An autopsy case of hepatoid carcinoma of the ovary with PIVKA-II production: Immunohistochemical study and literature review

A case of hepatoid carcinoma of the ovary in a 61-year-old Japanese woman, who showed high serum levels of alpha-fetoprotein and CA125, is reported. Grossly, the left ovarian tumor, which measured 12 x 9 cm, was solid and multinodular. Histologically, the tumor resembled hepatocellular carcinoma by its architectural and cytological features. Liver cell differentiation was indicated functionally by the immunohistochemical detection of alpha-fetoprotein and protein induced by vitamin K absence or antagonist II (PIVKA-II) and by positive bile production, and the hepatocellular differentiation was structurally in accord with keratin 7, 8 and 18 expression. CA125 expression, commonly present in ovarian surface epithelial carcinomas, suggested that this neoplasm originated from ovarian common epithelial cells. There are only nine such cases in the literature. A review of these cases reveals that hepatoid carcinoma of the ovary occurs exclusively in postmenopausal women (mean age, 62.7 years) and that the prognosis is poor.     

Ovarian yolk sac tumor associated with endometrioid carcinoma and mucinous cystadenoma of the ovary

The clinicopathologic and immunohistochemical findings of an unusual case of ovarian yolk sac tumor associated with endometrioid carcinoma and mucinous cystadenoma of the ovary are reported. The tumor was detected in a 51-year-old postmenopausal woman who presented with abdominal swelling and a pelvic mass. The patient underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy and omentectomy. The tumor was confined to the right ovary and measured 16.0 cm in greatest dimension. Microscopic examination revealed that the tumor had a yolk sac component associated with an endometrioid carcinoma, grade I, and a mucinous cystadenoma. A background of atypical endometriosis was noted. Immunoperoxidase studies showed that the yolk sac component stained diffusely with a cytokeratin cocktail and was focally positive for alpha-fetoprotein. It was negative for keratin 7. In contrast, the endometrioid carcinoma stained positive for keratin 7 in addition to the cytokeratin cocktail, but was negative for alpha-fetoprotein. After surgery, the patient received three cycles of chemotherapy. However, the disease progressed and the patient died 10 months after the diagnosis of the ovarian tumor.     

Squamous cell carcinoma of the ovary

A 45-year-old woman developed a grade III and stage III squamous cell carcinoma of the left ovary 12 years after a hysterectomy for treatment of endometriosis. Origin from a teratoma or a Brenner tumor was excluded. Despite extensive surgery with additional radiation therapy and chemotherapy, the patient died five months after the malignancy was diagnosed. Squamous cell carcinoma of the ovary, either de novo or arising from endometriosis, has rarely been reported. We describe a case of ovarian squamous cell carcinoma in which endometriosis is strongly favored as the origin, but that remains speculative.     

A case of Krukenberg carcinoma metastasized from colon cancer resembling mucinous cystadenocarcinoma of the ovary

We report a case of a 44-year-old woman with bilateral ovarian carcinoma that had metastasized from the colon and mimicked primary mucinous cystadenocarcinoma. Macroscopically, both ovarian tumors were large, multiloculated cystic masses with abundant mucinous content. Histologically, they were lined with mucinous epithelium with mild to moderate nuclear atypia and showed stromal invasion and surface involvement. At first, the tumors were diagnosed as bilateral primary ovarian mucinous cystadenocarcinomas. However, three months after surgery, a large villous tumor was discovered in the ascending colon by colonoscopic examination and was surgically resected. Histologically, the colonic tumor was a villous adenomatous tumor with invasive components of mucinous adenocarcinoma composed of well-differentiated adenocarcinoma and exhibited abundant extracellular mucin production. As a villous adenomatous component was present in the mucosal area, the colonic tumor was considered a primary tumor. Therefore, the original diagnosis of bilateral ovarian tumors was revised for consistent with metastasis from the colon carcinoma, in line with the findings of immunohistochemistry and loss of heterozygosity analysis. This case highlights the importance of considering the possibility of metastatic tumors from the gastrointestinal tract in the diagnosis of mucinous ovarian tumors.     

