PMC9259338_01
Hemosiderin laden macrophages in pleural fluid consistent with endometriotic cells.
CRIOG2022-7624305.001.jpg
PMC9259338_01_CRIOG2022-7624305.001.jpg
fig1
Pathologic examination of these implants was consistent with pleural involvement of endometriosis based on the presence of hemosiderin-laden macrophages (Figure 1).
Sagittal (a) and axial (b) contrast-enhanced CT images of the pelvis demonstrate a large heterogeneous lobulated mass (blue arrow) posterior to the uterus (green asterisk). The uterus contains a coarsely calcified exophytic fibroid (yellow asterisk). (c) Bilateral mild-moderate hydroureteronephrosis with ureteral collapse at the level of the pelvic mass. (d) Axial unenhanced CT image of the chest demonstrates a large left pleural effusion (white arrow) with compressive atelectasis of the lingula and left lower lobe (green asterisk) as well as left posterior pleural thickening (yellow arrow).
CRIOG2022-7624305.002.jpg
PMC9259338_01_CRIOG2022-7624305.002.jpg
fig2
CA-125 was within normal limits at 28.6 units/mL. CT studies of the abdomen and pelvis showed an enlarged complex pelvic mass (Figures 2(a) and 2(b)) causing bilateral hydroureteronephrosis (Figure 2(c)) as well as omental stranding and ascites, concerning for carcinomatosis. The CT of the chest demonstrated unchanged pulmonary nodules as well as a recurrent left pleural effusion and left pleural thickening (Figure 2(d)).
(a) The tumor in the ovary consists of glands lined with low cuboidal, polyhedral, hobnail or flattened cells with uniform nuclear atypia, and variable mitotic activity. Cytoplasmic clearing of tumor cells and background hyalinized stroma is prominent. (b) Extensive endometrioses were noted in multiple anatomical locations. The omentum is pictured here. (c) The tumor in the pleura consists of glands lined with tumor cells similar to those of ovarian cancer. Background hemosiderin-laden macrophage is prominent in this biopsy.
CRIOG2022-7624305.003.jpg
PMC9259338_01_CRIOG2022-7624305.003.jpg
fig3
Final pathology revealed clear cell adenocarcinoma involving both ovaries with capsular involvement (Figure 3(a)). All other biopsies and lymph nodes were negative for carcinoma but did reveal extensive endometriosis (Figure 3(b)). She was found intraoperatively to have multiple pleural nodules, which on final pathology confirmed metastatic clear cell carcinoma (Figure 3(c)).