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A Wolf in Sheep’s Clothing: High-Grade Ovarian Endometrioid Carcinoma Masquerading as Pregnancy

Authors:
Talal Almas at Royal College of Surgeons in Ireland
Talal Almas
Muneeb Ullah at MAROOF International Hospital
Muneeb Ullah
Maryam Ehtesham at Royal College of Surgeons in Ireland
Maryam Ehtesham
Abdul Haadi Sohl at Royal College of Surgeons in Ireland
Abdul Haadi Sohl
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Abstract and Figures

Ovarian carcinomas remain a cause of soaring mortality in the general population. Due to their anatomical location in the pelvis, malignant ovarian transformations often evade early detection, reaching astronomical proportions before eliciting clinically obvious symptoms. Epithelial ovarian carcinomas encompass a concoction of tumours derived from the ovarian surface epithelium, and are further subdivided into several subtypes ascertained primarily through histopathological workup. Of these subtypes, endometrioid ovarian carcinoma is noted to be a particularly well-differentiated tumour that often presents early in the disease course. Contrarily, advanced-stage tumours manifest a vague constellation of symptoms, such as abdominal distension and bloating, resulting in dilatory tumour detection. We hereby delineate an interesting case of a high-grade ovarian endometrioid carcinoma that, due to its vague presenting symptoms and a concomitant history of amenorrhea, was erroneously regarded as pregnancy. Subsequent diagnostic workup divulged a bilateral endometrioid ovarian carcinoma with associated serosal involvement and extensive lymph-vascular invasion.
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A Wolf in Sheep’s Clothing: High-Grade Ovarian Endometrioid Carcinoma Masquerading as Pregnan
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
 



 





  


  
 
 


   

  
 
  

  


  

  


  

