Hepatoid carcinoma of the ovary: a case report.

A case of a right ovarian tumor in a 64-year-old patient showing high blood levels of alpha-fetoprotein (AFP) is reported. Histologically, the tumor resembled hepatocellular carcinoma with hyaline globules. Localization of AFP was detected by the immunoperoxidase method. Electron microscopically, the rough-surfaced endoplasmic reticulum had developed into a meshwork, and the mitochondria were present within this meshwork. Because a transition from adenocarcinoma to a region resembling hepatocellular carcinoma was observed, this tumor was considered to originate as a common epithelial carcinoma. In the blood, 67% of the AFP was bound with concanavalin A (Con A), and the fraction pattern obtained by lentil agglutinin affinity chromatography (LCA) was of the germ cell type. From these results, the current case may be labeled clinicopathologically a hepatoid carcinoma of the ovary as described by Ishikura and Scully.     

Hepatoid carcinoma of the ovary and management

The designation'hepatoid carcinoma' has been introduced as a unique type of carcinoma that arises outside the liver but resembles, to a considerable extent, hepatocellular carcinoma both histologically and immunohistochemically in its staining for alpha-fetoprotein (AFP). The minimum histological criteria of hepatoid carcinomas are the evidence of AFP production and abundant eosinophilic cytoplasm. These tumors have been reported in the ovary, the lung, the stomach, the renal pelvis, and the bladder. We, in this study, present a rare patient with primary hepatoid carcinoma of the ovary (OHC) and review the previous reports.     

Three-year prospect of patients with common epithelial carcinoma of the ovary

In order to forecast the survival of patients, we collected 417 cases of common epithelial carcinoma of the ovary as a population for this study, then selected 141 cases who had survived more than 3 years and 131 cases who had died within 3 years as a sample of statistical inference. The sample was computerized inputting 25 factors which were obtained mainly on the first surgery. We selected 8 factors with 46 items considering their weight to forecast the prognosis on convenience. The selection of factors was carried out by following three basic principles. First, we selected factors that retained high partial correlation coefficients. Second, we selected factors which did not overlap each other in their contents. Third, we selected factors which were not decided intentionally. Accordingly, the score for forecasting the 3-year survival of patients with ovarian carcinoma was framed. The correct discrimination rate of the score when it was judged at the 0 point was 86.8% in the sample group. However, in the sample group outside the population, it was 83.1%.     

Hepatoid carcinoma of the ovary with sex cord stromal tumor: a previously unrecognized association

Background  

Hepatoid carcinoma (HC) of ovary is a rare type of epithelial tumor composed mainly of epithelioid cells with abundant acidophilic cytoplasm, histologically indistinguishable from hepatocellular carcinoma. We report a previously unrecognized case of HC of ovary concurrent with a Sertoli cell tumor.     

Renal cell carcinoma metastatic to the ovary: a report of three cases emphasizing possible confusion with ovarian clear cell adenocarcinoma.

The clinical and pathological features of three personally observed and six previously reported cases of renal cell carcinoma metastatic to the ovary are reviewed. The patients' ages ranged from 39 to 64 (average, 52) years. In five patients the ovarian tumor was discovered first. In four of these patients renal tumors were detected during the initial clinical studies or in the early postoperative period, but in the fifth the renal primary tumor was not detected until 8 years later. The ovarian tumor in two cases was initially misdiagnosed as a primary ovarian clear cell carcinoma. In the remaining four patients the ovarian metastasis was detected 5 months, 12 months, 19 months, and 11 years after a renal tumor had been removed. In two patients the initial clinical manifestations were due to a metastasis of the renal tumor, to the thyroid gland in one and to the vagina in the other. The renal tumors in these nine patients typically were well-differentiated renal cell adenocarcinomas of clear cell type. The ovarian tumors measured from 7 to 18 (average, 12.5) cm in greatest dimension; two of them were bilateral. Grossly they were usually solid or solid and cystic; one was a unilocular cyst with a predominantly smooth lining and a 2.5-cm solid nodule in one area. The solid component of the tumors was typically either uniformly yellow or had focal yellow areas with hemorrhagic foci. Microscopic examination showed a relatively uniform picture in most cases: solid or alveolar nests of epithelial cells with abundant clear cytoplasm or tubules lined by clear cells and containing intraluminal eosinophilic material and extravasated blood.(ABSTRACT TRUNCATED AT 250 WORDS)     

Hepatoid carcinoma with serous component of the fallopian tube: a case report with immunohistochemical and ultrastructural studies.

