PMC7436359_01
(a, b) T2-weighted magnetic resonance imaging of the pelvis and 18F-fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography revealed massive peritoneal dissemination, including in the Douglas' pouch, vesicouterine pouch, omentum, and the surface of the liver and spleen. Bilateral ovaries were not clearly enlarged and were not visualized in the image.
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Magnetic resonance imaging (MRI) and 18F-fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography (FDG PET/CT) revealed massive peritoneal dissemination, including in the Douglas' pouch, vesicouterine pouch, omentum, and the surface of the liver and spleen (Figure 1).
(a) Laparoscopic surgery was performed for the biopsy. The bilateral ovaries were not seen due to the frozen pelvis. The arrow indicates the uterus. (b) Laparoscopic findings of the peritoneal dissemination in the vesicouterine pouch.
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Laparoscopic findings documented the dissemination in the whole of the abdominal cavity, but the bilateral ovaries were not seen due to the frozen pelvis (Figures 2(a) and 2(b)).
Examination of hematoxylin and eosin-stained sections revealed that the tumor was composed of malignant epithelial elements and sarcomatous elements of spindle cells. (a) The epithelial component displayed the solid proliferation of severely atypical cells, thus mimicking ovarian high-grade serous carcinoma. (b) The stromal component consisted of atypical spindle cells mimicking leiomyosarcoma. Scale bars: (a) 200 mum and (b) 100 mum.
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Histological examination showed that the tumor was composed of malignant epithelial elements and sarcomatous elements of spindle cells (Figure 3).
(a, b) The bilateral ovaries could be observed within a normal size and normal findings during the laparotomy after three cycles of chemotherapy. The arrows indicate the ovaries, and the asterisk indicates the uterus. Therefore, the diagnosis was confirmed as primary peritoneal carcinosarcoma.
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Response Evaluation Criteria in Solid Tumors (RECIST). Although interval debulking surgery was attempted, tumor dissemination remained in the abdominal cavity, and we therefore performed an omentectomy only. Regardless of the strong adhesion in the Douglas' pouch, the bilateral ovaries could be observed to be within a normal size and with normal findings (Figure 4).
(a, b) Computed tomography revealed peritoneal dissemination of the surface of the liver and Douglas' pouch. (c, d) After four months of olaparib administration, computed tomography revealed a decrease in the size of the tumors.
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However, after four months of olaparib administration, CT revealed a significant response with a 43% decrease in the sum of the longest diameter of target lesions compared with the CT before the olaparib administration (Figure 5).