case_images: PMC11324275_01
case_images: a Magnetic resonance imaging showed a 17-cm multilocular cyst on the right side of the gravid uterus (yellow arrows). b CT suggested that the primary tumor was located in the right ovary (red arrowheads). c Intraoperative appearance of the tumor at 30 weeks of gestation. The right ovarian tumor occupied the abdominal cavity from the umbilicus to the subhepatic region.
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case_images: F1
case_images: Magnetic resonance imaging showed that the multilocular cyst was 17 cm in diameter and exhibited diffusion restriction, with a mixture of low and high signal areas on T2-weighted imaging; thus, right ovarian cancer was suspected (Fig. 1a). Computed tomography (CT) showed no lymph node enlargement or distant metastasis, and there were no findings suggestive of a primary site other than the right ovary (Fig. 1b). The patient underwent laparotomy to remove the right adnexa at 30 weeks 6 days of gestation under a preoperative diagnosis of primary ovarian cancer (Fig. 1c).
case_images: Immunohistochemical studies of the ovarian tumor. a Hematoxylin-eosin showed atypical columnar cells with a high nuclear-cytoplasmic ratio proliferating in a papillary or lumen-forming pattern (x100). b Cytokeratin-7 was partially positive (x100). c Cytokeratin-20 was positive (x100). d Estrogen receptor was negative (x100).
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case_images: Pathologically, atypical columnar epithelial cells proliferating in a papillary or ductal pattern were observed in the ovary, and immunostaining was partially positive for cytokeratin-7, positive for cytokeratin-20, and negative for estrogen receptor (Fig. 2a-d).
case_images: Macroscopic appearance of tumor. a The small bowel tumor with intestinal stenosis was located 20 cm anorectally from the ligament of Treitz (blue arrow). b Specimen with partial resection of the small bowel (green arrowhead).
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case_images: F3
case_images: Treitz. The small bowel was partially resected by gastrointestinal surgeons (Fig. 3a, b).
case_images: Immunohistochemical studies of the small bowel. a Small bowel carcinoma with a change in differentiation from the mucosal side of the jejunum to the deeper part was observed (hematoxylin-eosin. x20). b Highly columnar tumor cells were growing in a tubular pattern (hematoxylin-eosin. x200). c Cytokeratin-7 was partially positive (x200). d Cytokeratin-20 was positive (x200). e Estrogen receptor was negative (x200).
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case_images: F4
case_images: The lesion was morphologically and immunohistochemically similar to the ovarian tumor (Fig. 4a-e), and the margin was negative.