EP22.31: High‐grade serous carcinoma of apparent fallopian tube origin: ultrasound image presentation

A 75-year-old woman with an irrelevant medical history sought medical attention for a recent onset of abdominal pain radiating to the back, accompanied by laboratory findings of elevated CA125 and a cholestatic pattern of liver function. Abdominal-pelvic computerised tomography (CT) showed multifocal lymphadenopathies and a pelvic lesion with “apparent cervical origin” (cervical cytology: adenocarcinoma; negative HR-HPV). Pelvic magnetic resonance imaging (MRI) revealed multifocal lymphadenopathies and a “heterogeneous mass between the anterior rectal wall and the posterior cervical wall”. Positron emission tomography (PET)-CT described anomalous metabolic activity in the lymph nodes (above and below the diaphragm), liver, spleen, as well as in intra- versus juxtauterine pelvic lesion. Only then was the patient scanned by our gynecological ultrasound team, who identified as the most likely primary lesion an elongated solid sausage-like mass apparently originating from the left adnexa, extending into the left retro-cervical space and measuring 31 x 14 x 28mm – compatible with a primary lesion of the left fallopian tube (see figure 1). The IOTA ADNEX MODEL indicated a risk of primary adnexal malignancy (stage II - IV) of 94.1%. The patient underwent a right inguinal node biopsy (histology: serous high-grade carcinoma). She soon died due to the disease progression. We present this case to point out that in patients with disseminated abdominal-pelvic malignancy, gynecological ultrasound should be performed without delay, as part of the first diagnostic line, in order to shorten the diagnostic path and enable the earliest possible initiation of appropriate therapy, even though it is palliative. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.