CASE 12051 Published on 23.07.2014

Unusual ovarian tumour: Metastases from carcinoid tumour

Section

Abdominal imaging

Case Type

Clinical Cases

Authors

Trupti Prabhu Dabholkar

India; Email:truptidabholkar@yahoo.com
Patient

65 years, female

Categories
Area of Interest Genital / Reproductive system female, Abdomen ; Imaging Technique Ultrasound, CT
Clinical History
The patient was a 65-year-old woman who presented to the Gynaecology department with complaints of postmenopausal bleeding. She was otherwise in good health. No complaints of diarrhoea, flushing, weight loss, breathlessness or wheezing. Tumour markers (CA-125, CEA, CA 19-9) were all within normal limits.
Imaging Findings
Transvaginal ultrasound:
A complex multiseptated right ovarian mass measuring 5.5 x 4.5 cm was seen containing multiple thick septations. No solid elements were seen within. No mass was found in the left ovary or adnexa.
CT examination:
In addition to the complex right ovarian mass, CT showed a mass lesion in the terminal ileum involving the adjacent root of mesentery. Desmoplastic reaction was seen surrounding this mass. No small bowel obstruction or ischaemia was observed.
Multiple small omental and peritoneal deposits were seen. No hepatic metastases were noted.
Incidental findings were uterine fibroids. Left ovary was normal.
Minimal free fluid was seen in the pouch.
Discussion
In this case, laparoscopic biopsy and immunohistochemistry of the peritoneal deposits and ovarian mass showed findings typical of a neuroendocrine tumour. Immunohistochemistry was typical for a carcinoid tumour.
Terminal ileum is one of the most common sites of carcinoid tumour. These tumours secrete serotonin and cause desmoplastic reaction in the surrounding mesentery. The desmoplastic reaction can compromise mesenteric vasculature and result in small bowel ischaemia. It can also cause tethering and angulation deformity of small bowel loops, sometimes leading to bowel obstruction. Patients do not present with “Carcinoid syndrome” unless there are hepatic metastases. This is because the liver metabolizes the serotonin produced by the ileal tumour.
Ovarian carcinoid tumours are uncommon and can either be primary ovarian carcinoid tumours or metastases to ovary from carcinoid tumour elsewhere. [1] They constitute 0.3% of ovarian tumours and 0.5 % of carcinoid tumours. [1]
They mostly occur in perimenopausal and postmenopausal women [1].
Metastatic carcinoid tumours of the ovary typically originate from carcinoids of distal ileum [2]. They are usually bilateral [2], however, in our case the metastasis to ovary was unilateral. Multiple metastases on the peritoneal surface are common findings [2]. Hepatic metastases are also common.
Primary carcinoid tumours of the ovary are divided into four main types [1]
• Insular type: most common and the only type that is associated with the carcinoid syndrome 1
• Trabecular type
• Strumal type: second most common type
• Mucinous type (goblet cell 4) [1]

Radiographic features: Are indistinguishable from other ovarian neoplasms. Primary carcinoids of the ovary are almost always unilateral. They can occur as solid enhancing nodule within a cystic teratoma, or may be seen as a predominantly solid hypervascular mass [1].

Metastatic carcinoids are nearly always bilateral with scattered tumour deposits present throughout both ovaries [1]. Again radiographic appearances are indistinguishable from other ovarian neoplasms.

It should be remembered that the ovary can be rarely a site of a carcinoid tumour.
Differential Diagnosis List
Terminal ileum carcinoid tumour with metastases to right ovary.
Epithelial ovarian neoplasms
Metastases to ovary from other cancers like breast
Gastrointestinal etc.
Final Diagnosis
Terminal ileum carcinoid tumour with metastases to right ovary.
Case information
URL: https://www.eurorad.org/case/12051
DOI: 10.1594/EURORAD/CASE.12051
ISSN: 1563-4086