Correlapaedia - a Correlative Encyclopedia of Pediatric Imaging, Surgery, and Pathology

Case 42

Clinical History:
The patient was an 8 year old female with 12 hours of left lower quadrant / suprapubic pain with a palpable midline mass.

Clinical Physical Exam:
Palpable midline abdominal mass.

Clinical Labs:
Non-contributory

Clinical Differential Diagnosis:
Ovarian mass, abdominal abscess, bowel obstruction

Imaging Findings:
An ultrasound exam and a computed tomography exam of the abdomen on the day of admission showed a large inhomogeneous mass superior to the bladder. Chest CT and bone scan from the third day of admission (not provided) were negative for metastases.

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Imaging Differential Diagnosis:
Lymphoma, ovarian tumor, appendiceal abscess.

Operative Findings:
The mass was biopsied under ultrasound guidance on the second day of admission with 10 passes with a 15 gauge biopsy gun and Sure-cut needle. The biopsy was suggestive for ovarian germ-cell tumor. On the seventh day of admission the patient was taken to the operating room and explored via a lower midline incision. The mass was encountered, and was seen to arise from the left ovary. It was not invading any surrounding structures. The tumor and the ovary were torsed, along with its fallopian tube. The patient underwent a left salpingo-oophorectomy and biopsy of the periaortic lymph nodes.

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Pathological Findings:
Examination of the surgical specimen revealed it to measure 11 x 8 x 5 cm in size and was oval in shape with a tan outer surface. There was extensive hemorrhage and necrosis. Grossly, the lesion was soft but solid (necrotic) and hemorrhagic. Microscopic examination revealed it to have characteristics classic for an ovarian dysgerminoma, and the periaortic lymph nodes were positive for metastatic disease.

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Final Diagnosis:
Ovarian Dysgerminoma, Stage III, Torsed

Follow-up and Prognosis:
The patient had an uncomplicated post-operative course and underwent chemotherapy

Similar Cases:
Case 33, Case 40

References:

• WebPath

URL: http://www.virtualpediatrichospital.org/