Ovarian mucinous tumor with mural nodules of anaplastic carcinoma

A case of mucinous cystic ovarian tumor with mural nodules of anaplastic carcinoma in a 30-year-old woman is described. The carcinomatous components within the nodules showed strong immunopositivity for cytokeratin and carcinoembryonic antigen, and ultrastructurally they displayed epithelial and glandular differentiation. Omental metastasis had already developed in the patient, and she received postoperative adjuvant chemotherapy consisting of cyclophosphamide and cis-platinum. No sign of recurrence was evident 4 months after the operation. The literature is reviewed and the importance of adjuvant chemotherapy in the postoperative management of such patients highlighted. The salient pathologic features differentiating mural nodules of anaplastic carcinoma and true sarcoma from prognostically favorable sarcoma-like nodules are presented.     

Malign mural nodules associated with serous ovarian tumor of borderline malignancy: a case report and literature review

Background  

Cystic tumors of ovary, whether benign, borderline, or malignant may be associated with mural nodule of various types, including sarcomas, sarcoma-like mural nodules (SLMN), and foci of anaplastic carcinoma. Cases of serous borderline ovarian tumor with mural nodules of mixed type are very rare.     

Ovarian mucinous cystic tumor of borderline malignancy with a mural nodule of anaplastic spindle cell carcinoma: a case report

Ovarian cystic tumors with a mural nodule are a rare entity. We report a case of a mural nodule of anaplastic spindle cell carcinoma in an ovarian mucinous cystic tumor of borderline malignancy. The patient was a 45-years-old Japanese woman who presented with an ovarian cyst. She suffered from mature cystic teratoma of both ovaries 9 years before the present history. Image analysis and laboratory data showing a high serum CA19-9 level suggested ovarian malignancy. She underwent bilateral salpingo-oophorectomy with hysterectomy and omentectomy. There was a mural nodule in the ovarian mucinous cystic lesion. Microscopically, the nodule was composed of spindle-shaped cells with severe nuclear atypia. Immunohistochemical analysis allowed the cells to be categorized as anaplastic spindle cell carcinoma. Fifteen months after the operation the patient is alive without any clinical findings of tumor recurrence. To the best of our knowledge in the English literature, this is the first report of a mural nodule of an anaplastic spindle cell carcinoma within an ovarian mucinous cystic borderline tumor harboring previously confirmed cystic teratoma.     

Ovarian mucinous cystadenoma with a mural nodule of osteosarcoma: A case report

ObjectiveOsteosarcoma as a mural nodule in the ovary is extremely rare. We aimed to describe a case of a mural nodule with features of an osteosarcoma arising in an ovarian mucinous cystadenoma.Case reportThe 65-year-old woman presented with progressive abdominal swelling and poor intake. Image studies showed a huge (diameter, >30 cm) intra-abdominal multiloculated cystic lesion, suspected to be an ovarian tumor. She underwent unilateral salpingo-oophorectomy with no postoperative adjuvant therapy. She was disease-free at 16-month follow-up.ConclusionOsteosarcoma presenting as a primary ovarian neoplasm is rare, either as a pure osteosarcoma or arising from a teratoma. However, two osteosarcoma cases occurring arising from a mural nodule in an ovarian mucinous neoplasm have been reported. There is no consensus regarding the treatment strategy for osteosarcomatous mural nodules in mucinous tumors because of its rarity. More case studies are needed before its pathogenesis can be fully understood.     

