Aggressive ovarian psammocarcinoma: a case report

Serous psammocarcinoma is a rare form of ovarian carcinoma characterized by massive psammoma body formation. We report a new case of aggressive ovarian psammocarcinoma with omental and peritoneal implants.     

Primary peritoneal psammocarcinoma: a case presenting synchronously with bowel carcinoma

BACKGROUND: Psammocarcinomas are rare epithelial tumors usually originating from the ovarian surface epithelium or the peritoneum. In our case, a peritoneal psammocarcinoma was incidental surgical finding during laparotomy. CASE: An 83-year-old woman underwent surgery for bowel obstruction. Intraoperativelly, a bowel carcinoma was documented. Notable were numerous small disseminated peritoneal nodules that studded the omentum and bowel serosa. At reintervention, similar nodules were observed in the serosal surface of the two ovaries, uterus, left salpinx, and omentum. The nodules corresponded histologically to psammocarcinoma of peritoneal origin. Despite not receiving adjuvant treatment, the patient is still alive 53 months following the second operation, without signs of metastases or disease recurrence. CONCLUSION: Though unpredictable, psammocarcinomas might run an indolent course, and decisions regarding management should be individualized.     

Serous psammocarcinoma of the ovary: a case report and review of literature

BACKGROUND: Serous psammocarcinoma is a form of ovarian carcinoma, characterized by massive psammoma body formation, invasiveness, and low-grade cytological features. We reported a new bilateral case of serous psammocarcinoma. We also reviewed the literature in order to delineate clinical, pathological, and prognostic features of this rare neoplasm. CASE HISTORY: A 66-year-old white woman was admitted to our Institution for a voluminous abdomino-pelvic mass, which was suspected to be a leiomyoma of the uterus. Abdominal computed tomography scan revealed a heavily calcified abdominopelvic mass with cystic areas. The origin of this lesion was unclear in diverse scanning of computed tomography. Elevated serum CA-125 levels suggested the eventuality of an ovarian neoplasm. Thus, the patient underwent an exploratory laparotomy. Intraoperatory findings showed two ovarian calcified lesions. The surface of omentum was covered with a white nodule. Pathological findings were consistent with serous psammocarcinoma with invasive implant of the omentum. CONCLUSION: Serous psammocarcinoma is a rare form of ovarian carcinoma with only 13 cases reported in literature. Patient's age can range from 18 to 76 years. Prognostic factors suggest that this neoplasm has more favorable prognosis than usual serous carcinomas. It is important to differentiate these two neoplasms and other pelvic mass, such as calcified leiomyoma.     

Primary peritoneal psammocarcinoma: A case presenting with an upper abdominal mass and elevated CA-125.

Primary peritoneal serous adenocarcinoma with predominating psammoma bodies, psammocarcinoma, is a very rare tumor with only seven cases documented in the English literature. Pathological classification of this entity was established in 1990 and clinical behavior of this tumor is uncertain. Based on limited data these tumors appear to behave similarly to low malignant potential tumors of the ovary. This case describes a 59-year-old woman who underwent exploratory laparotomy for a large upper abdominal cystic mass. Findings included a large tumor mass involving the gastrocolic omentum and dense small bowel adhesions. The patient had normal ovaries and was debulked to no macroscopic disease. Final pathologic diagnosis confirmed a stage IIIC primary peritoneal psammocarcinoma. The patient has received no adjunctive therapy and is without evidence of disease 2 years after surgery. Primary peritoneal psammocarcinoma is a neoplasm which can mimic serous adenocarcinoma of the ovary. In contrast, primary peritoneal psammocarcinoma appears to behave in an indolent fashion. Primary surgical debulking should be attempted, while the utility of postoperative chemotherapy remains unknown.     

Psammocarcinoma of the ovary: a case report and review of the literature

Psammocarcinoma is a rare form of serous carcinoma of the ovary, associated with extensive psammoma body formation and invasion of surrounding structures. We report the case of a 63-year-old woman who presented with a highly calcified abdominopelvic mass and a raised CA-125 marker and who, following a full staging laparotomy, was diagnosed with stage IIIB ovarian psammocarcinoma. Serous ovarian psammocarcinoma is characterized by massive psammoma body formation, and despite the limited number of cases reported, it appears that the clinical prognosis is much more favorable than for the usual serous carcinomas and is similar to that of serous borderline lesions of the ovary. A summary of all the reported cases is provided to highlight the clinical and prognostic features of this rare tumor.     