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Long-term mortality among women with epithelial ovarian cancer: A population-based study in British Columbia, Canada
Article
Full-text available
  • Oct 2018
  • BMC CANCER
Objectives Among women with epithelial ovarian cancer (EOC), histotype is one of the major prognostic factors. However, few data are available on histotype- specific survival and mortality estimates among these patients. We therefore examined survival and causes of death among women with EOC by histotype. Methods A population- based cohort including all ovarian cancer patients diagnosed in British Columbia (BC) between 1990 and 2014 was built using population-based administrative datasets. We compared causes of death within histotypes, by age at diagnosis, BRCA status, and time since diagnosis. Results A total of 6975 women were identified as having been diagnosed with EOC between 1990 and 2014 in BC. The most common cause of death among these women was ovarian cancer until 10 years post diagnosis when other causes surpassed ovarian cancer as the leading cause of death. Among women with serous EOCs, ovarian cancer was the leading cause of death 12 years after diagnosis, whereas ovarian cancer was the leading cause of death for 8 years among women with non- serous EOCs. Among women with serous EOCs, ovarian cancer was the leading cause of death for 12 years among younger women (< 60 years of age) compared to 8 years among women > = 60 years of age, and those with BRCA mutations were more likely to die from ovarian cancer than those without a BRCA mutation. Conclusions Within 10 years from diagnosis, ovarian cancer is the leading cause of death among women diagnosed with EOC. Electronic supplementary material The online version of this article (10.1186/s12885-018-4970-9) contains supplementary material, which is available to authorized users.
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Apparent ectopic pregnancy with unexpected finding of a germ cell tumor: A case report
Article
Full-text available
  • May 2017
Highlights • Ovarian germ cell tumors can produce hCG and be confused with ectopic pregnancy. • Ovarian germ cell tumors can present with subacute pelvic pain. • Ectopic pregnancy should be the primary differential diagnosis due to its acuity.
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A Systematic Review of Symptoms for the Diagnosis of Ovarian Cancer
Article
Full-text available
  • Nov 2015
Context: Ovarian cancer is common and has significant morbidity and mortality, partly because it is often diagnosed at a late stage. This study sought to determine the accuracy of individual symptoms and combinations of symptoms for the diagnosis of ovarian cancer. Evidence acquisition: MEDLINE was searched, identifying 2,492 abstracts, reviewing 71 articles in full, and ultimately identifying 17 studies published between 2001 and 2014 that met the inclusion criteria. Data were abstracted by two researchers, and quality was assessed using the QUADAS-2 criteria adapted to the study question. Bivariate random effects meta-analysis was used where possible, and heterogeneity and threshold effects were explored using receiver operating characteristic curves. Data were analyzed in 2015. Evidence synthesis: Most studies were at high risk of bias, primarily because of case-control design or differential verification bias. The highest positive likelihood ratios (LRs+) were found for presence of abdominal mass (LR+, 30.0); abdominal distension or increased girth (LR+, 16.0); abdominal or pelvic pain (LR+, 10.4); abdominal or pelvic bloating (LR+, 9.3); loss of appetite (LR+, 9.2); and a family history of ovarian cancer (LR+, 7.5). No symptoms were helpful at ruling out ovarian cancer when absent. The Ovarian Cancer Symptom Index was validated in five studies and (after excluding one outlier with different inclusion criteria) was 63% sensitive and 95% specific (LR+, 12.6; LR-, 0.39). Two other symptom scores had not been validated prospectively. Conclusions: Several individual signs and symptoms significantly increase the likelihood of ovarian cancer when present. More work is needed to validate decision rules and develop new decision support tools integrating risk factors, symptoms, and possibly biomarkers to identify women at increased ovarian cancer risk.
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Global Cancer Statistics 2018: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries: Global Cancer Statistics 2018
Article
This article provides a status report on the global burden of cancer worldwide using the GLOBOCAN 2018 estimates of cancer incidence and mortality produced by the International Agency for Research on Cancer, with a focus on geographic variability across 20 world regions. There will be an estimated 18.1 million new cancer cases (17.0 million excluding nonmelanoma skin cancer) and 9.6 million cancer deaths (9.5 million excluding nonmelanoma skin cancer) in 2018. In both sexes combined, lung cancer is the most commonly diagnosed cancer (11.6% of the total cases) and the leading cause of cancer death (18.4% of the total cancer deaths), closely followed by female breast cancer (11.6%), prostate cancer (7.1%), and colorectal cancer (6.1%) for incidence and colorectal cancer (9.2%), stomach cancer (8.2%), and liver cancer (8.2%) for mortality. Lung cancer is the most frequent cancer and the leading cause of cancer death among males, followed by prostate and colorectal cancer (for incidence) and liver and stomach cancer (for mortality). Among females, breast cancer is the most commonly diagnosed cancer and the leading cause of cancer death, followed by colorectal and lung cancer (for incidence), and vice versa (for mortality); cervical cancer ranks fourth for both incidence and mortality. The most frequently diagnosed cancer and the leading cause of cancer death, however, substantially vary across countries and within each country depending on the degree of economic development and associated social and life style factors. It is noteworthy that high‐quality cancer registry data, the basis for planning and implementing evidence‐based cancer control programs, are not available in most low‐ and middle‐income countries. The Global Initiative for Cancer Registry Development is an international partnership that supports better estimation, as well as the collection and use of local data, to prioritize and evaluate national cancer control efforts. CA: A Cancer Journal for Clinicians 2018;0:1‐31. © 2018 American Cancer Society
