Meningioma in mature cystic teratoma of the ovary

A case of meningioma arising in a mature cystic teratoma of the ovary in a 60-year-old woman is described. The tumor was located in the right ovary, and salpingo-oophorectomy was performed. The right ovary was 10 x 10 x 8 cm in size and contained an unilocular cyst. In the wall, a solid nodule measuring 3 x 3 x 2 cm was noted. Histologically, the cyst wall was composed of typical mature cystic teratoma. In contrast, the mural nodule was composed of the proliferating spindle- and polygonal-shaped cells showing positive staining for epithelial membrane antigen and microcystic change was prominent. These findings were consistent with microcystic meningioma. The arachnoidal cells around mature brain tissue may be the origin of this unusual tumor. To the best of our knowledge, this is the first case of mature cystic teratoma with meningioma of the ovary reported in English medical literature. This case may further indicate the totipotential nature of mature cystic teratoma.     

A case of ovarian mature cystic teratoma presenting as a pedunculated ileal tumor

We report on a 34-year-old Japanese woman who presented with a pedunculated ileal tumor and who was finally diagnosed as having a right ovarian mature cystic teratoma penetrating and protruding into the ileum. She had undergone laparoscopic left ovarian cystectomy, whose specimen was diagnosed as dermoid cyst when she was 27 years old. The colon fiberscope revealed an ileal polyp, diagnosed as mature teratoma. Because of adhesion to the necrotic nodule between the tumor and the right ovary, ileocecal resection and right ovarian cystectomy were performed. The ileal tumor contained tissues of skin, neuroglia, ganglion, choroid, retina, smooth muscle, as well as fibrous and adipose tissues, cartilage, bone, mucous epithelium, and bronchial structures with bronchial glands. The necrotic nodule showed abscess, granulation tissue, foreign body reaction, hairs, normal ileal epithelium, and the ovary with ovums.     

Primary ovarian angiosarcoma: A case report and literature review

Primary ovarian angiosarcoma is extremely rare. Only 16 cases have histologicaliy been reported to date In the Ilterature. A case of angiosarcoma arising In the right ovary of a 46-year-old female is presented. Grossly, the resected right ovary was completely replaced by a solid tumor mass, which revealed multiple necrotic and/or hemorrhagic foci. This case revealed the typical histological features of angiosarcoma with sinusoldal and solid patterns of anaplastic tumor cells. Immunohlstochemically, tumor cells were strongly and diffusely positive for CD31 and CD34, in particular, along the cytoplasmic membrane of the tumor cells. Ultrastructurally, tumor cells possessed the intermediate junctions between tumor cells, discontinuous basal laminae attached to the irregularly shaped blood vessels and occasional cytoplasmic pinocytotlc vesicles. These findings confirmed the case as being one of angiosarcoma of the ovary. The patient died 9 months after surgery as a result of developed multlfocal brain metastases. A total of 17 cases reported as primary ovarian anglosarcoma, including this presented case, are clinicopathologically reviewed.     

Fibrosarcoma of the ovary arising in a fibrothecomatous tumor with minor sex cord elements. A Case report and review of the literature

We report the case of a 69-year-old woman who presented with postmenopausal bleeding. Endometrial curettings showed complex atypical hyperplasia with focal well-differentiated adenocarcinoma. A computed tomographic scan of the abdomen revealed a right ovarian mass. Histologically, the right ovarian tumor was a fibrothecoma with minor sex cord elements showing focal fibrosarcomatous change. Fibrosarcoma of the ovary is a rare tumor that is considered to arise de novo or secondary to benign fibromatous tumors. Fibrothecoma of the ovary with minor sex cord elements is also a rare entity. To the best of our knowledge, this is the first reported case of a fibrosarcoma arising in a fibrothecoma with minor sex cord elements.     