A very rare case of hepatoid carcinoma with serous component arising in the fallopian tube of a 79-year-old woman is presented. The lesion was a 5.0-cm unencapsulated, yellowish-white soft mass. The tumor was composed of hepatoid carcinoma (90%) and serous carcinoma (10%) components. The hepatoid carcinoma was histologically characterized by a proliferation of round to polygonal cells arranged in a trabecular, tubular, sinusoidal, papillary, or solid pattern. The serous component in the fallopian tube also showed in situ lesions. Both components showed an infiltration into the surface of the left ovary, omentum, peritoneum including the pouch of the Douglas, and serosa of the colon. Immunohistochemically, the hepatoid carcinoma was positive for alpha-fetoprotein, polyclonal carcinoembryonic antigen (CEA), hepatocyte paraffin 1, albumin, epithelial membrane antigen, and cytokeratin (CAM5.2). Ultrastructurally, the cytoplasm contained abundant ribosomes, moderate amounts of mitochondria, and rough endoplasmic reticulum that developed into a meshwork and contained mitochondria within it. Microbile channel-like structures and desmosomes were occasionally observed. The association with serous carcinoma indicates mullerian origin rather than germ cell origin. The patient received chemotherapy and was alive without disease at 10 months after surgery.     

Stage IV micropapillary serous ovarian carcinoma: a report of three cases.

Micropapillary serous carcinomas (MPSCs) have been distinguished from typical ovarian serous borderline tumors. Although the clinical features of MPSCs have been described in several studies, there is almost no clinicopathologic information regarding stage IV MPSC patients. We describe three cases of stage IV invasive MPSC with clinical and pathologic findings. One case had an umbilical metastasis (Sister Mary Joseph's nodule), and the other two cases had cytologically positive pleural effusions. These cases demonstrate the potential of MPSCs for aggressive clinical behavior and distant metastases.     

Small cell carcinoma of the ovary. A report of six cases

Six cases of small cell carcinoma of the ovary are presented. The tumors occurred in women with an average age of 27.5 years. According to the International Federation of Gynecology and Obstetrics (FIGO), two patients had Stage I, three Stage II, and one Stage III disease. The tumors behaved highly malignantly, as four of the patients died from disseminated disease within 20 months. Three of the tumors were found to be associated with elevated serum calcium levels. By light microscopy three of the tumors were originally misinterpreted: one as an undifferentiated tumor, probably of stromal origin; one as a germ cell tumor, probably endodermal sinus tumor; and the third as a granulosa cell tumor. In four tumors examined by electron microscopy, the epithelial nature was confirmed, and three of them contained neuroendocrine granules. Immunocytochemical examination in five cases revealed positive staining for neuron-specific enolase (NSE) and negative staining for beta 2-microglobulin, whereas one case was negative for NSE and positive for beta 2-microglobulin. A positive immunoreaction for parathyroid hormone was observed in three cases (all NSE positive). In two of these a raised serum calcium level was documented. This finding possibly gives a clue to the hypercalcemia so frequently found in these patients.     

Hepatoid carcinoma of the ovary: immunohistochemical finding of one case and literature review

Hepatoid carcinoma is a rare ovarian tumor and is thought to be a histopathologic subtype different from hepatoid type yolk sac tumor based on its pathologic features. A 63-year-old woman who had postmenopausal bleeding and lower abdominal pain was found to have right ovarian mass on pelvic examination and computed tomography. She had high serum levels of alpha fetoprotein (AFP) and CA125. Histologically, the tumor resembled hepatocellular carcinoma by architectural and cytologic features. Immunohistochemically tumor cells were immunoreactive for AFP, alpha 1 antitrypsin, and carcinoembryonic antigens.     

Merkel cell carcinoma: report of three cases]

Merkel cell carcinoma is a primary cutaneous neuroendocrine carcinoma occurring commonly in the head and neck of middle-aged and elderly patients. While not very rare, this disease has never been reported in Taiwan. We report the clinical and pathologic features of three patients with Merkel cell carcinoma. The patients included one male (aged 56) and two females (aged 70, 80). The primary sites of the tumors were the hand in one patient and the head and neck in two. Two patients had regional lymph node metastasis. Case 1 had concurrent chronic arsenicalism with multiple Bowen's disease and squamous cell carcinoma of the skin. Histopathology revealed tumor cell infiltration throughout the dermis. In two cases, the tumor cells were small, round and non-cohesive, like lymphocytic infiltrates. In Case 3, however, they were large, oval and formed in nests. The tumor cells were keratin (AE1), neuron-specific enolase and chromogranin positive by immunohistochemical staining. Electronmicroscopy in Case 1 revealed a few cytoplasmic intermediate filaments and neurosecretory granules. Therapy consisted of radiation in 2 patients and surgery in 1; one died during radiotherapy, the other two survived and showed no signs of recurrence at 10 and 21 months.     