Malignant Sertoli cell tumor of the ovary metastatic to the lung mimicking neuroendocrine carcinoma: report of a case.

A Sertoli cell carcinoma of the ovary with lung metastases mimicking neuroendocrine carcinoma is presented. Lung metastases frequently occur. Primary and secondary tumors may exhibit similar growth patterns and differentiating primary from secondary tumors may be troublesome. This process may be more difficult when metastases occur from a tumor in which metastases are uncommon and morphologically resemble only a small portion of the primary tumor. We report the case of a 52-year-old woman who underwent resection of a 4,550-g Sertoli cell tumor of the ovary. Histologically, in addition to the characteristic tubular pattern of growth, 5% of the tumor consisted of poorly differentiated areas with tumor cells in sheets, a high mitotic rate, and areas of necrosis. Eleven months after this surgery she presented at a different institution with multiple pulmonary nodules. Microscopic examination of a subsequently resected lung nodule showed histologic findings similar to those of the poorly differentiated areas of the ovarian tumor and initial immunohistochemical studies showed positive staining for cytokeratin, neuron-specific enolase, and focal positivity for synaptophysin. Without knowledge of the ovarian tumor the lung lesion was interpreted as large-cell neuroendocrine carcinoma. On review of the clinical history and comparison with the previous surgical material, however, both tumors showed similar light microscopy and immunohistochemical reactivity, and a final diagnosis of metastatic Sertoli cell tumor was made. Immunohistochemical staining for inhibin revealed weak positivity in the poorly differentiated areas of the ovarian tumor but not in the lung metastasis. This is one of the rare reports of ovarian Sertoli cell tumor metastasizing to the lungs and it emphasizes the importance of complete clinical histories, ancillary studies, appropriate sampling, and review of archival material in such unusual cases.     

Adenoid cystic carcinoma of the ovary

We describe a case of ovarian adenoid cystic carcinoma (ACC) of the left ovary in a 23-year-old woman. The tumor had the typical cribriform pattern of ACC, lacked any component of surface epithelial carcinoma, and showed myoepithelial differentiation. The features of salivary gland-type tumor seen in this case are unusual and different from those of so-called ACC-like carcinomas of the ovary, which only resemble the salivary gland tumor histologically.     

Solid adenoma with exclusive hepatocellular differentiation: a new variant among pancreatic benign neoplasms?

We report a unique, previously unreported pancreatic tumor with hepatoid differentiation associated with serous microcystic adenoma in a 70-year-old man. These two lesions localized, respectively, at the body and the tail of the pancreas, were found incidentally on abdominal ultrasonography. Serum alpha-fetoprotein was not increased and no hepatic lesion was displayed on computed tomography. A subtotal pancreatectomy with splenectomy was performed. The patient is alive and well 12 months after resection. Pathological examination showed a very unusual encapsulated solid tumor with hepatocytic differentiation, bile production and immunoreactivity for hepatocyte paraffin-1 antibody. The tumor cells were negative for endocrine (neuron-specific enolase, chromogranin A, synaptophysin) and acinar (amylase, trypsin) markers. Ultrastructurally, zymogen and neurosecretory granules were absent. The features of the tumor were almost indistinguishable from those of hepatocellular adenoma; therefore, we believe that this solid hepatoid tumor may represent a variant of pancreatic adenoma. Recognition of this entity is important because the only reported pancreatic hepatoid tumors to date have been malignant. The main differential diagnoses include hepatoid ductal adenocarcinoma, hepatoid acinar cell carcinoma, primitive hepatoid endocrine tumor, and metastatic hepatocellular carcinoma.     

