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Diagnostic Challenges in Patients With Tumors

CASE 3. NORMAL-SIZED OVARIAN CANCER DETECTED BY COLOR DOPPLER ULTRASOUND USING A MICROBUBBLE CONTRAST AGENT

Fukuoka University Medical School, Fukuoka, Japan

A 58-year-old postmenopausal woman first visited our gynecologic clinic with a high serum CA 19-9 value (3,483 U/mL) owing to an unknown cause. The serum CA-125 value was 28 U/mL (normal level, < 35 U/mL). In her previous clinical examinations, no evidence of a tumor was found on chest or abdominal computed tomography scans, abdominal ultrasound, or gallium-67 scintigraphy. The patient had no history of any gynecologic disorders. A bimanual vaginal examination revealed a normal uterus without any adnexal enlargement. Both ovaries were confirmed to be of normal size, and a small cyst measuring 24 x 20 mm in size was detected in the left ovary by transvaginal gray-scale ultrasound. Magnetic resonance imaging showed a small cyst, 26 x 21 mm in size, in her left ovary (Fig 1, arrow; T2-weighted image). Transvaginal color Doppler ultrasound (CDU) showed no detectable blood flow in both the normal-sized ovaries (Fig 2A, arrowheads; the left ovary). However, a dramatic blood flow (Fig 2B, arrow) was detected within the left ovary by CDU 20 seconds after the intravenous bolus injection of a microbubble ultrasound contrast-agent, Levovist (Schering AG, Berlin, Germany), at a concentration of 300 mg/mL. In addition, the intraovarian vessels showed a low-resistance to the blood flow (resistance index; 0.31, and pulsatility index; 0.28), thus suggesting a malignant lesion within the ovary.^1–4 In postmenopausal woman, because an ovarian malignancy may be suggested if a vascular-rich lesion in the ovary is identified by diagnostic imaging, a laparotomy was performed for this patient. A normal-sized ovarian cancer was found (Fig 3). A bilateral salpingo-oophorectomy, total abdominal hysterectomy, partial omentectomy, pelvic lymph node dissections, and para-aortic lymph node sampling were then performed during this surgery. The carcinoma was confined to the normal-sized ovaries (left, 3.8 x 2. 8 cm; right, 3.5 x 2.7 cm), and a histopathologic examination showed a stage I mucinous cystadenocarcinoma of the ovary (Fig 4, hematoxylin and eosin staining, x3), without any extraovarian spread or metastasis. The serum CA 19–9 level remarkably decreased to a normal level (30 U/mL) by 4 weeks after surgery.

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AUTHORS’ DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

The authors indicated no potential conflicts of interest.

REFERENCES

1. Bourne T, Campbell S, Steer C, et al: Transvaginal colour flow imaging: A possible new screening technique for ovarian cancer. BMJ 299:1367–1370, 1989[Abstract/Free Full Text]

2. Kurjak A, Zalud I, Alfirevic Z, et al: Evaluation of adnexal masses with transvaginal color ultrasound. J Ultrasound Med 10:295–297, 1991[Abstract]

3. Fleisher AC, Cullinan JA, Peery CV, et al: Early detection of ovarian carcinoma with transvaginal color Doppler ultrasonography. Am J Obstet Gynecol 174:101–106, 1996[CrossRef][Medline]

4. Emoto M, Iwasaki H, Mimura K, et al: Differences in angiogenesis of benign and malignant ovarian tumors, demonstrated by analyses of color Doppler ultrasound, immunohistochemistry, and microvessel density. Cancer 80:899–907, 1997[CrossRef][Medline]

5. Feuer GD, Shevchuk M, Calanog A: Normal-sized ovary carcinoma syndrome. Obstet Gynecol 73:786–792, 1989[Medline]

6. Blomley MJ, Cooke JC, Unger EC, et al: Microbubble contrast agents: A new era in ultrasound. BMJ 322:1222–1225, 2001[Free Full Text]

7. Frauscher F, Klauser A, Halpern EJ, et al: Detection of prostate cancer with a microbubble ultrasound contrast agent. Lancet 357:1849–1850, 2001[CrossRef][Medline]

8. von Herbay A, Vogt C, Haussinger D: Late-phase pulse-inversion sonography using the contrast agent Levovist: Differentiation between benign and malignant focal lesions of the liver. Am J Roentgenol 179:1273–1279, 2002[Abstract/Free Full Text]

9. Kupesic S, Kurjak A: Contrast-enhanced, three-dimensional power Doppler sonography for differentiation of adnexal masses. Obstet Gynecol 96:452–458, 2000[CrossRef][Medline]

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