Contributed by Amy Davis, MD and Mirka Jones, MD
Published on line in March 2003
The patient is a 53-year-old female with an enlarging mass in the right lower quadrant.
The specimen was submitted in 16 parts that included uterus with bilateral adnexa, omentum, appendix, and biopsies of sigmoid colon, pelvic lymph nodes, cul-de-sac, and pelvic sidewalls. The right adnexa consisted of a 220-gram, 17.5 x 11.5 x 5.5 cm, cystic mass. This mass was described as a "chocolate-type cyst" with necrotic appearing nodules covering the cyst lining. No normal ovarian parenchyma was identified. The left ovary contained a 2 cm cyst filled with soft brown material. The uterus, cervix, fallopian tubes, and appendix were grossly unremarkable.
The right ovarian mass exhibited several morphologic patterns. Solid areas of clear cells separated by thin fibrous septa are shown in image 1. Cells were polyhedral with well defined borders, eccentrically located nuclei, and clear cytoplasm, image 2. Papillary areas with hyalinized cores, image 3, and tubulocystic areas, image 4, were also present. Portion of the mass contained endometrioid areas, image 5. Eosinophilic globules were PAS positive, image 6. Also present in the right fallopian tube, sigmoid colon, left ovary, and appendix were numerous foci of endometriosis. Endometriosis of the left ovary is shown in image 7.