A 55-year-old postmenopausal woman is found on ultrasound to have a 9 cm right ovarian cyst with internal septations, papillary projections, and ascites. CA-125 is 380 U/mL. IOTA (International Ovarian Tumour Analysis) ADNEX model predicts 94% malignancy risk. At staging laparotomy, cytology is positive, disease is confined to both ovaries with pelvic peritoneal deposits only. According to FIGO 2014 staging, she is staged as IIIA1(i). What is the key distinction between IIIA1(i) and IIIA1(ii)?

• A IIIA1(i) = microscopic peritoneal metastasis; IIIA1(ii) = macroscopic peritoneal deposits >2 cm
• B IIIA1(i) = positive cytology only; IIIA1(ii) = peritoneal deposits outside pelvis
• C IIIA1(i) = unilateral ovary; IIIA1(ii) = bilateral ovarian involvement
• D IIIA1(i) = retroperitoneal node metastasis ≤10 mm; IIIA1(ii) = retroperitoneal node metastasis >10 mm ✓

Explanation

In the FIGO 2014 ovarian cancer staging system, Stage IIIA1 refers to retroperitoneal lymph node metastasis only (no peritoneal metastasis). IIIA1(i) is defined as metastasis ≤10 mm in greatest dimension; IIIA1(ii) is metastasis >10 mm. Stage IIIA2 refers to microscopic extrapelvic peritoneal metastasis with or without retroperitoneal nodal involvement. The distinction between IIIA1(i) and IIIA1(ii) is based solely on the size of the retroperitoneal nodal metastasis, which has prognostic implications.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.