{"ok":true,"case":{"slug":"catalina","displayTitle":"Case Study: Catalina","shortTitle":"Catalina","topic":"Ovarian cancer","subtitle":"A longitudinal evidence-based case study","tagline":"Understanding the clinical course, treatment context and evolving evidence.","language":"en","status":"published","reviewedAt":"2026-11-05","publicSummary":"An educational research case about ovarian cancer, built from reviewed records as they are curated. It keeps apart what happened, what is documented, what was available at the time, what is known today and what remains experimental or uncertain. One person's history is not a treatment plan for another person.","documentedDiagnosis":"Ovarian cancer is the approved topic of this case. Histological subtype, grade, stage, biomarkers, dates and treatment responses are not documented here until reviewed records are published; they are never inferred from the illustration, from general articles, from receipts or from a section title.","scope":"Public educational reference built from a separately curated and minimized projection of private records, published only through an explicit approval. The private originals, working notes and identifying details are not part of the public case.","limitations":["The detailed medical chronology has not been approved for publication; the timeline and the treatment sections show their structure with honest empty states.","A retrospective family recollection is labeled as such and is not a medical record.","A prescription, a medication note, a scheduled appointment and a confirmed administration are different events; a receipt is not an administration record.","Isolated laboratory values are not turned into response charts without a reviewed clinical interpretation; a missing value is not zero.","Knowledge available today is not applied backwards as proof that an earlier decision was wrong."],"howToRead":["Overview says what the case is and what it is not.","Clinical timeline lists reviewed events; each one shows its event date, document date and entry date separately, with its date precision, evidence type and uncertainty.","Treatment landscape keeps three views apart: what was available at a historical date, what is reviewed today, and what is investigational.","Evidence lists the references the case actually uses, with provenance, review dates, corrections and unresolved questions.","Questions for your care team offers neutral prompts for a consultation; it does not recommend anything."],"illustration":{"src":"/assets/images/labs/biolab/case-catalina-ovary-626.webp","srcset":"/assets/images/labs/biolab/case-catalina-ovary-480.webp 480w, /assets/images/labs/biolab/case-catalina-ovary-626.webp 626w","sizes":"(max-width: 1023px) calc(100vw - 40px), 560px","width":626,"height":238,"alt":"Educational conceptual illustration of an ovary with a magnified inset of cells. It is not a clinical image of Catalina and is not evidence of tumor appearance, subtype, extent or stage."}},"revision":{"number":4,"approvedAt":"2026-11-05T07:31:51.307Z","note":"Death certificate added: death at home on 7 May 2026; the certificate records a hydro-electrolytic imbalance (1 day) due to ovarian cancer (6 years), with non-Hodgkin lymphoma (26 years) as another significant condition; no necropsy. The course between the May 2022 summary and the death is not yet documented. Editorial review only; publication approved by the case owner on 2026-11-05."},"events":[{"id":"evt-3f435b3a-e","eventType":"test","title":"Diagnosis of non-Hodgkin lymphoma","summary":"Non-Hodgkin lymphoma diagnosed in 2000, according to the 2022 medical summary, which gives the year only.","findings":"The summary states a diagnosis of non-Hodgkin lymphoma in 2000, treated with radiotherapy the same year and under surveillance from 2001.","uncertainty":"Month, lymphoma subtype, stage and the diagnostic method are not stated in the summary.","eventDate":{"precision":"interval","start":"2000-01-01","end":"2000-12-31","label":"in 2000 (year only, as the medical summary states it)"},"documentDate":"2022-05-18","recordedAt":"2026-10-29T06:26:29.344Z","certainty":"documented","recollection":false,"evidenceType":"medical-record","sourceReference":"medical-record dated 2022-05-18","relatedEvidenceIds":[],"review":{"role":"editorial","scope":"Editorial review only: transcription from the IMSS medical summary GIN/004 (18 May 2022) checked against the document; publication approved by the case owner. No clinical-specialist review.","at":"2026-10-30"}},{"id":"evt-172448f6-1","eventType":"administration","title":"Radiotherapy for the lymphoma, 30 fractions, completed in 2000","summary":"Radiotherapy for the lymphoma, 30 fractions, completed in 2000 according to the medical summary.","findings":"Thirty fractions, completed in the same year as the diagnosis (2000), as recorded in