Ovarian endometrioid adenocarcinoma in a young woman with hemorrhagic shock due to tumor disintegration: A case report

Acute abdomen secondary to ovarian carcinoma is rare, especially in a young woman. A 28-year-old obese woman underwent bilateral salpingo-oophorectomy and omentectomy as emergency surgery. The specimen from the right ovarian adenocarcinoma was fragmented because the tumor had disintegrated. The largest fragment measured 14 × 8 × 2.5 cm. The left ovary had a solid adenocarcinomatous tumor measuring 6 × 5 × 3 cm. In addition, there were disseminated lesions in the greater omentum, peritoneum, pouch of Douglas and the serosal surface of the uterus. Microscopically, the specimen was a Grade 3 poorly differentiated ovarian endometrioid adenocarcinoma with focal cyst-like structures. Several moderately dilated follicular cysts were seen in addition to the adenocarcinomas but no definite endometriosis was identified in the noncancerous areas of the bilateral ovaries. The endometrium was atrophic and there was endometriosis in the serosa of the uterus, which was resected 3 months later during a second-look operation. These observations suggest that the acute abdomen in this case was caused by disintegration and bleeding right ovarian cancer. The risk factors for ovarian endometrioid adenocarcinoma in this case might have been obesity and possibly endometriosis.