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case_images: Abdominal ultrasound scan showed there was a huge mass in the pelvic and abdominal cavity. (A) The ultrasound showed a huge cystic mass in the pelvic and abdominal cavity (Arrow); (B) A few blood flow signals were found around the mass (Arrow).
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case_images: Ultrasonographic tomography and magnetic resonance imaging (MRI) demonstrated a monolocular cyst measuring 25 cm in diameter in the abdominal cavity (Figures 1 and 2).
case_images: Pelvic MRI enhancement scan of the huge mass in the sagittal plane and axial plane. (A) MRI of the mass with increased signal on T2W in the axial plane. (B) MRI of the mass with decreased signal on T1W in the axial plane. (C) MRI of the mass with increased signal on T2W in the sagittal plane.
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case_images: Ultrasonographic tomography and magnetic resonance imaging (MRI) demonstrated a monolocular cyst measuring 25 cm in diameter in the abdominal cavity (Figures 1 and 2).
case_images: Pathological and immunohistochemical findings of this case. (A) Microscopic finding (hematoxylin-eosin [HE] staining): Junction area of clear cell carcinoma and large cell neuroendocrine carcinoma (original magnification, x10). (B) Area of clear cell carcinoma (original magnification, x20). (C) Area of large cell neuroendocrine carcinoma, poorly-differentiated large cells (original magnification, x20). (D-F) Immunohistochemical studies of this case for representative neuroendocrine markers: CD56 (D: x20), chromogranin A (E: x20) and synaptophysin (F: x20). Immunohistochemical test also found CK and CK20 were positive (G and Hx10).
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case_images: On pathological examination, the right attachment contained ovarian clear cell carcinoma (approximately 10%) and poorly differentiated carcinoma (consistent with large cell neuroendocrine carcinoma, accounting for approximately 90%) (Figure 3A-C). The neuroendocrine component proved positive for CD56, chromogranin, and synaptophysin (Figure 3D-F). Besides, the tumor cells were also intensely positive for CK and CK7 (Figure 3G and H), while immunostaining for ER and PR was negative.
case_images: Lumbar MRI enhancement scan showed destruction of L3 vertebra. (A) Destruction of L3 vertebra caused by tumor invasion with decreased signal on T1W in the sagittal plane (Arrow). (B) Destruction of L3 vertebra caused by tumor invasion with increased signal on T2W in the sagittal plane (Arrow).
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case_images: Meanwhile, the third lumbar spine vertebrae (L3 vertebra) showed osteolytic bone destruction, FDG metabolism is abnormally increased, considering metastasis, which was further proved by lumbar MRI (Figure 4).
case_images: Timeline of the process of diagnosis and treatments of this case.
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case_images: The timeline of the process of diagnosis and treatment for this case is shown in Figure 5.