Ovarian endosalpingiosis mimicking hydrosalpinges. Unexpected intraoperative findings and a diagnostic rollercoaster.

Over 80 % of ovarian cancer diagnoses are in women aged over 50 years. Post-menopausal women are at significantly increased risk compared with other age groups. Tumour biomarkers and ultrasound assist with diagnostics. A post-menopausal woman was referred with a possible left adnexal cyst on ultrasound. A tertiary gynaecological ultrasound suggested bilateral hydrosalpinges without cysts. Tumour markers were negative. Unexpectedly, while undergoing a laparoscopy, the tubes were normal in appearance; however, multiple cystic deposits suspicious for malignancy were noted on the ovaries. A laparoscopic bilateral salpingo-oophorectomy was performed without spillage and pelvic washings obtained. On histopathology, the ovaries contained multiple, benign epithelial cysts and pelvic washings were negative. This case demonstrates an unanticipated peri-operative diagnostic dilemma. It highlights the surgical management decisions required to balance duty of care and consent compliance within the scope of general gynaecology. It emphasizes the importance of histopathological examination to confirm diagnoses.

Concordant PET/CT and ICG positive lymph nodes in endometrial cancer: a case of mistaken identity.

Endometrial carcinoma is the most common gynecological malignancy in developed countries. In early stage endometrial cancer, routine systemic pelvic lymphadenectomy showed no survival benefits and results in increased morbidity. The role of PET/CT imaging for the pre-operative detection of lymph node metastases in endometrial cancer is unclear. Sentinel lymph node (SLN) mapping may reduce the surgical staging morbidity while maintaining prognostic information of the lymph node status. Recently, indocyanine green (ICG) SLN mapping has been utilized to detect nodal metastasis in endometrial cancer. Endosalpingiosis is defined as the presence of tubal-like epithelium outside of the fallopian tube and can sometimes be misinterpreted as cancer metastasis. Here, we discuss a patient with newly diagnosed endometrial cancer who had pelvic and para-aortic lymph nodes with high glucose avidity on PET/CT, and ICG positivity on SLN mapping, suspected clinically to be metastatic adenocarcinoma, but with the pathological finding of endosalpingiosis only.