Teaching Case

Acute abdominal pain, pelvic palpable mass

Patient was admitted to our hospital because of acute abdominal pain localized in the inferior abdominal quadrants where it was possible to appreciate a mass of ligneous consistence. Body temperature was 36.8¡ Laboratory findings were normal.

US and CT findings (pelvic mass with mixed parenchimal structure, presence of internal and irregular septa, marked enhancement of septa and solid portion), suggest hypotesis of ovarian cystoadenocarcinoma. Among the gynecologic malignancies, ovarian cancer is the second most common in incidence (1). As most patients presents with advanced disease, the prognosis is poor. Five year survival is only 41% for all stages (2). Both MR and CT can be helpful adjunct in the treatment planning of ovarian cancer. Several studies have addressed the value of CT in the preoperative management of ovarian tumor with reported accuracies of 77%; staging accuracy for MR imaging was similar 78% (3). Detection of peritoneal implants on CT and MR has been studied extensively and both modalities had limitation in detection of implant lesion smaller than 10 mm and localized on bowel surface, mesentery and peritoneum (3). MR now seems to be superior to in the evaluation of local extention of the tumor and in the definition of implants with possible involvment of the hemidiaphragma and liver surface. However cross sectional imaging provides paramount information for surgical and management planning