A Case Report: Metastasis of Clear Cell Ovarian Cancer in Morrison’s Pouch as Differential Diagnosis to Exophytic Kidney Tumor

Abstract

A 62-year-old woman with a history of curatively treated mucinous ovarian cancer, presented with dyspnea, anorexia and right-upper-quadrant pain at consultation with her general practitioner. A CT scan revealed several lymph node metastases in lungs and abdomen as well as a tumor in Morrison's pouch and biopsy revealed renal cell carcinoma. Therefore, she was referred to Department of Urology. The multidisciplinary team could not immediately reject that there could be an exophytic tumor in the right kidney but discrepancy between histology and imaging, led to several biopsies including laparoscopic procedure. Re-examination of the primary ovarian cancer showed that one percent was classified as clear cell carcinoma. The final diagnose was metastatic clear cell ovarian carcinoma. The patient was terminal and suffered of cachexia and pleural effusion. The patient deceased four months after first consultation.

Neglected Anatomical Areas in Ovarian Cancer: Significance for Optimal Debulking Surgery

“…However, fluid accumulation occurs in the pouch due to gravity, as it is one of the posterior spaces in the peritoneal cavity. For this reason, Morison's pouch is one of the most affected anatomical zones in AEOC [9,[53][54][55]. It is also a frequent site for OC recurrences [55].…”

“…Studies suggest that dissection of OB could be omitted in cases of adhesions of Winslow's foramen and the absence of enlarged paraaortic, mesenteric and suprarenal lymph nodes [5,7,13]. The liver area should be carefully evaluated in cases of peritoneal carcinomatosis at the Glisson capsule and PH [51][52][53][54][55][56]58]. The spleen should be always investigated for hilum metastases in the case of transcoelomic dissemination of the omental bursa and the presence of omental cake [5,[67][68][69][70].…”