the summary.","uncertainty":"Start date, treated site, dose per fraction and total dose are not stated.","eventDate":{"precision":"interval","start":"2000-01-01","end":"2000-12-31","label":"completed in 2000 (year only, as the summary states it)"},"documentDate":"2022-05-18","recordedAt":"2026-10-29T06:26:30.343Z","certainty":"documented","recollection":false,"evidenceType":"medical-record","sourceReference":"medical-record dated 2022-05-18","relatedEvidenceIds":[],"review":{"role":"editorial","scope":"Editorial review only: transcription from the IMSS medical summary GIN/004 (18 May 2022) checked against the document; publication approved by the case owner. No clinical-specialist review.","at":"2026-10-30"}},{"id":"evt-fa301242-3","eventType":"outcome","title":"Lymphoma surveillance from 2001","summary":"Under surveillance for the lymphoma from 2001, according to the medical summary.","findings":"The summary records surveillance from 2001 and mentions no relapse of the lymphoma.","uncertainty":"The surveillance schedule and its findings are not described in the summary.","eventDate":{"precision":"approximate","date":"2001-01-01","label":"from 2001 (year only, as the summary states it)"},"documentDate":"2022-05-18","recordedAt":"2026-10-29T06:26:31.197Z","certainty":"documented","recollection":false,"evidenceType":"medical-record","sourceReference":"medical-record dated 2022-05-18","relatedEvidenceIds":[],"review":{"role":"editorial","scope":"Editorial review only: transcription from the IMSS medical summary GIN/004 (18 May 2022) checked against the document; publication approved by the case owner. No clinical-specialist review.","at":"2026-10-30"}},{"id":"evt-e5c713e6-a","eventType":"test","title":"Laboratory studies requested, including tumor markers","summary":"On 2 October 2020 a general and digestive surgeon in private practice requested laboratory studies, among them the tumor markers CA-125, carcinoembryonic antigen, CA 19-9, alpha-fetoprotein and human chorionic gonadotropin.","findings":"Requested: complete blood count, 35-element blood chemistry, coagulation times, febrile agglutinins, CA-125, gynecologic hormonal profile, carcinoembryonic antigen, human chorionic gonadotropin, CA 19-9 and alpha-fetoprotein.","uncertainty":"The document is a request and contains no results. The results are in the preliminary laboratory report of 4 October 2020 (printed 5 October), registered separately: CA-125 531.4 U/mL flagged outside the reference interval, the other markers within reference.","eventDate":{"precision":"exact","date":"2020-10-02"},"documentDate":"2020-10-02","recordedAt":"2026-11-05T04:56:17.215Z","certainty":"documented","recollection":false,"evidenceType":"other","sourceReference":"other dated 2020-10-02","relatedEvidenceIds":[],"review":{"role":"editorial","scope":"Editorial review only: transcription from the original report checked against the document (identifiers omitted); publication approved by the case owner on 5 November 2026. No clinical-specialist review.","at":"2026-11-05"}},{"id":"evt-1ec6140f-9","eventType":"test","title":"Lower-abdominal and transvaginal ultrasound requested","summary":"The same request of 2 October 2020 asked for a lower-abdominal and a transvaginal ultrasound, with emphasis on the ovaries, uterus and tubes.","findings":"Both ultrasounds requested, «énfasis ovarios y utero y trompas».","uncertainty":"The document is a request and contains no results. Both ultrasounds were performed on 5 October 2020 at a private laboratory and are registered separately: ascites, uterus of normal sonographic appearance, endometrial thickening of 16 mm on the transvaginal study, left ovary not evaluable there.","eventDate":{"precision":"exact","date":"2020-10-02"},"documentDate":"2020-10-02","recordedAt":"2026-11-05T04:56:17.765Z","certainty":"documented","recollection":false,"evidenceType":"other","sourceReference":"other dated 2020-10-02","relatedEvidenceIds":[],"review":{"role":"editorial","scope":"Editorial review only: transcription from the original report checked against the document (identifiers omitted); publication approved by the case owner on 5 November 2026. No clinical-specialist review.","at":"2026-11-05"}},{"id":"evt-335f6c25-5","eventType":"test","title":"CT of the abdomen with contrast and plain chest CT requested","summary":"The same request of 2 October 2020 asked for a CT of the abdomen, plain and with oral and intravenous contrast, and a plain chest CT.","findings":"«TAC DE ABDOMEN SIMPLE Y CONTRASTE ORAL E IV, TAC DE TORAX SIMPLE».","uncertainty":"The document is a request and contains no results. The abdominal CT with contrast (5 to 6 October 2020) and the chest CT (6 October 2020) were performed and are registered separately: ascites of undetermined cause and bilateral pleural effusion, no masses or adenopathies reported. The