Carcinoma psamomatoso ovárico bilateral

We report the case of a 53-year-old woman who had received neoadjuvant chemotherapy for peritoneal carcinomatosis of probable ovarian origin and who was referred to our department for evaluation of surgical rescue. After good response to treatment, surgery was performed and a pathological diagnosis of bilateral ovarian psammocarcinoma with multiple implants in other structures was established. We wish to highlight the rarity of the diagnosis of this entity and the scarcity of scientific evidence on its treatment.     

Enormous cystic tumor of peritoneal psammocarcinoma exhibiting complete response to Cisplatin and cyclophosphamide after suboptimal cytoreduction: case report and review of the literature

Psammocarcinoma is a serous peritoneal tumor arising from the ovary or the peritoneum and characterized by low-grade nuclear features, extensive psammoma bodies, and invasiveness. Only 62 cases have ever been documented, 30 primary peritoneal and 32 primary ovarian, most of which presented as small tumors. Adjuvant therapies, including chemotherapy and radiation, were performed in 12 of the primary peritoneal cases, without any clear evidence of benefit. We present a case of an unusually large primary peritoneal psammocarcinoma with unexpected outcome. The patient was a 38-year-old woman with a tumor of the peritoneum which adhered densely to the uterus and rectum and developed into the intra-abdominal cavity and retroperitoneal space. After adhesiolysis of the tumor and rectum, suboptimal surgical reduction left a 4 cm × 2 cm tumor segment. Postoperative chemotherapy, consisting of paclitaxel and carboplatin (TC) for 1 course, and cyclophosphamide and cisplatin (CP) for 5 courses, was conducted. The residual tumor responded completely to the chemotherapy and the patient is alive today, with no evidence of disease 15 months after the surgery. Our case implies that CP therapy is a potential regimen of postoperative remission-induction therapy for suboptimally resected primary peritoneal psammocarcinoma.     

Serous psammocarcinoma of the ovary and peritoneum

We report 11 cases of serous psammocarcinoma, a rare variant of serous carcinoma characterized by massive psammoma body formation and low-grade cytological features. The patients ranged in age from 36 to 76 (mean of 57) years. The tumors were stage three in every case (three stage IIIA, seven stage IIIB, and one stage IIIC). Eight of the patients had ovarian psammocarcinomas with ovarian tumors measuring 5-22 (mean of 11) cm in diameter; the other three patients had primary peritoneal psammocarcinomas. The surfaces of the ovarian tumors were smooth and intact in seven of eight ovarian psammocarcinomas. Cysts were present in six of eight ovarian tumors, and the solid portions were typically gritty or granular. Necrosis was not seen. Microscopically there was destructive invasion of ovarian stroma or vascular invasion in the ovarian tumors; the extraovarian tumor implants were invasive of intraperitoneal viscera in five cases. The epithelium was arranged in small nests with no areas of solid epithelial proliferation, and at least 75% of the epithelial nests were associated with psammoma body formation. No more than moderate nuclear atypicality was identified in any case. No mitotic figures were found in 10 of the tumors, with a single mitotic figure identified in the other tumor. Follow-up data for more than 1 year was available for six patients, with two patients lost to follow-up and three patients followed without evidence of recurrence for less than 1 year. One patient died of tumor 6 1/2 years after presentation, and five patients were alive without evidence of recurrent tumor 3-10 (mean of 8.3) years after presentation. Although based on a small number of cases, these data suggest that the clinical behavior of psammocarcinoma more closely resembles that of borderline serous tumors than of serous carcinomas of the usual type, following a protracted course and being associated with a relatively favorable prognosis.     

Serous psammocarcinoma of the ovary: an unusual finding

BACKGROUND: Serous psammocarcinoma of the ovary is a rare and infrequently described variant of ovarian cancer, characterized histologically by the pervasive presence of psammoma bodies. The risk of recurrent disease following surgical resection is low. CASE HISTORY: A 70-year-old patient was admitted to the emergency room after falling at home. CT evaluation revealed a pelvic mass and free fluid in the abdomen and pelvis. Her serum CA-125 level was greatly elevated. The patient underwent an abdominal hysterectomy with bilateral salpingo-oophorectomy. Histologic examination revealed serous psammocarcinoma of the ovary. CONCLUSION: Psammocarcinoma is a rare form of ovarian cancer associated with a favorable prognosis. However, the rare incidence of this disease and inconsistent biological behavior can confound the diagnosis for the treating physician.     