Sarcoma-like mural nodules combined with a microfocus of anaplastic carcinoma in mucinous ovarian tumor

A case of mucinous ovarian tumor with sarcoma-like mural nodules, one of which coexisted with a microfocus of anaplastic carcinoma, was studied by light, electron microscopic, and histochemical examinations. The case suggested that the formation of sarcoma-like mural nodules may be the result of the proliferation of undifferentiated mesenchymal cells which exist beneath the mucinous epithelium by some stimulation like hemorrhage in the cyst wall. Histologically, the mononucleated cells composing the sarcoma-like mural nodules had epithelioid characteristics, particularly at the areas where the covering mucinous epithelium had already detached. The case also suggested that the findings of epithelioid characteristics in the sarcoma-like mural nodules themselves do not imply these nodules to be anaplastic carcinoma, but merely an epithelioid differentiation from undifferentiated mesenchymal cells, namely one of reactive products. However, the existence of a microfocus of anaplastic carcinoma combined with the sarcoma-like mural nodule necessitates a careful histologic analysis of mural nodules for the treatment of patients and the determination of the prognosis.     

Ovarian cancer associated with carcinomatous meningitis: a case report and review of the literature

We report the case of a 62-year-old patient who developed a carcinomatous meningitis while on second-line chemotherapy for ovarian cancer. Cytologic analyses confirmed that carcinomatous cells of ovarian origin were present in cerebrospinal fluid. Carcinomatous meningitis is a very rare event in the natural history of ovarian carcinoma. We discuss the specificity of our case in the light of the literature. In addition, we present some relevant radiologic and pathologic documents illustrating this rare entity.     

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.     

Ovarian serous cystadenofibroma with stromal sex cord elements: report of a unique case.

This report describes an ovarian serous cystadenofibroma, in a postmenopausal woman, which exhibited extensive sex cord differentiation, in the form of solid and hollow tubules resembling Sertoli cell elements, within the stroma. The sex cord elements, which were located just beneath the epithelium, were positive with both alpha inhibin and calretinin and negative with epithelial membrane antigen. They were also CD56 positive but negative with other neuroendocrine markers. True sex cord structures or sex cord-like elements have been described in ovarian adenosarcomas and pure stromal tumors, especially fibromas. However, as far as we are aware, these elements have not been reported in a serous cystadenofibroma. The endometrium exhibited simple hyperplasia, perhaps secondary to estrogenic activity of the sex cord elements. We discuss the significance of CD56 positivity of the sex cord elements.     

Ovarian low-grade serous carcinoma: a comprehensive update

Ovarian low-grade serous ovarian carcinoma (OvLGSCa) comprises a minority within the heterogeneous group of ovarian carcinomas. Despite biological differences with their high-grade serous counterparts, current treatment guidelines do not distinguish between these two entities. OvLGSCas are characterized by an indolent clinical course. They usually develop from serous tumors of low malignant potential, although they can also arise de novo. When compared with patients with ovarian high grade serous carcinoma (OvHGSCa) patients with OvLGSCa are younger and have better survival outcomes. Current clinical and treatment data available for OvLGSCa come from retrospective studies, suggesting that optimal cytoreductive surgery remains the cornerstone in treatment, whereas chemotherapy has a limited role. Molecular studies have revealed the preponderance of the RAS-RAF-MAPK signaling pathway in the pathogenesis of OvLGSCa, thereby representing an attractive therapeutic target for patients affected by this disease. Improved clinical trial designs and international collaboration are required to optimally address the unmet medical treatment needs of patients affected by this disease.     

Bilateral micropapillary serous carcinoma of the ovary: a case report

BACKGROUND: Micropapillary serous carcinoma (MPSC), a recently described entity in the group of serous borderline tumor, needs to be recognized and separated from serous borderline tumor of usual type (SBT) as MPSC has a worse prognosis. CASE REPORT: We report the case of a 21-year-old female with gradually increasing lump abdomen for 6 months. Ultrasonography showed bilateral ovarian enlargement with cysts. Laparotomy revealed both ovaries to be enlarged and right ovary showed capsular breach. With a per-operative diagnosis of bilateral malignant ovarian tumor, total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed. Multiple sections from both ovaries showed non-invasive micropapillary serous carcinoma with right ovary showing surface growth but no definite capsular breach. The final histological diagnosis was bilateral micropapillary serous carcinoma. The patient has been asymptomatic in 10-month follow-up. CONCLUSION: MPSC, classified as serous borderline tumor, needs to be differentiated from APST as well as conventional serous carcinoma. It is diagnosed according to strict criteria laid down. Multiple sections should be studied to exclude invasion. Adequate peritoneal sampling should be performed to look for implants, which is of prognostic significance.     

