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Case Report
Ovarian mucinous adenocarcinoma and false negative frozen pathology: A case report and review of the literature
1 Resident Physician, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California at San Diego, 9300 Campus Point Drive, MC 7433, La Jolla, CA 92037, USA
2 Assistant Professor, Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California at San Diego, 3855 Health Sciences Drive, La Jolla, CA 92037, USA
Address correspondence to:
Renee T Sullender
9300 Campus Point Drive, MC 7433, La Jolla, CA 92037,
USA
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Article ID: 100153Z08RS2023
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Sullender RT, Binder PS. Ovarian mucinous adenocarcinoma and false negative frozen pathology: A case report and review of the literature. J Case Rep Images Obstet Gynecol 2023;9(1):83–86.ABSTRACT
Introduction: In this case report we discuss the presentation and management of a woman with a large adnexal mass.
Case Report: This report describes a 32-year-old year healthy woman who presented with four months of increasing abdominal fullness. Computed tomography (CT) imaging showed a 34 cm fluid-filled left adnexal mass with few thin septations. Tumor markers were within normal limits. She strongly desired minimally invasive surgery in the setting of low concern for malignancy. A mini-laparotomy was performed, purse string sutures were placed through the cyst wall, and fluid was aspirated with minimal spillage. Her left tube and ovary were resected laparoscopically. Intraoperative frozen pathology returned as mucinous cystadenoma with some areas of atypia. Final pathology resulted with Grade 2 mucinous adenocarcinoma and she was taken back to the operating room for a surgical staging procedure. Pathology from her laparoscopic staging surgery was benign. She underwent chemotherapy with carboplatin/paclitaxel for Stage 1C1, Grade 2 mucinous adenocarcinoma of the ovary based on intra-operative spillage.
Conclusion: Despite reassuring imaging and tumor markers, particularly in the setting of frozen pathology with low concern for malignancy, final pathology may indicate carcinoma. Although the accuracy of intra-operative frozen pathology is generally high, both gynecologic oncologists and non-oncologic gynecologists should be aware of the limitations of the test and counsel patients that the final pathology may be discordant. Appropriate counseling about the risk of intra-operative spillage and subsequent upstaging is of particular importance.
Keywords: Adnexal mass, Frozen pathology, Ovarian cancer, Ovarian mucinous adenocarcinoma
SUPPORTING INFORMATION
Acknowledgments
We would like to thank the patient who allowed us to share her story in this article so that it may inform future gynecologic care.
Author ContributionsRenee T Sullender - Substantial contributions to conception and design, Analysis of data, Interpretation of data, Drafting the article, Final approval of the version to be published
Pratibha S Binder - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Guaranter of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2023 Renee T Sullender et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