IMSS summary of 2022 records the stage IV assignment on the basis of the pleural effusion.","eventDate":{"precision":"exact","date":"2020-10-02"},"documentDate":"2020-10-02","recordedAt":"2026-11-05T04:56:18.334Z","certainty":"documented","recollection":false,"evidenceType":"other","sourceReference":"other dated 2020-10-02","relatedEvidenceIds":[],"review":{"role":"editorial","scope":"Editorial review only: transcription from the original report checked against the document (identifiers omitted); publication approved by the case owner on 5 November 2026. No clinical-specialist review.","at":"2026-11-05"}},{"id":"evt-6cd7e733-1","eventType":"test","title":"Tumor markers: CA-125 at 531.4 U/mL, flagged outside the reference interval; CEA, CA 19-9, alpha-fetoprotein and beta-hCG within reference","summary":"Blood drawn on 4 October 2020 at a private hospital laboratory (preliminary report printed 5 October) gave a CA-125 of 531.4 U/mL against a reference interval of 0 to 35, flagged by the laboratory as outside the interval; carcinoembryonic antigen, CA 19-9, alpha-fetoprotein and beta-hCG were within their reference intervals.","findings":"CA 125 531.4 U/mL (reference 0.0-35.0, flagged *). Carcinoembryonic antigen 1.0 ng/mL (0.0-5.0). CA 19-9 4.5 U/mL (0.0-37.0). Alpha-fetoprotein 2.8 ng/mL (0.9-8.8). Beta-hCG 4.5 mIU/mL, reported negative (<5.0). Method: chemiluminescence.","uncertainty":"The report is marked preliminary and informative; the definitive signed report was not handed over. The IMSS summary of 2022 reports 'the tumor marker' negative on 26 January 2022 without naming it; this document does not establish which marker that was.","eventDate":{"precision":"exact","date":"2020-10-04"},"documentDate":"2020-10-05","recordedAt":"2026-11-05T05:00:49.997Z","certainty":"documented","recollection":false,"evidenceType":"laboratory-report","sourceReference":"laboratory-report dated 2020-10-05","relatedEvidenceIds":[],"review":{"role":"editorial","scope":"Editorial review only: transcription from the original report checked against the document (identifiers omitted); publication approved by the case owner on 5 November 2026. No clinical-specialist review.","at":"2026-11-05"}},{"id":"evt-ecddd963-0","eventType":"test","title":"General laboratory panel: blood count, coagulation, febrile agglutinins, chemistry, lipids, electrolytes and hormonal profile","summary":"The same preliminary report of 4 October 2020 covered a complete blood count, coagulation times, febrile agglutinins, a 24-element blood chemistry with lipids and electrolytes, and a gynecologic hormonal profile. The laboratory flagged as outside its reference intervals: erythrocytes 5.65 x10^6/uL, mean corpuscular volume 79.3 fL, globulins 3.7 g/dL, lactate dehydrogenase 238 U/L, cholesterol 260 mg/dL, triglycerides 199 mg/dL, total lipids 827 mg/dL and LDL 190 mg/dL. Hemoglobin, platelets, leukocytes, coagulation, kidney and liver values and electrolytes were within reference; febrile agglutinins were negative; the hormonal values were reported next to post-menopausal reference ranges.","findings":"Hemoglobin 14.6 g/dL, hematocrit 44.8%, platelets 350 x10^3/uL, leukocytes 6.7 x10^3/uL with neutrophils 63%, lymphocytes 27%, monocytes 6%, eosinophils 3%, basophils 1%; erythrocytes 5.65 (flagged, 4.20-5.40), MCV 79.3 fL (flagged, 80.0-99.0), MCH 25.8 pg, RDW 14.2%. aPTT 12.0 s (control 11.7), PT 32.8 s (control 30.4), INR 1.02. Febrile agglutinins all negative. Glucose 107 mg/dL, BUN 14.4, urea 30.7, creatinine 0.76, total proteins 7.2 g/dL, albumin 3.5, globulins 3.7 (flagged), calcium 8.7, phosphorus 3.96, magnesium 2.3, bilirubin total 0.44, alkaline phosphatase 100.2 U/L, AST 20.1, ALT 15.7, LDH 238 (flagged, 125-220), amylase 60, GGT 24.1, cholesterol 260 (flagged), triglycerides 199 (flagged), total lipids 827 (flagged), HDL 60, LDL 190 (flagged), VLDL 10.6, sodium 141, potassium 3.69, chloride 104, apolipoprotein A1 187.9, B 134.3. LH 23.3 mIU/mL, FSH 46.1 mIU/mL, prolactin 5.9 ng/mL, testosterone 23.6 ng/dL, estradiol 24.0 pg/mL, progesterone 0.15 ng/mL, total estrogens 37.2 pg/mL.","uncertainty":"Preliminary report; the definitive signed version was not handed over. The uric acid line carries no value. The request asked for a 35-element chemistry and the report is headed 24 elements. The flags are the laboratory's reference-interval comparisons, not a clinical interpretation.","eventDate":{"precision":"exact","date":"2020-10-04"},"documentDate":"2020-10-05","recordedAt":"2026-11-05T05:00:50.623Z","certainty":"documented","recollection":false,"evidenceType":"laboratory-report","sourceReference":"laboratory-report dated 2020-10-05","relatedEvidenceIds":[],"review":{"role":"editorial","scope":"Editorial review only: transcription from the original report checked against the document (identifiers omitted); publication approved