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A multidisciplinary approach to ovarian cancer at diagnosis

St James's University Hospital, Leeds LS9 7TF, UK

View larger version (150K): [in a new window]   Figure 1. CT of the upper abdomen in a woman with stage IIIC ovarian cancer showing tumour filling the supracolic spaces between the spleen and stomach both of which have extensive serosal disease. Such tumour bulk suggests unsuccessful cytoreductive surgery.

View larger version (158K): [in a new window]   Figure 2. CT of a patient with stage IIIC ovarian cancer showing bulky high retroperitoneal lymphadenopathy again beyond the scope of cytoreductive surgery.

View larger version (130K): [in a new window]   Figure 3. CT guided biopsy of a woman with a large omental cake, other peritoneal tumour and bilateral solid ovarian masses but no ascites. Histology: non-Hodgkin lymphoma.

View larger version (114K): [in a new window]   Figure 4. Ultrasound guided biopsy of a large omental cake showing echogenic needle track (courtesy of Dr Michael Weston).

View larger version (116K): [in a new window]   Figure 5. Ultrasound of a large omental cake. Such lesions may be mistaken for bowel loops.

View larger version (66K): [in a new window]   Figure 6. CT guided biopsy of a wispy omental infiltrate in a woman with prior breast cancer. Histology: infiltrating lobular breast cancer.

View larger version (94K): [in a new window]   Figure 7. (a) CT of the pelvis showing a large solid partially necrotic ovarian mass and (b) of the upper abdomen showing a non-obstructive cicatrizing right colon cancer. The mass was resected by a general gynaecologist and histology was that of a Krukenberg tumour. At review of the pre-operative CT in the multidisciplinary meeting the colonic primary was discovered.

View larger version (92K): [in a new window]   Figure 8. (a) CT of the upper abdomen showing bulky supracolic peritoneal tumour invading the hilum of the spleen, (b) CT of the right lower quadrant showing a large calcified infracolic omental cake and (c) CT of the pelvis showing a 4.5 cm right adnexal mass, partially calcified. Note tumour encasing the sigmoid colon. Histology of CT guided core biopsy: papillary serous adenocarcinoma consistent with primary peritoneal carcinoma.

View larger version (129K): [in a new window]   Figure 9. (a) Axial T2 weighted MR of the pelvis showing one large and one small solid adnexal mass and a fibroid uterus in the left posterior aspect and T1 weighted MR images (b) before and (c) after injection of gadolinium showing bland masses which show marked enhancement. Histology: Krukenberg tumours. Note the areas of necrosis and the lobulated surface.

View larger version (110K): [in a new window]   Figure 10. (a) Axial T2 weighted MR of the pelvis in a pregnant woman found to have a complex pelvic mass at her booking scan. The mass behind the gestation sac in the right posterior pelvis shows complex papillary elements on the right lateral wall and coronal T1 weighted MR images (b) without and (c) with fat suppression showing small bright fatty elements superiorly. Histology: mature cystic teratoma with skin appendage elements accounting for the wall complexity. The fatty element was not recognized by ultrasound and the complex mural elements raised concerns for malignancy.

View larger version (13K): [in a new window]   Figure 11. Pathway of imaging in investigation of suspected ovarian cancer.