Mixed mesodermal tumor of the ovary: Immunohistochemical study with histogenetic consideration

The clinical, histological and immunohistochemical features of three cases of ovarian mixed mesodermal tumor (MMT) were examined. The epithelial component was serous papillary cystadenocarclnoma in case 1 and 3, and endometrioid adenocarcinoma in case 2. In case 1, undifferentiated adenocarcinoma was also seen. The mesenchymal component was fibrosarcomatous and chondrosarcomatous in case 1 and 2. In case 3, only fibrosarcomatous area was seen. No endometriosis was observed. Immunohistochemically, the epithelial component showed positivity for epithelial membrane antigen in all three cases. S-100 protein was positive in two cases with chondrosarcomatous differentiation. The fibrosarcomatous area showed positivity for vimentin in all three cases. However desmin, myosin and myoglobin were negative. The antibodies thought to be epithelial or mesenchymal markers unexpectedly reacted positively in some cells; for example, EMA was positive in fibrosarcomatous and chondrosarcomatous cells. Therefore, it was speculated that because the undifferentiated tumor cells had a biphasic character, MMT might originate from immature multipotential cells of surface epithelium and subcapsular connective tissue of the ovary.     

Trophoblastic differentiation in a malignant mixed mesodermal tumor of the ovary

Trophoblastic differentiation in an extragonadal carcinoma is a rare and unusual phenomenon which has been observed in the carcinomas of stomach, bronchus, esophagus, ovary, liver, urinary bladder, endometrium, and, rarely, in the sarcomas. To our knowledge, this phenomenon has not been observed previously in a mixed mesodermal sarcoma (MMS), and the present communication is to record such a case of MMS of ovary with this phenomenon.     

Heterotopic mesodermal tumor of the fallopian tube

An observation of heterologous mesodermal tumor of the fallopian tube in a woman of 53 is described. The tumor had the structure of adenoacanthocarcinosarcoma with inclusions of atypical cartilage. The patient died 6 months after the operation from generalized process. The rare localization of this tumor is noted.     

Primary malignant mixed mesodermal tumor of the gallbladder

Summary A rare case of primary malignant mixed mesodermal tumor of the gallbladder arising in a 75 year old woman is reported. The previously published cases of similar tumors were reviewed in order to outline the histological features and the histogenesis. In diagnosing a malignant mixed mesodermal tumor of the gallbladder it was imperative that we excluded malignant neoplasms with multiple histological patterns. The diffuse and close intermingling of the epithelial and mesenchymal component ruled out a collision tumor. The high mitotic rate, the typical reticulin pattern and the obviously malignant osteoblasts excluded a spindle cell carcinoma with osseous metaplasia. The authors conclude that this is the first case of malignant mixed mesodermal tumor with evident osteosarcomatous areas, described in the gallbladder.     

Mixed germ cell tumor of the ovary with rhabdomyosarcomatous component. A case report

Malignant germ cell tumors of the ovary are rare representing 3% of all ovarian neoplasms. Hence, they are the most common ovarian malignancy in girls and young women and account for approximately two-thirds of the ovarian cancers that occur in the first two decades of life. Germ cell tumors constitute a heterogeneous group of tumors and are often mixed associating at least two different tumoral components. Exceptionally, sarcomatous areas can be found. We present a case of a 15-year old girl admitted for a voluminous left ovarian mass revealed by pelvic pain. Pathological examination of the dissected material revealed the tumor to be a mixed germ cell tumor (immature teratoma and yolk sac tumor) with rhabdomyosarcomatous component of embryonal type. Clinico-pathological characteristics of such ovarian tumors will be discussed with emphasis on diagnostic difficulties.     

Ultrastructure of mesodermal mixed tumor of the uterus.

A case of mesodermal mixed tumor arising in the uterus of a 57-year-old woman is presented. The tumor was a mixture of adenocarcinoma with occasional squamous metaplasia, stromal sarcoma, myxosarcoma and chondrosarcoma. Light and electron microscopic examinations of the tumor revealed close transition between stromal sarcomatous component and each of other sarcomatous and carcinomatous component. The histogenesis of mixed mesodermal tumor was discussed and it was concluded that the tumor might be derived from endometrial stromal cell which possessed the pluripotency to differentiate toward various epithelial and mesenchymal tissues including the heterologous mesenchymal tissue.     

Heterologous mesodermal tumor of the uterus of the chondrolipomyxosarcoma type]

A case of heterologous mesodermal tumor of the uterus of the chondrolipomyxosarcoma type in a woman of 70 is described. This observation was peculiar in that the tumor was benign for 25 years. Malignancy and extensive metastases into bones developed during the last year of life.     