Ovarian cancer, diagnosed with PET, with bilateral inguinal lymphadenopathy as primary presenting sign

BACKGROUND: Ovarian cancer groin lymph nodes metastases are rare. Only one case of disease spread isolated to the groins has been reported in the English literature. We report the case of a patient with bilateral inguinal lymphadenopathy due to tumor metastases and in which tumor origin was diagnosed using [(18)F]fluorodeoxyglucose positron emission tomography (PET). CASE REPORT: This is the first case of bilateral groin lymph nodes as sole site of metastases from ovarian cancer. Primary origin was identified using PET. CONCLUSIONS: In rare cases, the ovaries can directly metastasis to the groin even in a relatively initial tumor growth phase. PET may play a role in the diagnosis of occult ovarian tumors.     

Normal-sized ovarian papillary serous carcinoma: a case report

A normal-sized ovarian papillary serous carcinoma is rare. We present the case of a 46-year-old woman with progressive abdominal fullness of one week's duration. The medical evaluation revealed abdominal carcinomatosis with normal-sized ovaries and an elevated serum CA-125 level of 147,365.8 U/ml. Cytoreductive surgery (hysterectomy, bilateral salpingo-oophorectomy, omentectomy, lymphadenectomy, infracolic omentectomy, peritoneal biopsy, washing cytology, and appendectomy) was performed. The histologic examination revealed an ovarian serous papillary carcinoma. Adjuvant chemotherapy was administered. The serum CA-125 level decreased after completion of treatment. Normal-sized ovarian serous surface papillary carcinomas should be kept in mind as an origin of disease in patients who have peritoneal carcinomatosis, which sometimes is a diagnostic dilemma of the disease source. We report this case to emphasize the clinical symptoms and importance of the early and accurate diagnosis of a normal-sized ovarian papillary serous carcinoma.     

Axillary lymph node metastasis from serous ovarian cancer: a case report and review of the literature

Introduction  The symptoms and findings of ovarian cancer are parallel with the degree of intra-abdominal expansion of the tumor. Metastases in the early stage occur by peritoneal fluid’s tracking via the circulatory system. Renal and cerebral metastases of ovarian cancer have been previously reported, but axillary lymph node metastasis is quite rare. Axillary lymph node metastasis usually occurs in the advanced stage. Materials and methods  We present a 47-year-old female who had applied adjuvant chemotherapy following cyto-reductive surgery because of stage 3C ovarian cancer. Axillary lymph node metastasis was detected in the postoperative 32 months. Conclusion  As tumors in axillary lymph nodes are found in patients with an ovarian carcinoma, the treatment is also so important too. Metastasis to the breast be differentiated accurately from primary breast cancer, because prognosis and treatment differ significantly. Accurate diagnosis of these metastases may allow more appropriate theraphy such as chemotherapy and prevent the patient from an unnecessary major breast surgery.     

"Malignant struma ovarii" with peritoneal metastasis: report of two cases

Malignant struma ovarii with metastasis in an extremely rare form of ovarian carcinoma. We describe two cases of malignant struma ovarii that demonstrated widespread peritoneal metastases. In the second case described here, furthermore, the tumor recurred II years later in the contralateral ovary and omentum, while the primary tumor previously was pure struma ovarii with no evidence of metastasis. Although thyroid tumors themselves are characterized by a long latent interval, patients with benign thyroid tissue arising in nonthyroidal organs with or even without dissemination should be managed with caution and need appropriate long-term follow-up after the initial surgery.     

Long-term survival in an ovarian cancer patient with brain metastases

BACKGROUND: Central nervous system (CNS) metastases from ovarian adenocarcinoma are uncommon. The long-term prognosis for these patients is poor, with studies reporting a mean survival of less than 12 months. CASE: We present a case involving a 57-year-old woman diagnosed and treated for primary ovarian cancer in 1994. She underwent optimal cytoreductive surgery and received adjuvant chemotherapy. In 1996, she was diagnosed with a right cerebellar metastatic lesion, and treated with surgery and whole-brain radiotherapy. She is currently 7 years post-treatment of her brain metastasis without evidence of recurrent disease. CONCLUSION: Brain metastases from primary ovarian cancer are a relatively rare finding. These patients have a poor prognosis, with studies reporting a mean survival of 12 months. However, the patient in this report remains disease-free since her treatment for metastatic disease. Aggressive surgical and radiation treatment for patients with isolated CNS metastases is reasonable.     

