarian metastases deriving from the colon, rectum, appendix and biliary tract. Ultrasonography is often chosen as a first-line imaging modality to investigate patients presenting with pelvic complaints based on its demonstrated safety and effectiveness for decades. On occasion, findings may not align with traditional gynecologic etiologies and in these instances, rare conditions should be entertained as possible diagnoses. Adjunct imaging modalities may be necessary to investigate sonographic findings further. This case series highlights two rare...