Urachal adenocarcinoma metastatic to the ovary simulating primary mucinous cystadenocarcinoma of the ovary: report of a case

A 56-year-old woman had a large multicystic ovarian tumour 4 years after undergoing partial cystectomy for a deeply invasive urachal adenocarcinoma. On microscopic examination the ovarian tumour was a moderately differentiated mucinous cystadenocarcinoma similar to the urachal tumour. Several peritoneal biopsies and the omentum were positive for metastatic adenocarcinoma. Although initially interpreted as representing primary mucinous adenocarcinoma of the ovary with peritoneal spread, subsequent comparison with the previous urachal adenocarcinoma led to re-interpretation of the ovarian tumour as metastatic urachal carcinoma. Metastatic mucinous adenocarcinomas involving the ovary may be misinterpreted as primary ovarian carcinomas and the urinary bladder is a potential source of these neoplasms.     

Lymphoepithelioma-like carcinoma of the ovary: a case report and review of the literature

Lymphoepithelioma-like carcinoma is an undifferentiated carcinoma morphologically characterized by sheets of pleomorphic epithelioid cells with an intense lymphoid infiltrate. A 51-year-old woman presenting with low abdominal pain was found to have a right ovarian mass and enlarged pelvic, left para-aortic, and left supraclavicular lymph nodes. Based on a clinical diagnosis of right ovarian carcinoma with lymph node metastases, she received 9 cycles of chemotherapy, resulting in a reduction of her ovarian tumor, disappearance of the enlarged pelvic and para-aortic lymph nodes, and normalization of serum CA 125 level. The residual mass was removed surgically. The histology of the multinodular tumor resembled that of lymphoepithelioma of the nasopharynx and was observed in the right ovary. However, there was no viable tumor in either supraclavicular or para-aortic lymph nodes. Seven months after surgery, the patient has no evidence of disease. Lymphoepithelioma-like carcinoma appears to be rare in the female genital tract.     

Glomus tumor arising in a mature teratoma of the ovary: report of a case simulating a metastasis from cervical squamous carcinoma

Glomus tumors involving the female genital tract are rare. Herein we report the case of a glomus tumor constituting the major component of a mature teratoma of the ovary. This lesion represented an incidental finding in a 43-year-old woman who underwent bilateral salpingo-oophorectomy at the time of detection of locally recurrent squamous carcinoma of the cervix. The glomus tumor was initially interpreted as a metastasis due to its superficial morphologic resemblance to the recurrent carcinoma in the vagina. It was, however, morphologically similar to glomus tumors that classically arise in the extremities. The diagnosis was supported by immunohistochemistry and ultrastructural examination. To our knowledge, no similar tumor has been described in the ovary or in teratomas at any other site.     

Epidermoid cyst of the ovary: a case report

In the ovary, epidermoid cysts are rare and their origin is controversial. This rare lesion was uniformly an incidental finding in the study of hysterectomy specimens. The patient was a 48-year-old woman. Because of multiple leiomyomas she had a total hysterectomy and bilateral salpingo-oopherectomy operation. A Epidermoid cyst was found incidentally in the right ovary on the microscopic examination.     

Intestinal adenocarcinoma arising in a mature cystic teratoma of the ovary: a case report

Gastrointestinal adenocarcinoma arising in mature cystic teratomas of the ovary is extremely rare. We report a case of well-differentiated intestinal adenocarcinoma arising in a mature cystic teratoma of the ovary in a 77-year-old woman, presenting as acute abdomen with ovarian torsion. An immunohistochemical study revealed expression of CK20 and CK7, and the tumor was also positive for MUC2. The patient had no evidence of disease after 12 months of follow-up.     

Metastatic and independent cancers of the endometrium and ovary: a clinicopathologic study of 34 cases

Twenty-one of 34 simultaneous cancers involving the endometrium and ovary were classified as endometrial primary tumors with ovarian metastases. The criteria for this classification were either a multinodular ovarian pattern (major criterion) or two or more of the following minor criteria: small (less than 5 cm) ovary(ies), bilateral ovarian involvement, deep myometrial invasion, vascular invasion, and tubal lumen involvement. Twelve cancers were classified as independent neoplasms, primarily by the absence of the above criteria. Although they were classified as independent, the histologic features of the endometrial and ovarian tumors were the same in 11 of these 12 cases. Only one case represented an ovarian primary tumor with an endometrial metastasis. Both the group believed to have endometrial primaries with ovarian metastases and that with independent primaries showed high incidences of associated endometrial hyperplasia, supporting the belief that the endometrium is a primary site in both groups. The cancers classified as metastatic, with no known spread outside the endometrium-myometrium and ovary, were found to involve other sites significantly (P less than 0.01) more frequently than those classified as independent. Grade 3 endometrioid carcinoma, adenosquamous carcinoma, and malignant mixed müllerian tumors occurred only in the metastatic group, whereas the independent group had a variety of endometrioid and nonendometrioid tumors.     