Complex karyotypic anomalies, including an i(5p) marker chromosome, in malignant mixed mesodermal tumor of the ovary

Cytogenetic analysis of short-term cultures initiated from an ovarian malignant mixed mesodermal tumor yielded the following karyotype: 59-61, XX,t(1;?)(p36;?), +t(1;9) (q43;q21), +t(2;?)(p25;?), +i(5p), +i(5p), +7, +t(7;?)(p13;?), +8,der(11) (pter----cen----q23::q13----q23::q13----q23::?), +12, + der(13)t(13;15)(q21;q15), -15,der(16) (16qter----cen----16p13::hsr::8q21----8qter), +19, + der(20)t(X;20)(q13;p13), -22, +4 - 6mar. Because the only other cytogenetically characterized ovarian neoplasm of this rare histopathologic subtype also had a small metacentric marker interpreted as an isochromosome for the short arm of a B-group chromosome, we suggest that i(5p) constitutes a nonrandom anomaly in mixed mesodermal tumors.     

Mixed germ cell tumor with embryonal carcinoma, choriocarcinoma, and epithelioid trophoblastic tumor in the ovary of a cynomolgus monkey

A seven-year-old female cynomolgus monkey had a mass in the left ovary with metastasis to the lung and the right ovary. The mass of these organs showed three different characteristics, and its immunohistochemical profiles were consistent with embryonal carcinoma (EC), choriocarcinoma (CC), and epithelioid trophoblastic tumor (ETT). The EC was characterized with sheets and glandlike structures with large pleomorphic, single-nucleated epithelial cells that were immunohistochemically positive for α-fetoprotein, octamer-4, and CD30, and with multinucleated giant cells resembling syncytiotrophoblasts. The CC also represented biphasic proliferation of the cytotrophoblast positive for cytokeratin 7 (CK7), which showed negative immunoreactivity for all three of the above antibodies, and it was syncytiotrophoblast positive for human chorionic gonadotropin. The ETT showed numerous floating cells in an abundant eosinophilic extracellular matrix with vacuolated or eosinophilic cytoplasm and was immunohistochemically positive for CK7, p63, and α-inhibin, which features nodule or cordlike structures. Collectively, this neoplasm was identified as a mixed germ cell tumor with EC, CC, and ETT. To our knowledge, this is the first report of EC in nonhuman primates as a component of mixed germ cell tumor.     

A malignant mixed mesodermal tumor of the uterine corpus with hypercatecholaminemia

We report an unusual case of malignant mixed mesodermal tumor of the uterine corpus associated with various symptoms related to overproduction of catecholamine by the tumor cells. Histologically, the tumor was dominated by carcinomatous epithelium with foci of malignant mesenchyma. The type of epithelium was endometrioid with papillary adenocarcinomas containing foci of malignant squamous epithelium. The malignant mesenchyma consisted mainly of a fibrous stroma with many large and bizarre cells and spindle cells mimicking leiomyosarcoma, many of which were pleomorphic and contained large bizarre hyperchromatic nuclei. Foci of atypical adult-type cartilage and neoplastic osteoid formation were noted. In the tumor tissue, membrane-bound neurosecretory-type cytoplasmic granules were demonstrated by electron microscopy and polypeptide hormone synthesis was demonstrated by immunohistochemistry. Furthermore, the patient suffered frequent attacks of sudden hypertension with hypercatecholaminemia.     

Giant cell tumor of the ovary

Summary A 31 year old woman with primary sterility was found, at operation, to have endometriosis of the Fallopian tubes and a giant cell tumor of the ovary, histologically indistinguishable from giant cell tumor of bone. The tumor is considered to be primary and benign, with a follow-up period of 4 1/2 years and no signs of recurrence or malignancy.     

Mixed tumor of the mediastinum

A 36-year-old asymptomatic man was found to have a large middle mediastinal mass on a chest x-ray film. At surgery the tumor was located adjacent to the carina and beneath the aortic arch. It measured 7.0 X 5.0 X 4.0 cm and was well circumscribed and soft, with mucoid areas. The histologic features were those of a benign pleomorphic adenoma of salivary gland origin. This is, to our knowledge, the first reported case of primary pleomorphic adenoma of the mediastinum. We propose an origin from the ectopic salivary gland tissue. We also describe an additional patient in whom ectopic benign salivary gland tissue was found within mediastinal lymph nodes to support our hypothesis.     

Proliferative Brenner tumor of the ovary

A 72-year-old woman was admitted with abdominal distention and a hard mass in the pelvis. Abdominal laparotomy was performed, and a large solid left ovarian tumor was found. Left salpingo-oophorectomy was carried out. Histology showed cords and nests of stratified high cellular epithelium with dense eosinophilic material in epithelial nests and dense fibrous stroma identified as a Brenner tumor of the ovary. Because mild to moderate cytologic atypia with mitotic activity was present, a diagnosis of proliferative Brenner tumor was made. After the operation, the patient was in good condition with no recurrence or metastasis so far.