Ovarian Carcinosarcoma with Perirenal Metastasis: A Case Report

Abstract

Objectives Ovarian carcinosarcoma is a rare and aggressive biphasic tumour comprising of both carcinomatous malignant epithelial and sarcomatous mesenchymal elements. Patient usually presents with advanced stage disease which is associated with poor prognosis. The mainstay of treatment is cytoreductive surgery followed by platinum-based chemotherapy. Methods We report a case of a patient with ovarian carcinosarcoma with metastasis to perirenal space, which is unusual for ovarian malignancy. Results A 76-year-old woman presented with abdominal bloating and examination found a large mass arising from the pelvis. CT scan showed 20cm complex right ovarian tumour with internal septations and solid mural nodules, small volume ascites, peritoneal disease within the pelvis and a 6.3cm enhancing mass at the upper pole of the right kidney. Her CA125 was 89 kU/l and serum creatinine 70 umol/l. Preoperative differential diagnosis included synchronous primary ovarian and renal malignancies or ovarian carcinoma with renal metastasis. She underwent primary debulking surgery with laparotomy, total abdominal hysterectomy, bilateral salpingo-oophorectomy, right nephrectomy, omentectomy and peritoneal stripping of nodular disease. Optimal debulking was achieved with <1cm residual disease. Histopathology showed right ovarian carcinosarcoma with heterologous elements and metastatic carcinosarcoma to right perirenal space (tumour arise in perinephric fat), pelvic peritoneum, omentum, bilateral parametrium and left ovary. Postoperatively, she made a good recovery and received adjuvant chemotherapy. Conclusions Ovarian cancer may rarely metastasise to perirenal space, especially in high grade tumours. Preoperative diagnosis to differentiate between synchronous cancers and metastasis may be difficult.