Breast carcinoma metastasis within granulosa cell tumor of the ovary: morphologic,immunohistologic, and molecular analyses of the two different tumor cell populations

Gynecologic metastasis of breast carcinoma is not an infrequent event, but metastases within another tumor is very rare. We report a case of unilateral ovarian tumor arising in a 63-year-old woman receiving tamoxifen therapy with a past history of breast carcinoma. The microscopic appearance was principally that of a granulosa cell tumor, but the presence of atypical cells closely admixed within the classical areas was reminiscent of metastasis from breast carcinoma. The diagnosis of this first reported case of breast carcinoma metastasis within granulosa cell tumor was supported by immunohistologic analysis. The diagnosis of tumor-to-tumor metastasis was also confirmed by molecular study using microdissections of samples from the initial breast tumor and from the subsequent ovarian tumor. When compared with normal tissue, carcinomatous cells in the breast tissue exhibited genomic abnormality at the same locus as the metastatic cells in the ovary. In contrast, granulosa cell tumor areas did not show any loss of heterozygosity or instability for the microsatellites analyzed.     

Malignant clear cell cystadenoma of the ovary

A 50-year-old female had suffered from abdominal distension and a lower abdominal mass for 3 months. Ultrasonographic examination demonstrated a myoma uteri pattern with a large cystic ovarian tumor. Laparotomy was done on August 30, 1983 and simple total hysterectomy with bilateral salpingo-oophorectomy was carried out. FIGO stage IIC ovarian cancer was stated clinically. Histologically, clear cell cystadenoma of right ovary having benign, proliferative and malignant epithelial elements without dense ovarian stroma was found and diagnosed as malignant clear cell cystadenoma. In spite of Cisplatin therapy, the patient expired on April 6, 1984.     

Sertoliform endometrioid carcinomas of the ovary: a clinicopathologic and immunohistochemical study of 13 cases.

Ovarian endometrioid carcinomas with sertoliform features (SECs) are infrequent and often misinterpreted as sex cord-stromal tumors. The clinicopathologic features and immunohistochemical expression of keratin, epithelial membrane antigen (EMA), inhibin, and estrogen and progesterone receptors were evaluated in 13 cases of SEC. The women were 41 to 89 years of age (mean, 60 yr) with abdominal enlargement secondary to a unilateral ovarian mass as the most frequent clinical presentation. One patient displayed virilization. At presentation, 10 patients were Stage I, one was Stage II and two were Stage III. The tumors were composed of compact anastomosing cords and small tubules embedded within a fibrous stroma. Nuclear features were Grade 1 or 2 in all but one tumor. Areas of conventional endometrioid carcinoma were observed in 12 cases. An adenofibromatous component comprising 5 to 60% of the lesion was present in seven cases. All 12 cases examined immunohistochemically were positive for keratin and EMA and negative for inhibin with focal, luteinized stromal cells positive for inhibin in 10 cases. Estrogen and progesterone receptors were positive in 10 and 11 cases, respectively. Follow-up on 6 of 10 patients with Stage I and the one patient with Stage II disease displayed no evidence of disease 10 to 120 months (mean, 57 mo). Progressive disease and death occurred at 12 and 72 months only in the two women with Stage III disease, one of which had an associated serous carcinoma in the contralateral ovary. Adequate sampling, a careful search for areas of conventional endometrioid carcinoma, and immunohistochemical studies (including EMA, keratin, and inhibin) are helpful in the evaluation of ovarian tumors with sex cord-stromal features. SEC should be considered a well-differentiated endometrioid carcinoma despite the presence of a solid, sex cord-like proliferation, with a good prognosis when confined to the ovary.     