by the case owner on 5 November 2026. No clinical-specialist review.","at":"2026-11-05"}},{"id":"evt-e924fb40-1","eventType":"test","title":"Pelvic ultrasound: ascites; uterus and ovaries without alterations","summary":"A pelvic ultrasound on 5 October 2020 at a private laboratory found abundant free fluid in the pelvis and both iliac fossae (ascites), a uterus of normal sonographic appearance and ovaries without alterations.","findings":"Uterus anteflexed, 69 x 28 x 44 mm, homogeneous myometrium without cystic or solid images; endometrium 8 mm, normal; cervix usual. Right ovary 20 x 15 x 18 mm (2.8 cc), left ovary 28 x 12 x 24 mm (4.1 cc), both of normal echogenicity without solid or cystic images. Abundant anechoic free fluid without clots. Impression: ascites, uterus of normal sonographic appearance, ovaries without alterations.","uncertainty":"An ultrasound describes appearance, not histology; the report does not name a cause for the fluid.","eventDate":{"precision":"exact","date":"2020-10-05"},"documentDate":"2020-10-05","recordedAt":"2026-11-05T04:59:20.167Z","certainty":"documented","recollection":false,"evidenceType":"imaging-report","sourceReference":"imaging-report dated 2020-10-05","relatedEvidenceIds":[],"review":{"role":"editorial","scope":"Editorial review only: transcription from the original report checked against the document (identifiers omitted); publication approved by the case owner on 5 November 2026. No clinical-specialist review.","at":"2026-11-05"}},{"id":"evt-7f14294a-3","eventType":"test","title":"Transvaginal ultrasound: ascites and endometrial thickening (16 mm); left ovary not evaluable","summary":"A transvaginal ultrasound the same day found abundant diffuse free fluid and a thickened endometrium of 16 mm, to be correlated clinically; the right ovary showed small diffuse follicles and the left ovary could not be evaluated by this method.","findings":"Uterus anteflexed, 67 x 41 x 44 mm, normal myometrium; endometrium central, high echogenicity, thickened at 16 mm, homogeneous; cervix usual. Right ovary 22 x 13 x 20 mm (3.1 cc) with small diffuse follicles; left ovary not evaluable. Abundant diffuse free fluid. Impression: ascites, endometrial thickening, to be correlated clinically.","uncertainty":"The two ultrasounds of the same day give slightly different uterine and ovarian measurements and the transvaginal study could not see the left ovary; neither establishes a cause.","eventDate":{"precision":"exact","date":"2020-10-05"},"documentDate":"2020-10-05","recordedAt":"2026-11-05T04:59:20.746Z","certainty":"documented","recollection":false,"evidenceType":"imaging-report","sourceReference":"imaging-report dated 2020-10-05","relatedEvidenceIds":[],"review":{"role":"editorial","scope":"Editorial review only: transcription from the original report checked against the document (identifiers omitted); publication approved by the case owner on 5 November 2026. No clinical-specialist review.","at":"2026-11-05"}},{"id":"evt-78539fbd-9","eventType":"test","title":"Abdominal CT with contrast: ascites of undetermined cause and bilateral pleural effusion; no masses or adenopathies reported","summary":"A CT of the abdomen with oral and intravenous contrast, performed on 5 October 2020 for ascites and abdominal pain and reported on 6 October, found an important amount of free fluid in the abdomen and pelvis and a bilateral pleural effusion with left predominance. Liver, spleen, pancreas, adrenals, kidneys, bowel and the uterus were reported normal, with no retroperitoneal, iliac or inguinal adenopathies.","findings":"Bilateral pleural effusion, left predominance, with segmental atelectasis in the left lower lobe. Solid organs without focal or diffuse lesions; no biliary dilatation; gallbladder without radiopaque stones; no adenopathies; uterus lateralized to the right with normal characteristics; important free fluid in the abdominal and pelvic cavity; bones and soft tissues normal. Conclusion: 1. Ascites of etiology to be determined. 2. Bilateral pleural effusion, left predominance.","uncertainty":"The scan found no tumor mass and left the cause of the ascites undetermined; the diagnosis came later from the pathology of 17 to 22 October 2020. The report lists reception on 5 October 2020 at 18:23 and printing on 6 October 2020.","eventDate":{"precision":"exact","date":"2020-10-05"},"documentDate":"2020-10-06","recordedAt":"2026-11-05T04:59:21.292Z","certainty":"documented","recollection":false,"evidenceType":"imaging-report","sourceReference":"imaging-report dated 2020-10-06","relatedEvidenceIds":[],"review":{"role":"editorial","scope":"Editorial review only: transcription from the original report checked against the document (identifiers omitted); publication approved by the case owner on 5 November 2026. No clinical-specialist