Rapidly Progressive Stage IIIA2 Ovarian Cancer With Anaplastic Features

What happened, in summary

A 38-year-old woman developed painless abdominal swelling over 3 weeks and became severely underweight. Ultrasound showed an 18 cm complex pelvic mass with substantial ascites, and CA-125 was 419 IU/mL. Her condition quickly worsened with pain, breathlessness, nausea, and rapid enlargement of the mass. A firm 2.5 cm nodule at the umbilicus added to concern for advanced disease.

Fourteen days after admission, laparoscopy showed a large left-sided pelvic mass and pelvic peritoneal deposits but no visible disease in the upper abdomen. She proceeded to major cytoreductive surgery, including hysterectomy, removal of both ovaries and fallopian tubes, omentectomy, appendicectomy, pelvic and bladder peritoneal surgery, and dissection of bulky pelvic and para-aortic lymph nodes. No visible disease remained after surgery. Pathology identified high-grade primary ovarian mucinous adenocarcinoma with extensive anaplastic carcinoma, with positive lymph nodes confirming FIGO stage IIIA2.

Adjuvant chemotherapy was planned, but 30 days after surgery she was readmitted with multiorgan failure. CT showed an 18 cm retroperitoneal lymph-node mass causing obstruction of both ureters, together with new lung and liver metastases. She received dialysis and intensive supportive care. After multidisciplinary discussion with her family, she moved to hospice care and died a few days later, 5 weeks after the original operation.