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Epidemiology of epithelial ovarian cancer
Article
  • Oct 2016
Globally, ovarian cancer is the seventh most common cancer in women and the eighth most common cause of cancer death, with five-year survival rates below 45%. Although age-standardised rates are stable or falling in most high-income countries, they are rising in many low and middle income countries. Furthermore, with increasing life-expectancy, the number of cases diagnosed each year is increasing. To control ovarian cancer we need to understand the causes. This will allow better prediction of those at greatest risk for whom screening might be appropriate, while identification of potentially modifable causes provides an opportunity for intervention to reduce rates. In this paper we will summarise the current state of knowledge regarding the known and possible causes of epithelial ovarian cancer and discuss some of the main theories of ovarian carcinogenesis. We will also briefly review the relationship between lifestyle and survival after a diagnosis of ovarian cancer.
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Endometriosis Mimicking an Advanced Malignant Tumor
Article
  • May 2016
A 27-year-old woman with swelling left leg, groin pain, and increased serum CA125 level underwent FDG PET/CT to evaluate a pelvic mass revealed by an MRI performed from an outside hospital. A large hypermetabolic solid mass in the left pelvic wall and several lymph nodes with elevated FDG activity were noted, which indicated malignancy. However, histopathological examination demonstrated endometriosis.
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Ovarian cancer: Epidemiology and risk factors
Article
  • Jan 2016
The present overview of ovarian cancer epidemiology summarizes the main results for a network of case-control studies in Italy and from the Collaborative Group on Epidemiological Studies of Ovarian Cancer. There are consistent inverse relations between parity, oral contraceptive use and the risk of ovarian cancer. For other menstrual and hormonal factors (i.e. early age at menarche and late menopause), there are established associations, but of limited impact on ovarian cancer incidence on a population level. Serous and endometrioid ovarian cancers (but not mucinous or clear cell types) are related to current and recent use of hormone replacement therapy in menopause. There are no strong associations with alcohol and tobacco overall, but a direct link for tobacco with (borderline) mucinous cancers, of limited impact, however, on overall ovarian cancer mortality. There are direct associations of ovarian cancer risk with height and BMI, as well as possible relations with selected dietary factors - in the absence, however, of consistent findings - and a possible inverse association with physical activity. There is a strong association with a family history of ovarian cancer (and a few selected other neoplasms, including colorectum and endometrium). Recognized risk factors explain only a limited proportion of ovarian cancer cases on a population level. A key reason for the recent favourable trends of ovarian cancer incidence and mortality in several high-income countries is the widespread use of oral contraceptive in the generations born after 1930.
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Cancer Incidence and Mortality Worldwide: sources, methods and major patterns in GLOBOCAN 2012
Article
Estimates of the worldwide incidence and mortality from 27 major cancers and for all cancers combined for 2012 are now available in the GLOBOCAN series of the International Agency for Research on Cancer. We review the sources and methods used in compiling the national cancer incidence and mortality estimates, and briefly describe the key results by cancer site and in 20 large “areas” of the world. Overall, there were 14.1 million new cases and 8.2 million deaths in 2012. The most commonly diagnosed cancers were lung (1.82 million), breast (1.67 million), and colorectal (1.36 million); the most common causes of cancer death were lung cancer (1.6 million deaths), liver cancer (745,000 deaths), and stomach cancer (723,000 deaths). © 2014 Wiley Periodicals, Inc.
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Early de novo ovarian carcinoma. A study of fourteen cases
Article
Background: The search for methods of early detection of ovarian carcinoma in recent years has emphasized the lack of information regarding the histologic features of early carcinoma or its precursor lesions; few examples of early de novo ovarian carcinoma have been reported. Methods: The clinicopathologic features of 14 cases of early ovarian carcinoma detected as microscopic findings in grossly normal ovaries retrieved from a consultation practice and the files of the Massachusetts General Hospital were reviewed. Results: The patients ranged in age from 27-65 years (mean, 50 years). Three women had a family history of ovarian carcinoma and six did not. The tumors ranged from microscopic to 7 mm in greatest dimension; all were unilateral and four were multifocal. One tumor involved the surface and its crypts; four, the surface and superficial cortex; eight, the superficial cortex only; and in one, surface involvement was not ascertainable. Ten carcinomas were serous; one, endometrioid; one, clear cell; and two, poorly differentiated, of undetermined cell type. Severe atypia of the noncarcinomatous surface epithelium or its inclusion cysts was additionally present in three cases. Among the seven patients whose diagnoses were made at the time of oophorectomy who had follow-up data of at least 2 years or until recurrence or death, five were alive without recurrences, one was alive with recurrence, and one died of tumor. Two of the three women died whose ovarian tumors were diagnosed retrospectively on discovery of subsequent peritoneal carcinomatosis, and the third was alive with recurrent tumor. No relation between any clinical or pathologic feature and survival was apparent in this small series except for a suggestion that well differentiated tumors had a good prognosis. Conclusions: These findings document that at least a subset of ovarian epithelial cancers develops de novo. The guarded prognosis associated with these tumors despite their minute dimensions raises questions about the value of current screening techniques for early detection of ovarian cancer.
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