review.","at":"2026-11-05"}},{"id":"evt-4072f7cb-e","eventType":"test","title":"Chest CT: bilateral pleural effusion with passive atelectasis, moderate ascites, no suspicious lung lesions","summary":"A chest CT without contrast on 6 October 2020 at a private imaging center found a bilateral pleural effusion, mild on the right and moderate on the left, with passive atelectasis; moderate ascites in the upper abdomen; a 6 mm calcified granuloma in the left upper lobe; and no suspicious lung lesions, lymphadenopathy or bone lesions.","findings":"Heart and mediastinal vessels normal; no mediastinal, hilar or axillary lymphadenopathy; thyroid normal. Lungs without apparent alteration; 6 mm calcified granuloma, left upper lobe. Bilateral pleural effusion, mild right, moderate left, passive atelectasis of left predominance. No osteoblastic or osteoclastic lesions. Moderate ascites in the upper abdomen; hyperdense gallbladder content attributed to vicarious excretion of contrast from previous studies, and contrast in the colon. Conclusion: no acute or infectious intrathoracic pathology at the time of the study.","uncertainty":"The report does not characterize the effusion; its cause was established by the pleural fluid cytology and pleural biopsy taken on 17 October 2020.","eventDate":{"precision":"exact","date":"2020-10-06"},"documentDate":"2020-10-06","recordedAt":"2026-11-05T04:59:21.853Z","certainty":"documented","recollection":false,"evidenceType":"imaging-report","sourceReference":"imaging-report dated 2020-10-06","relatedEvidenceIds":[],"review":{"role":"editorial","scope":"Editorial review only: transcription from the original report checked against the document (identifiers omitted); publication approved by the case owner on 5 November 2026. No clinical-specialist review.","at":"2026-11-05"}},{"id":"evt-d60d68f5-1","eventType":"test","title":"Diagnosis of ovarian cancer, stage IV (pleural effusion), poorly differentiated adenocarcinoma","summary":"Ovarian cancer, stage IV because of a pleural effusion, with a diagnosis of poorly differentiated adenocarcinoma, as stated in the 2022 medical summary.","findings":"Stage IV assigned on the basis of a pleural effusion; histology reported as poorly differentiated adenocarcinoma. The summary presents the laparoscopy of 17 October 2020 as a consequence of this diagnosis.","uncertainty":"The date of diagnosis, the histological subtype beyond 'poorly differentiated adenocarcinoma', biomarkers and how the effusion was confirmed are not stated.","eventDate":{"precision":"approximate","date":"2020-10-17","label":"shortly before the laparoscopy of 17 October 2020 (date not stated)"},"documentDate":"2022-05-18","recordedAt":"2026-10-29T06:26:32.018Z","certainty":"documented","recollection":false,"evidenceType":"medical-record","sourceReference":"medical-record dated 2022-05-18","relatedEvidenceIds":[],"review":{"role":"editorial","scope":"Editorial review only: transcription from the IMSS medical summary GIN/004 (18 May 2022) checked against the document; publication approved by the case owner. No clinical-specialist review.","at":"2026-10-30"}},{"id":"evt-99f7054e-a","eventType":"procedure","title":"Laparoscopy at another institution","summary":"Laparoscopy performed on 17 October 2020 at an institution other than the IMSS Oncology Hospital, according to the medical summary.","findings":"«fuera del hospital»: performed outside the IMSS Oncology Hospital, on 17 October 2020.","uncertainty":"The institution, the findings of the laparoscopy and whether tissue was taken are not stated.","eventDate":{"precision":"exact","date":"2020-10-17"},"documentDate":"2022-05-18","recordedAt":"2026-10-29T06:26:32.797Z","certainty":"documented","recollection":false,"evidenceType":"medical-record","sourceReference":"medical-record dated 2022-05-18","relatedEvidenceIds":[],"review":{"role":"editorial","scope":"Editorial review only: transcription from the IMSS medical summary GIN/004 (18 May 2022) checked against the document; publication approved by the case owner. No clinical-specialist review.","at":"2026-10-30"}},{"id":"evt-468a8ce7-d","eventType":"test","title":"Pleural fluid cytology positive for malignancy; pleural biopsy with metastatic adenocarcinoma","summary":"Pleural fluid and a fragment of pleura taken on 17 October 2020 were reported on 22 October 2020 by a private pathologist: the cytology was positive for malignancy and the pleural biopsy showed metastatic infiltration by adenocarcinoma with zones of mucinous aspect.","findings":"70 cc of reddish pleural fluid (ten Papanicolaou slides) and a 4 x 1 x 0.2 cm tissue fragment. Cytology: small groups of epithelial cells with oval and cuboidal nuclei and coarse, poorly distributed chromatin on a dense proteinaceous background; positive for malignancy. Histology: pleura with abundant clusters of cells in nests, loss of the nucleus-cytoplasm