A Case of Ovarian Cancer with Metastasis to the Sternum and Costae

This report describes a case of ovarian cancer with metastases to the sternum and costae. Sternal and costal metastases from ovarian cancer are extremely rare. We introduce a case of sternal metastasis from ovarian cancer that occurred over 7 years after initial diagnosis which was successfully treated with local resection and systemic chemotherapy. Possible metastatic routes are discussed.     

Conservative surgery in a young patient with peritoneal psammocarcinoma.

Psammocarcinoma is a rare epithelial neoplasm of the ovary and peritoneum. The reported management of patients with this tumor includes radical surgery and chemotherapy. We report the case of a young woman with metastatic psammocarcinoma treated with conservative surgery who is alive 6.5 years following positive second-look laparotomy.     

Well-differentiated serous ovarian carcinoma presenting as a breast mass: a case report and flow cytometric DNA study

Ovarian carcinoma metastatic to the breast is uncommon. We report a rare occurrence of ovarian carcinoma that initially presented as a breast mass. Complete examination revealed bilateral ovarian tumors with widespread peritoneal and abdominal disease. One of the ovarian tumors was a papillary serous tumor of low malignant potential, and the other was a well-differentiated papillary serous carcinoma. Although the neoplasm within the breast resembled serous ovarian carcinoma with psammoma bodies, the initial presentation and the presence of an apparent intraductal component created a potential for its misdiagnosis as a primary breast carcinoma. Using DNA flow cytometry, we demonstrated the relationship between the breast, lymph node, and peritoneal metastases and the serous carcinoma, thereby supporting the histologic diagnoses.     

Anaplastic carcinoma arising in an ovarian mucinous cystadenocarcinoma in a 17-year-old female

BACKGROUND: Anaplastic carcinoma arising within a mucinous ovarian neoplasm is rare, with only about 30 reported cases. Reported cases have given a broad age range, ranging from 17 to 72 years of age, but occurrence in adolescents is exceptional, with only a few cases reported. CASE: We report a case of anaplastic carcinoma arising in a mucinous cystadenocarcinoma in a 17-year-old female who presented with severe abdominal pain, an unusual symptom for an ovarian malignancy in the postmenopausal patient, but not in the adolescent. The patient had widespread metastases at the time of presentation, consistent with the aggressive behavior of this neoplasm. CONCLUSIONS: This case illustrates that, although rare, epithelial ovarian malignancy is in the differential diagnosis of abdominal pain in an adolescent.     

Serous psammocarcinoma of the ovary and peritoneum: two case reports and review of the literature

Serous psammocarcinoma (SPC) is a rare variant of ovarian carcinoma or peritoneum that may present with features consistent with malignancy, or tumors of low malignant potential. This is two-case reports of a SPC of the ovary and peritoneum and review of the literature. A 41-year-old woman was referred to our clinic for adnexal mass. Ultrasonography revealed endometrioma. Endometriotic cyst excision and sacrouterine biopsy were performed via laparoscopy. Histological examination revealed endometrioma and psammocarcinoma of the peritoneum. Staging laparotomy was performed. She received six courses of chemotherapy. She has no evidence of disease after 6 years from surgical therapy and chemotherapy. A 50-year-old woman presented with pelvic pain and discomfort in the upper abdomen with nausea and emesis. CT scan showed extensive tumor in the lower abdomen, and free fluid in the abdomen and pelvis which appeared to be an ovarian tumor. She underwent a laparotomy and a right and left ovarian tumor measuring about 20 × 15 and 8 × 8 cm, respectively, were seen. Staging procedure was performed. Microscopic examination revealed SPC of the ovary. Chemotherapy was planned. The biologic behavior of this disease remains unresolved. Primary surgical debulking should be attempted, while the utility of postoperative chemotherapy remains unknown.     

HPV induced ovarian squamous cell carcinoma: case report and review of the literature

Background Ovarian squamous cell carcinoma is usually derived from a teratoma, a Brenner tumour or endometriosis. Association with an HPV infection is rare. Case A fourth case of ovarian squamous cell cancer associated with HR-HPV is presented. Debulking for stage IIIc ovarian squamous cell cancer was performed and she received adjuvant combination chemotherapy. She developed bone metastases and received radiotherapy. The Progression of these metastases and the newly developed metastases did not respond to an oral tyrosine kinase inhibitor (gefitinib). Conclusion The development of bone metastases in association with an ovarian squamous cell carcinoma is a rare finding, and it did not respond to treatment with a tyrosine kinase. A review of literature is presented.