Metastatic high-grade undifferentiated ovarian carcinoma: A case report from Sub-Saharan Africa.

BACKGROUND: Undifferentiated ovarian carcinoma (UDOC) is an exceptionally rare and highly aggressive subtype of epithelial ovarian cancer, accounting for less than 1% of cases and infrequently reported in the literature, particularly in resource-limited settings. To our knowledge, this represents the first reported case of metastatic UDOC from Sub-Saharan Africa. CASE PRESENTATION: We report a case of high-grade UDOC in a 63-year-old postmenopausal woman presenting to a tertiary referral center in Northern Tanzania with a one-year history of progressive abdominal pain, distension, early satiety, and weight loss. Imaging demonstrated a large heterogeneous pelvic mass with extensive exophytic hepatic metastases and omental involvement, consistent with advanced-stage disease. Exploratory laparotomy revealed a frozen pelvis with extensive adhesions and intraabdominal metastases, precluding optimal cytoreductive surgery. Histopathologic evaluation demonstrated sheets of poorly differentiated tumor cells with marked cytologic atypia and high mitotic activity, a high proliferative index, and negative staining for Wilms tumor 1 (WT1), estrogen receptor (ER), and epithelial membrane antigen (EMA), supporting the diagnosis of FIGO stage IVB UDOC. Multidisciplinary tumor board review recommended platinum-based chemotherapy; however, treatment was not initiated due to financial barriers, and the patient was subsequently lost to follow-up. CONCLUSION: UDOC is a rare and aggressive malignancy that often presents at an advanced stage with nonspecific gastrointestinal symptoms and widespread metastases. This case highlights the intersection of aggressive tumor biology and structural healthcare barriers that continue to limit access to timely cancer diagnosis and treatment in resource-constrained settings, underscoring persistent disparities in global cancer care delivery.