ratio, dense coarse chromatin, some atypical mitoses, mucinous aspect. Diagnoses: pleural fluid cytology positive for malignancy; pleural biopsy with metastatic infiltration by adenocarcinoma (zones of mucinous aspect).","uncertainty":"The report states the primary site only as 'metastatic adenocarcinoma'; no immunohistochemistry is mentioned. The collection date, 17 October 2020, coincides with the laparoscopy recorded in the IMSS summary, but this report does not name the procedure.","eventDate":{"precision":"exact","date":"2020-10-17"},"documentDate":"2020-10-22","recordedAt":"2026-11-05T04:59:22.396Z","certainty":"documented","recollection":false,"evidenceType":"laboratory-report","sourceReference":"laboratory-report dated 2020-10-22","relatedEvidenceIds":[],"review":{"role":"editorial","scope":"Editorial review only: transcription from the original report checked against the document (identifiers omitted); publication approved by the case owner on 5 November 2026. No clinical-specialist review.","at":"2026-11-05"}},{"id":"evt-3f4c764d-c","eventType":"test","title":"Diaphragmatic dome biopsy reported compatible with papillary serous cystadenocarcinoma of the ovary","summary":"A biopsy of the diaphragmatic dome, reported on 21 October 2020 by a private pathologist, showed infiltration by a malignant epithelial neoplasm forming glands and papillae, compatible with papillary serous cystadenocarcinoma of the ovary.","findings":"Irregular fragment 1.4 x 1 x 0.7 cm. Dense fibroconnective tissue with hemorrhagic zones and fibrinous surfaces, infiltrated by a malignant epithelial neoplasm forming glands and dispersed papillae, some with tortuous lumen, lined by atypical hyperchromatic epithelium, without mucin; associated chronic lymphocytic inflammation. Diagnosis: compatible with papillary serous cystadenocarcinoma of the ovary; the report refers to companion reports 730 and 728.","uncertainty":"The date the biopsy was taken and the procedure are not stated; 21 October 2020 is the date of the report. Reports 730 and 728 were not handed over. 'Compatible with' is the pathologist's wording; no immunohistochemistry is mentioned. The IMSS summary of 2022 records the histology as poorly differentiated adenocarcinoma.","eventDate":{"precision":"exact","date":"2020-10-21"},"documentDate":"2020-10-21","recordedAt":"2026-11-05T04:59:22.998Z","certainty":"documented","recollection":false,"evidenceType":"laboratory-report","sourceReference":"laboratory-report dated 2020-10-21","relatedEvidenceIds":[],"review":{"role":"editorial","scope":"Editorial review only: transcription from the original report checked against the document (identifiers omitted); publication approved by the case owner on 5 November 2026. No clinical-specialist review.","at":"2026-11-05"}},{"id":"evt-9e796758-1","eventType":"administration","title":"Adjuvant chemotherapy, four cycles, completed","summary":"Adjuvant chemotherapy, four cycles, administered at the IMSS Oncology Hospital and completed on 10 March 2021, according to the medical summary.","findings":"Four cycles administered at the hospital that issued the summary; the last one ended on 10 March 2021.","uncertainty":"Drugs, doses, schedule and the start date are not stated in the summary; no regimen is named here.","eventDate":{"precision":"exact","date":"2021-03-10","label":"date the fourth and last cycle ended"},"documentDate":"2022-05-18","recordedAt":"2026-10-29T06:26:33.542Z","certainty":"documented","recollection":false,"evidenceType":"medical-record","sourceReference":"medical-record dated 2022-05-18","relatedEvidenceIds":[],"review":{"role":"editorial","scope":"Editorial review only: transcription from the IMSS medical summary GIN/004 (18 May 2022) checked against the document; publication approved by the case owner. No clinical-specialist review.","at":"2026-10-30"}},{"id":"evt-80d9ee42-5","eventType":"procedure","title":"Interval cytoreductive surgery, reported as optimal","summary":"Interval cytoreductive surgery on 17 May 2021, reported as optimal: hysterectomy, bilateral salpingo-oophorectomy, omentectomy and bilateral pelvic lymphadenectomy, without complications.","findings":"Optimal cytoreduction consisting of hysterectomy, bilateral salpingo-oophorectomy, omentectomy and bilateral pelvic lymphadenectomy; no complications reported.","uncertainty":"Residual disease measurement and the pathology of the specimens are not stated.","eventDate":{"precision":"exact","date":"2021-05-17"},"documentDate":"2022-05-18","recordedAt":"2026-10-29T06:26:34.301Z","certainty":"documented","recollection":false,"evidenceType":"medical-record","sourceReference":"medical-record dated 2022-05-18","relatedEvidenceIds":[],"review":{"role":"editorial","scope":"Editorial review only: transcription from the IMSS medical summary GIN/004 (18 May 2022) checked against