Clinical case presentation In May 2020, a patient sought medical attention for lower abdominal pain, initiating a comprehensive diagnostic evaluation to uncover the underlying cause. The patient has been diagnosed with bilateral high-grade serous cystadenocarcinoma of the ovaries, classified as ypT3bN0, Stage III B. The disease is characterized by metastatic progression, and the patient is platinum-sensitive with BRCA positivity. The patient has a significant family history, with the mother having a history of gynecological malignancy, and the elder sister diagnosed with ovarian malignancy. H/o Investigations CT abdomen and pelvis on 14/7/2020: Enlarged left ovary with heterogeneous enhancement (4.3 x 3.3 cm), raising suspicion of ovarian malignancy. Metastatic deposits in mesentery and hypodense lesions in liver segment VII/VIII, suggestive of metastatic liver lesions. Elevated CA 125 on 16/7/2020 (196.7 U/ml). PET CT on 21/7/2020: Metabolically active bilateral ovarian masses and peritoneal disease, including lower omentum, the serosal surface of ascending colon and cecum, and left posterior peritoneal lining. Active deposits along the undersurface of the diaphragm and hepatic surface. USG-guided biopsy from peritoneal mass on 27/7/2020: Histopathological examination confirmed metastatic high-grade serous carcinoma of ovarian origin. What was the primary histopathological diagnosis based on the biopsy from the peritoneal mass in the presented case of bilateral high-grade serous cystadenocarcinoma of the ovary? A) Metastatic Liver Lesions B) Ovarian Malignancy C) Mesentery Deposits D) High-grade Serous Carcinoma of Ovarian Origin Treatment History CA 125 on 8/10/2020: 8.1 U/mL (after 3 cycles) 4 cycles of Paclitaxel and Carboplatin completed by 13/10/2020. PET CT on 3/11/2020 demonstrated interval resolution of deposits in the undersurface of the diaphragm and regression of peritoneal disease. Pathologic findings post-surgery revealed bilateral High-grade serous cystadenocarcinoma ovary, with a partial response (ypT3bN0, Stage III B) after 4 cycles of neoadjuvant chemotherapy. Postoperative histopathology showed ovarian involvement with a 2.5 x…
