QUIZ: No. 3, Mar 16 , 2025

Case 3 (16/03/2025): A 65-year-old female with c/o bilateral pedal oedema for 1 month came for radiological assessment. Medical history – Nil. Surgical history - TAH with BSO for ovarian malignancy before 8 years. No comorbidities. X Ray, USG and CECT images are provided. What’s your diagnosis? 

                                                                                                                              X ray 

Ultrasound 

                                                                                                                                               CT 

                                                                                                                                           MRI 

ANSWER  – Calcified metastases with extension into IVC and RA from ovarian tumour (low grade serous papillary) 

Findings: Irregular lamellated calcified lesion in the right paravertebral region with extension into the IVC and right atrium. Heterogeneous enhancement on contrast administration.

Serous Papillary Ovarian Cancer is a type of ovarian cancer characterized by the formation of papillary projections and serous appearance. Calcifications in the form of psammoma bodies are a common finding in serous papillary ovarian cancer, especially in the metastases. Calcified metastases are more common in low-grade serous papillary tumours compared to high-grade tumours. 

Carcinomas causing calcifying secondaries

• Breast cancer

• Osteosarcoma

• Papillary thyroid cancer

• Ovarian cancer (Mucinous and Papillary)

• Mucinous adenocarcinoma 

Take home points

• Presence of calcified metastasis anywhere in females should prompt the evaluation of ovaries.

• IVC metastasis not contiguous with renal or hepatic veins should raise the possibility of gonadal malignancy.