the document; publication approved by the case owner. No clinical-specialist review.","at":"2026-10-30"}},{"id":"evt-36c2d907-f","eventType":"outcome","title":"Hospital discharge after the cytoreduction","summary":"Discharged on 19 May 2021 after the cytoreduction, without complications, according to the medical summary.","findings":"Discharged two days after the surgery; the summary reports no complications.","uncertainty":"Nothing further about the postoperative course is stated.","eventDate":{"precision":"exact","date":"2021-05-19"},"documentDate":"2022-05-18","recordedAt":"2026-10-29T06:26:35.087Z","certainty":"documented","recollection":false,"evidenceType":"medical-record","sourceReference":"medical-record dated 2022-05-18","relatedEvidenceIds":[],"review":{"role":"editorial","scope":"Editorial review only: transcription from the IMSS medical summary GIN/004 (18 May 2022) checked against the document; publication approved by the case owner. No clinical-specialist review.","at":"2026-10-30"}},{"id":"evt-9d42282d-4","eventType":"test","title":"Tumor marker reported negative at the gynecologic-oncology evaluation","summary":"At the gynecologic-oncology evaluation of 26 January 2022 the tumor marker was reported negative, according to the medical summary.","findings":"«su marcador tumoral fue negativo»; reported at the evaluation of 26 January 2022.","uncertainty":"The marker is not named and no value or reference range is given.","eventDate":{"precision":"exact","date":"2022-01-26"},"documentDate":"2022-05-18","recordedAt":"2026-10-29T06:26:35.737Z","certainty":"documented","recollection":false,"evidenceType":"medical-record","sourceReference":"medical-record dated 2022-05-18","relatedEvidenceIds":[],"review":{"role":"editorial","scope":"Editorial review only: transcription from the IMSS medical summary GIN/004 (18 May 2022) checked against the document; publication approved by the case owner. No clinical-specialist review.","at":"2026-10-30"}},{"id":"evt-732aa5d1-b","eventType":"outcome","title":"Evaluation of 26 January 2022: stable, no evidence of recurrence, ECOG 0","summary":"At the last gynecologic-oncology evaluation recorded in the summary (26 January 2022) she reported no symptoms, was considered stable with no evidence of recurrence, and had an ECOG performance status of 0.","findings":"Asymptomatic by her own account; considered stable, without data of recurrence. Physical examination: conscious, ECOG 0, abdomen soft and depressible, non-tender, no tumor activity.","uncertainty":"Imaging at that visit is not described; the summary records the examination and the tumor marker only.","eventDate":{"precision":"exact","date":"2022-01-26"},"documentDate":"2022-05-18","recordedAt":"2026-10-29T06:26:36.633Z","certainty":"documented","recollection":false,"evidenceType":"medical-record","sourceReference":"medical-record dated 2022-05-18","relatedEvidenceIds":[],"review":{"role":"editorial","scope":"Editorial review only: transcription from the IMSS medical summary GIN/004 (18 May 2022) checked against the document; publication approved by the case owner. No clinical-specialist review.","at":"2026-10-30"}},{"id":"evt-c084da24-1","eventType":"outcome","title":"No evidence of disease, stable, as of the medical summary","summary":"As of the medical summary of 18 May 2022, the patient was reported without evidence of disease and stable.","findings":"«Paciente actualmente sin datos de enfermedad, estable.» This is the status stated on the date of the summary.","uncertainty":"The summary does not say which findings support the statement beyond the 26 January 2022 evaluation.","eventDate":{"precision":"exact","date":"2022-05-18","label":"date of the medical summary"},"documentDate":"2022-05-18","recordedAt":"2026-10-29T06:26:38.117Z","certainty":"documented","recollection":false,"evidenceType":"medical-record","sourceReference":"medical-record dated 2022-05-18","relatedEvidenceIds":[],"review":{"role":"editorial","scope":"Editorial review only: transcription from the IMSS medical summary GIN/004 (18 May 2022) checked against the document; publication approved by the case owner. No clinical-specialist review.","at":"2026-10-30"}},{"id":"evt-d119b0d2-5","eventType":"outcome","title":"Death at home on 7 May 2026; the certificate records a hydro-electrolytic imbalance due to ovarian cancer","summary":"The patient died at home in Mexico City on 7 May 2026, with medical attention during the illness, according to the death certificate certified that day by a physician. The certificate records the cause of death as a hydro-electrolytic imbalance (interval of about one day) due to ovarian cancer (interval of about six years), and lists non-Hodgkin lymphoma (about 26 years) as another significant condition that did not lead to the death. The death is recorded as due to illness, not accidental