case_images: PMC11068450_01
case_images: MRI findings. (a) MRI shows a 50 mm multicystic tumor with an internal nodule 15 mm in diameter in the right ovary. The fluid on the dorsal side of the tumor indicates high intensity (white arrow), and the nodule with multiple cysts shows low intensity (yellow arrow) in T2-weighted image. (b) The fluid on the dorsal side of the tumor indicates high intensity in T1-weighted image (blue arrow). (c) DWI shows partially reduced diffusion of the nodule (orange arrow). (d) Contrast-enhanced imaging shows heterogeneously enhanced contrast of the tumor (purple arrow). (e) The nodule in the right round ligament in T2-weighted image (green arrow). (f) Swollen lymph nodes of the pelvis in contrast-enhanced T1-weighted imaging (coronal plane, red arrow). MRI: magnetic resonance imaging; DWI: diffusion-weighted image.
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case_images: PMC11068450_01_CRIOG2024-8851045.001.jpg
case_images: fig1
case_images: T1-weighted image and low intensity on T2-weighted image, suggesting that the fluid was bloody content (Figures 1(a) and 1(b)). The nodule with multiple cysts showed low intensity on T2-weighted image, reduced diffusion, and heterogeneously enhanced contrast (Figures 1(a), 1(c), and 1(d)). Additionally, MRI revealed the nodule in the right round ligament and swollen lymph nodes of the pelvis (Figures 1(e) and 1(f)).
case_images: PET-CT findings. (a) PET/CT shows moderate FDG accumulation in the nodule of the right ovarian tumor (white arrow). (b) No significant FDG accumulation can be observed in mammary glands (yellow arrows). (c) Abnormal FDG accumulation can be observed in the lymph nodes of the supraclavicular, mediastinum, hilar, para-aorta, and pelvic regions (blue arrows). PET/CT: positron emission tomography/computed tomography; FDG: F-18 fluorodeoxyglucose.
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case_images: PMC11068450_01_CRIOG2024-8851045.002.jpg
case_images: fig2
case_images: Positron emission tomography (PET)/computed tomography (CT) showed moderate F-18 fluorodeoxyglucose (FDG) accumulation in the nodule of the right ovarian tumor (SUV max: 1.79) (Figure 2(a)); abnormal accumulation in multiple lymph nodes, including the mediastinum, hilar, para-aorta, pelvic, and supraclavicular regions (SUV max: 6.96); and multiple bone metastasis including vertebrae (cervical to lumbar), ilium, and pubis. No notable accumulation was observed in either mammary gland (Figures 2(b) and 2(c)).
case_images: Operative findings. (a) 50 mm cystic tumor in the right ovary (white arrow). (b) 10 mm nodules in the right round ligament (yellow arrow). (c) Enlarged lymph nodes can be observed at the cranial side of the right common iliac artery bifurcation (blue arrow).
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case_images: PMC11068450_01_CRIOG2024-8851045.003.jpg
case_images: fig3
case_images: Surgical findings revealed a 50 mm cystic tumor in the right ovary (Figure 3(a)), 10 mm nodules in the right round ligament (Figure 3(b)) and mesentery of the small intestine, and swollen lymph nodes of the para-aorta and right common iliac artery (Figure 3(c)).
case_images: Resected specimens and histopathological findings. (a) Right adnexa (white arrow), left adnexa (yellow arrow), and the nodule of the right round ligament (blue arrow) were resected laparoscopically. (b, c) Histopathological examination shows that the ovarian tumor is a seromucinous borderline tumor. Papillary structure with serous, endocervical-type mucinous, and ciliated cells with mild nuclear atypia was found in the nodule of the cyst. (d) Adenocarcinoma tissues can be observed in the right round ligament and mesenteric nodules. Adenocarcinoma tissues are (e) GATA3 positive, (f) CK7 positive, (g) CK20 negative, (h) ER negative, and (i) PgR weakly positive. GATA3: GATA-binding protein; CK: cytokeratin; ER: estrogen receptor; PgR: progesterone receptor.
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case_images: PMC11068450_01_CRIOG2024-8851045.004.jpg
case_images: fig4
case_images: Bilateral salpingo-oophorectomy and right round ligament resection were performed (Figure 4(a)). Histopathological examination revealed a seromucinous borderline tumor in the right ovary (Figures 4(b) and 4(c)). Conversely, adenocarcinoma tissue was detected in the right round ligament (Figure 4(d)). TTF-1(-), and calretinin(-) (Figures 4(e)-4(g)). The estrogen receptor (ER) showed negative with total score (TS) 2, comprising proportion score (PS) 1 and intensity score (IS) 1 (Figure 4(h)). The progesterone receptor (PgR) showed weakly positive with TS of 5, comprising PS 4 and IS 1 (Figure 4(i)). The HER2 expression was scored 2+.
case_images: Histopathological findings of lymph node biopsy. (a) Adenocarcinoma tissues consistent with the tissues derived from the right round ligament and mesenteric nodules. Adenocarcinoma tissues were (b) GATA3 positive, (c) PAX-8 negative, and (d) ER-positive. GATA3: GATA-binding protein; ER: estrogen receptor.
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case_images: PMC11068450_01_CRIOG2024-8851045.005.jpg
case_images: fig5
case_images: Retroperitoneal lymph node biopsy specimens showed adenocarcinoma with an immunohistochemical pattern similar to that of breast cancer (Figures 5(a)-5(d)).