Ovarian carcinoma with thyroid metastases causing clinical hypothyroidism: a case report

BACKGROUND: Ovarian cancer is known to metastasize to the thyroid gland. Despite an incidence of ovarian metastasis to the thyroid of 3-15%, clinical hypothyroidism resulting from such metastasis has not yet been reported. We present a case of metastatic ovarian cancer to the thyroid resulting in clinical hypothyroidism. CASE: A 55-year-old woman with recurrent papillary adenocarcinoma of the ovary presented with fatigue, abdominal distention, lymphedema, and depression. Thyroid stimulating hormone was markedly elevated, and thyroid biopsy demonstrated bilateral metastatic ovarian carcinoma. CONCLUSION: Although uncommon, metastatic disease to the thyroid should be considered when evaluating a patient with advanced ovarian cancer and clinical hypothyroidism.     

Ovarian carcinoma presenting with axillary lymph node metastasis: a case report

Ovarian cancer is usually limited to the abdomen and frequently remains confined. The occurrence of extrabdominal mestastases is unusual. In this report we describe a rare case of axillary involvement at initial presentation of ovarian cancer in a 48-year-old woman. The axillary mass was the only clinical abnormality. Cytological and histological findings, performed on axillary lymph nodes, showed the presence of psammoma bodies and specific immunohistochemical tumor markers (OC-125 and WT1), supporting the evidence of a metastatic axillary lymphadenopathy from ovarian cancer. Subsequently, chest and abdominopelvic computed tomography showed a right ovarian complex mass of 30 x 25 mm and biochemical tests showed high levels of CA125. Surgical therapy was performed. Histology confirmed the diagnosis, evidencing a poorly differentiated serous-papillary carcinoma of the right ovary. In conclusion, cytological and histological findings can play a crucial role in suggesting the correct origin of a metastatic adenocarcinoma when the clinical presentation is atypical.     

Ovarian endometriosis associated with carcinoma and sarcoma: case report

Endometriosis is a common clinical disorder that shares certain characteristics, metastasis and recurrence, with malignant neoplasms. Most malignant ovarian tumors arising from endometriosis are clear cell carcinoma or endometrioid adenocarcinoma. Few reports exist of sarcoma associated with endometriosis, and even fewer exist of multiple types of malignancies occurring simultaneously. Here, we report the case of a 32-year-old woman who presented with infertility and a pelvic mass. She underwent exploratory laparotomy and bilateral salpingo-oophorectomy. She was then referred to our institution for treatment recommendation. The pathologic findings revealed bilateral endometrioid adenofibroma of low malignant potential, which was associated with endometrioid intraepithelial carcinoma in the left ovary and high-grade sarcoma in the right ovary. Both tumors seemed to have arisen from endometriosis. She was treated with 75 mg/m2 of doxorubicin and 10 g/m2 of ifosfamide every three weeks for eight courses. She was later found to have bilateral brain metastases, which were resected and treated by whole-brain irradiation. She was again treated with doxorubicin and ifosfamide. The optimal treatment for endometriosis-associated ovarian cancer depends on the type of malignancy; simultaneously occurring multiple tumor types should be treated individually.     

