PMC9745153_01
(A): Transvaginal scan (TVS) of the uterus shows an endometrial thickness of 16 mm. (B): TVS of the uterus shows anechoic areas with Doppler colour flow within the endometrial cavity. (C): TVS shows a right adnexal solid cystic mass measuring 74 x 58 x 63 mm, with the solid component measuring 40 mm. (D): TVS with colour Doppler, demonstrating moderate blood flow through the right adnexal mass. (E): Pelvic MRI shows a polypoidal lesion in the uterine cavity. The right adnexal mass is seen within a pool of free ascitic fluid extending both behind and in front of the uterus.
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The rest of the endometrium was regular and well defined with preservation of the endo-myometrial junction. ( Figures 1A, B ). In the right adnexa, a solid cystic mass measuring 74 x 58 x 63 mm was seen, with the solid component measuring 40 mm with shadowing ( Figure 1C ). The mass had a colour score of 3, suggestive of moderate blood flow through the mass ( Figure 1D ). T1 weighted series and featured small cysts, suggestive of an enlarged, torted, solid cystic right ovarian mass ( Figure 1E ). The MRI was inconclusive of malignancy because of the distorted architecture caused by the torsion.
Endometrium showing features of an endometrioid endometrial carcinoma (A): x20 magnification and (B): x40 magnification. There is a glandular proliferation with no intervening stroma composed of cells with pseudostratified nuclei. Mild nuclear atypia is present consistent with grade 1.
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The endometrial polypoid tissue showed changes consistent with grade 1 endometrioid endometrial adenocarcinoma ( Figures 2A, B ).
Ovary showing replacement by variably sized glands (A): x20 magnification, and solid areas (B): x40 magnification. The glands are lined by endometrioid type epithelium with cytological atypia. Necrosis is present.
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Sections from the right ovarian mass showed features in keeping with a well-differentiated endometrioid ovarian carcinoma ( Figures 3A, B ).