Endometrial carcinoma associated with pregnancy: A report of three cases and review of the literature.

Endometrial carcinoma associated with pregnancy is uncommon. In case 1, a 40-year-old gravida 2, para 2, was diagnosed with focal well-differentiated papillary adenocarcinoma 4 months postpartum. In case 2, a 35-year-old gravida 1, para 0, was diagnosed with a well-differentiated papillary adenocarcinoma of the endometrium after a D&C for an incomplete abortion at 7 weeks gestation. In case 3, a 32-year-old gravida 2, para 1, was diagnosed with a moderately differentiated adenocarcinoma with squamous metaplasia 4 months postpartum. All are without evidence of disease more than 2 years after therapy. A literature review shows 24 previous cases of pregnancy associated with endometrial cancer. These cases demonstrate the importance of endometrial sampling for abnormal postpartum bleeding despite the protective effects of pregnancy.     

Endometrial carcinoma and non-Hodgkin's lymphoma involving the female genital tract: a report of three cases.

The occurrence of both non-Hodgkin's lymphoma and carcinoma involving the female genital tract of the same patient is rare; we describe three such cases. In case 1, a 56-year-old woman with endometrioid endometrial carcinoma had synchronous follicular lymphoma of the uterus and ovary. In case 2, a 57-year-old woman with diffuse large B-cell lymphoma of the uterine cervix presented 5 years later with an endometrioid endometrial carcinoma. In case 3, a 69-year-old woman with an endometrioid endometrial carcinoma presented with a diffuse large B-cell lymphoma of the vagina 3 years later. In two patients, the non-Hodgkin's lymphoma was unsuspected clinically and would have been missed without biopsy and tissue diagnosis.     

Small cell carcinoma of the vagina with neuroendocrine features. A report of three cases

Three patients were treated for primary small cell carcinoma of the vagina. The light microscopic features were similar to those of small cell carcinoma of the lung, cervix and endometrium. Electron microscopy revealed occasional cytoplasmic, neurosecretory-type granules and cytoplasmic processes, features consistent with neuroendocrine cells. Radiotherapy appears to provide local control, but widespread disease at presentation or early metastases suggest the use of adjuvant chemotherapy in the initial management of the neoplasm.     

Familial carcinoma of the ovary. Case report.

A patient was successfully treated by surgery, progestogens and chlorambucil for a poorly differentiated cystadenocarcinoma of the ovary. Four of her relatives had died of ovarian cancer; it was ascertained that two of them also had poorly differentiated cystadenocarcinoma.     

Pregnancy with Implanon: a report on three cases

We explored the potential causes associated with pregnancies occurring in patients using an etonogestrel contraceptive implant (Implanon). Three cases of treatment failure were reported where no predisposing factors were found (i.e. Body Mass Index, hepatic inducing therapy). Etonogestrel plasmatic detection was positive in two cases whereas in the third case with negative endocrinological makers, neither palpation nor ultrasonography identified the device. Therefore, true contraceptive failure can be considered in two of the reported cases. Furthermore, pregnancies associated with Implanon use warrant additional attention including notification to drug monitoring centers and Organon SA.     

Stage IV ovarian carcinoma following ovulation induction: a report of three cases

Recent attention, in both the medical and lay communities, has been focused on a possible causal relationship between ovulation induction and ovarian carcinoma. The three cases reported here display marked heterogeneity in their risk factor profiles for ovarian cancer, illustrating several of the inconsistencies that have hampered epidemiological studies examining the proposed mutagenic effect of fertility drugs on ovarian epithelium. Three cases of stage IV invasive ovarian carcinoma, developing in infertility patients following from one to seven cycles of ovulation induction, are presented. The biological plausibility of a causal effect of fertility drugs on ovarian carcinogenesis has not been corroborated by consistent dose-dependent or lag-time effects. Fertility drug use may be an incidental finding associated with the known ovarian cancer risk factor of infertility. Nevertheless, until the precise effects of fertility drugs on ovarian epithelium are elucidated, a high index of suspicion for malignant ovarian neoplasms in women using these medications is indicated.