Large cell neuroendocrine carcinoma of the ovary

Large cell neuroendocrine carcinoma of the ovary is a recently described tumour entity that is now included in the WHO classification of primary ovarian neoplasms. Although mostly in stage I at diagnosis, this tumour shows an aggressive clinical behaviour with subsequent metastases and mean survival is less than one year. In addition to the neuroendocrine carcinoma, most cases also have a malignant surface epithelial tumour component. I here report a 64-year-old woman who was operated on for a right-sided ovarian large cell neuroendocrine carcinoma without a surface epithelial component, which constitutes only the second reported tumour of this "pure" kind. Histological and immunohistochemical findings are described and a review of the literature is presented. The patient was treated postoperatively with chemotherapy. She developed bleomycin-induced lung fibrosis that responded well to treatment with steroids. There have been no signs of local tumour recurrence or metastases at follow-up examinations during the first 9 months after the operation.     

Wolffian tumor of the ovary with a prominent spindle cell component: report of a case with brief discussion of unusual problems in differential diagnosis, and literature review

An 87-year-old woman underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy for endometrioid adenocarcinoma. At operation, a 4.5-cm partially solid and partially cystic right ovarian mass was identified. Frozen section showed a cytologically bland spindle cell proliferation reminiscent of cellular fibroma. Extensive sampling of the ovarian mass revealed a focus with the classic sieve-like pattern of a Wolffian adnexal tumor that merged with the fibroma-like appearance. The uterus showed well-differentiated, superficially invasive endometrioid adenocarcinoma arising in a background of atypical complex hyperplasia. Given the recent reports implying a therapeutic value for Gleevec (Novartis, Stein, Switzerland) (STI-571) in the treatment of Wolffian tumor of the ovary, paraffin immunostain for CD117 (c-kit) was performed that yielded negative results. Without further therapy, the patient was alive without disease 7 months after surgery. This case demonstrates the heterogeneity of Wolffian tumor of the ovary and shows how crucial sampling is in arriving at the correct diagnosis.     

Small cell carcinoma of the ovary: A case report of large cell variant

An extremely rare case of large cell variant of ovarian small cell carcinoma is described. A 34-year-old woman (gravid 1. para 1) had a unilateral ovarian mass measuring 17 cm in great at diameter and a metastasis lesion in the omentum. Microscopically, the tumor showed a diffuse arrangement of large, closely packed epithelial cells with abundant eosino-philic cytoplasm and large nuclei with prominent nucleoli. The tumor cells also were arranged in follicle-like and trabe-cular structures and cords. Immunohlstochemically, many tumor cells were diffusely positive for epithelial membrane antigen and some cells contained cytokeratin CAM5.2, valentine, neurofiiament, neuron-specific enoiase, or alpha-1 antitrypsn. However, no specific IIneage was detected. The tumor was aneuploid by flow cytometry. The patient received chemotherapy postoperatively. However, the patient showed metastases in the Inguinal and retruperitoneal lymph nodes. The aerum calcium level, which was not measured preoperatively, was mildly elevated postoperatively. The patient was well with no evidence of disease 17 months after diagnosis. This tumor must be distinguished from other primary or metelltatic 'undifferentiated' neoplasms, especially ovarian small cell carcinoma of pulmonary type and granulosa cell tumor.     

Embryonal cell carcinoma (endodermal sinus type) of the ovary

This report describes two patients with the pure endodermal sinus type of embryonal carcinoma. The first patient had embryonal cell carcinoma in one ovary and a benign cystic teratoma in the opposite ovary. The second patient had embryonal cell carcinoma confined to one ovary.Embryonal cell carcinoma is a rare and highly malignant ovarian tumor. Only 29 cases of the pure endodermal sinus type of embryonal cell carcinoma have been reported. It commonly occurs during childhood, adolescence, or early adulthood. The prognosis is poor, as shown by the first case.