Correspondence Address:
Subhashish Das
Department of Pathology, Sri Devaraj Urs Medical College, Kolar - 563 101, Karnataka
India

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Ovarian cancer is the third common gynecologic malignant tumor (25%). Frequent ovulation, family history, increasing age, and use of ovulatory drugs are known risk factors. Elevated serum levels of CA 125 have a very limited role in distinguishing ovarian malignancy from normal pregnancy.[1]

A high index of clinical suspension along with appropriate laboratory results and radiological investigations such as endovaginal color Doppler sonography may be helpful in making a correct preoperative diagnosis.[1]

Some of the characteristic radiological features of ovarian cancer include (a) size >4 cm, (b) solid or complex (solid and cystic), (c) necrosis, and (d) high flow pulsatility of the tumor vessels along with certain associated findings, namely (a) infiltration of pelvic sidewall, (b) ascites, (c) peritoneal implants, and (d) lymph node enlargement may help in the diagnosis of ovarian cancer.[1]

However, despite well-established imaging criteria for ovarian cancer, findings in benign and malignant ovarian lesions overlap and a variety of ovarian cancer mimics contribute to the diagnostic dilemmas and challenging the clinical scenarios.[2]

Some of the common mimics of the ovarian cancer include [2] (1) solid pelvic/adnexal lesions (mature solid teratoma, massive ovarian edema), (2) complex adnexal lesions (tubo-ovarian abscess, endometrioma), and (3) mimics of metastasizing ovarian cancer (gastrointestinal, breast cancer or melanoma metastasizing to the ovary and peritoneum, pseudomyxoma peritonei).

Of late, fine needle aspiration cytology has been used as a diagnostic tool a distinguish between ovarian pregnancy and ovarian carcinoma with limited success.[3] Peritoneal washing cytology may also help in the diagnosis of ovarian pregnancy.[4] Recent review of literature revealed a few cases where a correct diagnosis of ectopic pregnancies was done from Arias-Stella reaction in cervicovaginal smears.[5]

Although it is possible to retrieve trophoblastic cells by fine needle aspiration following rupture in ectopic pregnancies, interpretation of cytology smears should be done cautiously along with proper clinical and radiological correlation as it is difficult to differentiate on smears between trophoblastic and malignant cells.[6] This because trophoblastic cells are large cells with basophilic or eosinophil cytoplasm and multiple nuclei with irregular nuclei and a finely granular chromatin pattern.[7] Occasionally, papillary projection may be seen which probably reactive tubal epithelial cells.[8]

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