Swanner Keana-Kelley D, Lanpher Nick W, Sehbai Aasim
College of Medicine, Alabama College of Osteopathic Medicine, Dothan, USA.
Hematology and Oncology, Alabama Cancer Care, Anniston, USA.
Cureus. 2023 Sep 2;15(9):e44564. doi: 10.7759/cureus.44564. eCollection 2023 Sep.
Ovarian carcinoma often doesn't show noticeable symptoms and is frequently diagnosed at an advanced stage. It is the most fatal cancer within the gynecologic system. Our understanding of ovarian pathology is limited, necessitating the use of multiple markers to accurately detect ovarian cancer, particularly when it presents abnormally, such as in pleural effusion or lymph nodes. A 45-year-old woman presented to the emergency room (ER) due to abdominal pain lasting for two weeks. A computed tomography (CT) scan revealed peritoneal carcinomatosis accompanied by ascites and calcification in the lymph nodes. The likely primary sources were determined to be mucinous adenocarcinomas from either the colon or ovary. Following the CT findings, a fine needle aspiration was conducted on a perigastric lymph node. Histopathology results indicated a "poorly differentiated carcinoma [with] malignant cells present." Subsequently, a PowerPort was inserted, and adjuvant chemotherapy commenced two days later, utilizing a combination of carboplatin, bevacizumab, and paclitaxel. Paracentesis was performed, yielding clear-yellow fluid. However, abdominal fullness gradually increased again after paracentesis. The patient began experiencing more intense abdominal pain, particularly in the left lower quadrant. Surgical exploration revealed widespread disease involvement throughout the intestines. Our patient exhibited an atypical manifestation of ovarian carcinoma, challenging its identification due to ectopic foci and the absence of many distinctly identifiable markers. Through comprehensive testing and a process of elimination, we successfully differentiated ovarian carcinoma from other potential cancers. The conclusive histopathological report, along with a markedly elevated CA-125 level, provided substantial support for the probable final diagnosis of ovarian carcinoma. Despite numerous advancements in staining and identification techniques, the diagnosis of ovarian carcinoma remains inadequately understood. Identifying ovarian carcinoma without clear visualization is often challenging, and further research is warranted to enhance our understanding of pathological methods. Moreover, there is a need to prioritize the development and exploration of ovarian carcinoma screening and testing methods to prevent delayed disease detection.
卵巢癌通常没有明显症状，常常在晚期才被诊断出来。它是妇科系统中最致命的癌症。我们对卵巢病理学的了解有限，因此需要使用多种标志物来准确检测卵巢癌，尤其是当它出现异常时，比如在胸腔积液或淋巴结中。一名45岁女性因持续两周的腹痛前往急诊室。计算机断层扫描（CT）显示腹膜癌病伴腹水和淋巴结钙化。可能的原发部位被确定为来自结肠或卵巢的黏液腺癌。根据CT检查结果，对胃周淋巴结进行了细针穿刺。组织病理学结果显示为“低分化癌[存在]恶性细胞”。随后插入了一个输液港，两天后开始辅助化疗，使用卡铂、贝伐单抗和紫杉醇联合用药。进行了腹腔穿刺，抽出清亮黄色液体。然而，腹腔穿刺后腹部胀满又逐渐加重。患者开始感到更剧烈的腹痛，尤其是左下腹。手术探查发现整个肠道都有广泛的病变。我们的患者表现出卵巢癌的非典型表现，由于异位病灶和缺乏许多明显可识别的标志物，给诊断带来了挑战。通过全面检测和排除过程，我们成功地将卵巢癌与其他潜在癌症区分开来。最终的组织病理学报告以及显著升高的CA - 125水平为卵巢癌的可能最终诊断提供了有力支持。尽管在染色和识别技术方面有许多进展，但对卵巢癌的诊断仍了解不足。在没有清晰可视化的情况下识别卵巢癌往往具有挑战性，需要进一步研究以增进我们对病理方法的理解。此外，有必要优先开发和探索卵巢癌的筛查和检测方法，以防止疾病检测延迟。