Ovarian clear cell carcinoma associated with endometriosis: a case report with immunohistochemical study

Endometriosis is a frequent benign gynecological disease; nonetheless, it can demonstrate some aspects that resemble malignant disease. Malignant transformation of endometriosis occurs mainly in the ovary. A rare case of transition between typical endometriosis and clear cell carcinoma with immunohistochemical study is presented. The patient, a 30-year-old Caucasian woman (para 0), was diagnosed with endometriosis ten years before. Six months later she developed a left cystic ovarian tumor (58 cm3) that persisted after two ultrasounds in a four-month period. Tumor markers were normal (CA125, CA 15.3, CA 19.9, alpha-fetoprotein, carcinoembrionary antigen A1). There was no ascites. The left ovarian mass was removed by laparotomy and endometriosis in continuity with carcinoma positive for cytokeratin 7 and estrogen receptor was revealed. CD10 was positive in the stromal cells of the endometriosis. Clear cell carcinoma grade 3 was diagnosed. In conclusion, although a rare event, the association of typical endometriosis and clear cell carcinoma of the ovary should be kept in mind, mainly in patients with a persistent ovarian cyst.     

Squamous cell carcinoma with sarcomatoid features of the vulva: a case report and review of literature

BACKGROUND: A squamous cell carcinoma with sarcomatoid features of the vulva is an extremely rare malignancy of the female genital tract. This type of tumor is known to grow rapidly and associated with poorer clinical outcomes than those of squamous cell carcinoma of the vulva. CASES: A 43-year-old woman presented to our institute with a 4-month history of an aggravated vulvar mass. A radical local excision, bilateral inguinal lymph node dissection and laparoscopic assisted vaginal hysterectomy were performed. The FIGO stage of the vulvar cancer was stage II (T(2)N(0)M(0)) and the pathologic finding was consistent with a poorly differentiated squamous cell carcinoma with extensive sarcomatoid features. No further treatment was given and there was no clinical evidence of recurrence during the 2 years of follow-up. CONCLUSION: A squamous cell carcinoma with sarcomatoid features of the vulva is a tumor with aggressive biological behavior. To date, there have been only 15 cases of this disease reported in the literature. So, a collection and close study of these cases would be extremely useful in singling out and identifying the best treatment possible for this type of tumor.     

Ovarian endodermal sinus tumor associated with pregnancy--a case report

An ovarian endodermal sinus tumor was found in a 29-years old patient with a 32-week intrauterine gestation. She received caesarean section, conservative surgery and three courses of combination chemotherapy. She died 6 months after the diagnosis.     

Virchow's node as a first manifestation of ovarian serous carcinoma: case report

Ovarian carcinoma is a malignancy with a poor prognosis especially in patients with advanced disease. The majority of patients with ovarian serous carcinoma are diagnosed in advanced stages. Palpable extraabdominal lymphadenopathy at the time of presentation is distinctly uncommon. This case report addresses a patient with serous ovarian carcinoma presenting as left supraclavicular lymphadenopathy (Virchow's node) and no other symptoms. Not only thyroid or thoracic malignancies but also ovarian malignancies like serous ovarian carcinoma could present with a supraclavicular lymph node without any other symptoms.     

Retroperitoneal primary mucinous adenocarcinoma with a mural nodule of anaplastic tumor: a case report and literature review.

A 38-year-old female presented with a lower abdominal mass. During the operation the mass was found to be retroperitoneal and was excised. Gross examination revealed a mucin-containing cystic lesion with a mural nodule. On microscopic examination, the cystic areas were lined by an invasive mucinous adenocarcinoma and the nodule was composed of an anaplastic sarcomatoid tumor that was immunoreactive for cytokeratin. This present case is the 21st example of a retroperitoneal primary mucinous cystadenocarcinoma and the fourth with a mural nodule. Three of four cases with a mural nodule, including our case, had a rapidly fatal outcome.     

Ovarian primary primitive neurectodermal tumor coexisting with endometrioid adenocarcinoma: a case report.

We report an unusual case of a 78-year-old woman with primary ovarian tumor that consisted of primitive neurectodermal tumor and endometrioid adenocarcinoma. The patient presented with abdominal pain and weight loss and had disseminated disease at her initial presentation. She was treated with debulking surgery followed by chemotherapy. The patient was still asymptomatic at the 6-month follow-up.