or violent; no necropsy was performed.","findings":"Place of death: home. Date and time: 7 May 2026, 12:35. Medical attention during the illness before death: yes. Type of death: illness; accidental or violent: no. Part I of the cause chain: a) hydro-electrolytic imbalance, 1 day; b) ovarian cancer, 6 years. Part II (other significant conditions): non-Hodgkin lymphoma, 26 years. Necropsy: no. Brain death: no. Pregnancy-related section: not applicable. Certified by a physician other than the treating physician ('otra/o médica/o'), certification dated 7 May 2026.","uncertainty":"The certificate is the only record in this case after the medical summary of 18 May 2022, which reported no evidence of disease; the course of the disease between those dates (recurrence, treatments, care at the end of life) is not documented here. The cause chain is the certifying physician's statement on the sheet, without a necropsy and without the clinical records that support it. The question on surgery in the last four weeks carries no date or reason, and its yes/no answer is not legible on the photograph. The intervals ('1 day', '6 years', '26 years') are as printed, rounded by the certifier. Editorial comparison, not stated on the sheet: the printed intervals agree with the diagnosis of ovarian cancer in October 2020 and of non-Hodgkin lymphoma in 2000 recorded earlier in this case.","eventDate":{"precision":"exact","date":"2026-05-07","label":"date and time of death as certified: 7 May 2026, 12:35"},"documentDate":"2026-05-07","recordedAt":"2026-11-05T07:28:22.964Z","certainty":"documented","recollection":false,"evidenceType":"other","sourceReference":"other dated 2026-05-07","relatedEvidenceIds":[],"review":{"role":"editorial","scope":"Editorial review only: transcription from the death certificate data sheet checked against the photograph handed over by the case owner (identifiers omitted); publication approved by the case owner on 5 November 2026. No clinical-specialist review.","at":"2026-11-05"}},{"id":"evt-46fc6dd7-4","eventType":"appointment","title":"Follow-up appointment with a control CT scan","summary":"A follow-up visit was scheduled about four months after the 26 January 2022 evaluation, with a control CT scan, according to the medical summary.","findings":"«se citó en 4 meses con una tomografía de control». Whether the visit took place is not stated in this document.","uncertainty":"Exact date and whether the CT was performed are not stated.","eventDate":{"precision":"unknown","label":"about four months after 26 January 2022, with a control CT (exact date not stated)"},"documentDate":"2022-05-18","recordedAt":"2026-10-29T06:26:37.410Z","certainty":"documented","recollection":false,"evidenceType":"medical-record","sourceReference":"medical-record dated 2022-05-18","relatedEvidenceIds":[],"review":{"role":"editorial","scope":"Editorial review only: transcription from the IMSS medical summary GIN/004 (18 May 2022) checked against the document; publication approved by the case owner. No clinical-specialist review.","at":"2026-10-30"}},{"id":"evt-3856b4ce-6","eventType":"test","title":"The physician's explanation of the diagnosis, as the family recalls it","summary":"As the family recalls the physician's explanation: an ovarian cancer that was hard to localize, found in the uterus rather than in the ovaries, producing ascites whose fluid was already causing a pleural effusion. Surgery to remove the ovaries and the surrounding tissue was suggested, with a biopsy after the operation.","findings":"Family recollection of a verbal explanation: cancer of ovarian origin barely localizable, located in the uterus (outside the ovaries); it causes ascites and the fluid already produces a pleural effusion; surgery suggested to remove the ovaries and surroundings, with a post-operative biopsy.","uncertainty":"This is the family's recollection of what a physician said, not a written diagnosis. The physician, the date, and whether «localizable en útero» reflects the physician's words or the family's understanding are not established. The written IMSS summary of 2022 records stage IV ovarian cancer by pleural effusion, poorly differentiated adenocarcinoma, and a laparoscopy on 17 October 2020.","eventDate":{"precision":"unknown","label":"date not stated; the family associates it with the studies requested on 2 October 2020"},"documentDate":null,"recordedAt":"2026-11-05T04:56:18.791Z","certainty":"probable","recollection":true,"evidenceType":"family-recollection","sourceReference":"family-recollection","relatedEvidenceIds":[],"review":{"role":"editorial","scope":"Editorial review only: family recollection transcribed as typed by the case owner, labelled as recollection; publication approved by the case owner on 5 November 2026. No clinical-specialist review.","at":"2026-11-05"}}],"evidence":[],"notes":[]}