PMC4899427_01
Post contrast enhanced CT images demonstrating a large heterogenous mass (PM) occupying the majority of the pelvis. The pelvic mass can be seen compressing the uterus (Ut). Enhancing nodularity is noted in the pelvic mass, which is suspicious for malignancy. Small pelvic ascites is noted (Asc). Several subcentimeter retroperitoneal lymph nodes are noted (LN). A, Axial view. B, Coronal view. C, Sagittal view.
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Computed tomography (CT) scan demonstrated a 15.5 x 16.6 x 18.2 cm heterogeneous pelvic mass worrisome for malignancy, possibly ovarian (Fig. 1A-C). Ascites was present, but no evidence of small bowel obstruction was noted (Fig. 1A-C). The liver, spleen, pancreas, and appendix appeared normal (Fig. 1A-C).
Photomicrographs of left ovarian clear cell carcinoma (A-C) and right ovarian endometriosis (D). Prominent hyalinized stroma is often seen in clear cell ovarian carcinomas. Neoplastic cells are noted to have distinct cell borders and a wide range of nuclear and cytologic atypia. A, 400 x H&E. B, 400 x p53 immunohistochemistry (negative). C, 400 x estrogen receptor immunohistochemistry (negative). D, 400 x H&E.
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Final pathology returned as moderately differentiated clear cell carcinoma of the ovary limited to the left ovary with ovarian surface involvement (Fig. 2A-C). The immunohistological features of the tumor including hyalinized papillary architecture lined by cytologically atypical cells with clear cytoplasm with lack of immunohistochemical evidence of p53 mutation or estrogen receptor (ER) expression, are typical of clear cell carcinoma (Fig. 2B-C). Incidentally, endometriosis was noted on the ovaries bilaterally (Fig. 2D).