Ovarian carcinoma recurring as carcinosarcoma

Malignant mixed mesodermal tumor is a rare tumor of the ovary and its histogenesis is controversial. We report the case of an ovarian tumor that seemed to be a pure carcinoma and recurred as a carcinosarcoma, and suggest a possible histogenesis for this kind of tumor. The patient was a 62-year-old Japanese woman. The primary tumor was confined to the right ovary and was a histologically poorly differentiated endometrioid adenocarcinoma with focal squamous differentiation. The tumor recurred as peritoneal dissemination 9 months later showing a histological appearance of carcinosarcoma of heterologous type. The recurrent tumor also contained intermingled foci of similar histology as the primary tumor. The carcinomatous component of the recurrent tumor showed more obvious differentiation to adenocarcinoma with increased expression of epithelial markers compared to the primary tumor. Epithelial membrane antigen was positive also in a few cells of the sarcomatous component, which implies that this tumor had features of metaplastic carcinoma. The DNA ploidy pattern of the primary ovarian tumor was diploid, while an additional aneuploid subpopulation appeared in the recurrent tumor. These findings suggest the possible histogenesis of carcinosarcoma of the ovary as progression and clonal evolution of endometrioid adenocarcinoma.     

Clear cell carcinoma of the ovary simulating a yolk sac tumor

Clear cell carcinoma (CCC) of the ovary is uncommon. In young patients, this tumor may simulate a yolk sac tumor. In this case, the morphologic distinction between these tumors is often difficult but the immunohistochemical staining for CA125 and alpha foeto protein (AFP) and the response to chemotherapy are particularly helpful to resolve this problem of differential diagnosis. We report a case of a 17 year old patient who was operated for a tumor of the right ovary. The diagnosis of a yolk sac tumor was first suggested. However, because of the non response to chemotherapy, a second laparotomy was performed; the definitive pathologic examination concluded to the diagnosis of a CCC of the ovary. The young age and the immunohistochemical staining for AFP are unusual and misleading features for a CCC. Our objective about this particular case is to discuss the anatomoclinical aspects of the CCC of the ovary and to prove the role of immunohistochemistry in the differential diagnosis.     

Multicentric infarcted leiomyoadenomatoid tumor: a case report

Adenomatoid tumor is a benign, usually small lesion that may be found within the wall of fallopian tubes or beneath the uterine serosa near the uterine cornu. It is often accompanied by smooth muscle hypertrophy that may obscure the adenomatoid tumor. We herein report a very unusual case of infarcted leiomyoadenomatoid tumor of the uterus and ovary in a 24-year-old woman who presented with severe lower abdominal pain and masses in the uterus and right ovary. Pelvic ultrasonography and computed tomography revealed a 5 cm mass in the myometrium and a 4 cm mass in the right ovary. Laparoscopy-assisted transvaginal mass removal was performed under the clinical impression of a uterine leiomyoma and benign ovarian teratoma. On a microscopic examination, prominent fascicles of smooth muscle separated or infiltrated by cuboidal or signet ring-like vacuolated cells, as well as tubular formations lined by flattened mesothelial cells and extensive necrosis were observed in both masses. The microscopic appearance often suggested the possibility of a malignant neoplasm due to irregular pseudoinfiltration with atypical cuboidal cells and the paucity of a typical adenomatoid tumor due to infarction, and the presence of epithelial-appearing cells in the hypertrophic smooth muscle bundles that mimicked an infiltrating carcinoma for a leiomyoma or myometrium. These unemphasized features of leiomyoadenomatoid tumors may potentially lead to more aggressive therapy than warranted if not correctly interpreted, especially for infarcted cases.     

Ascitic fluid cytology of adenosarcoma of the ovary: a case report

Extrauterine adenosarcoma is very rare and originates in the ovary, adnexa, or myometrium. Cytologic study of ascites is very important to determine clinical staging of malignant ovarian tumors and provide adequate therapy for recurrence. The cytomorphologic features of adenosarcoma have been only rarely described. A 77-yr-old woman visited a hospital with a complaint of lower abdominal pain for 1 mo. A tumor originating from the right adnexa in the pelvis, and involving the rectum, was found in surgery. In the ascitic fluid cytology, a few dispersed tumor cells with large cytoplasm and nuclei were oval-shaped, with nuclear invagination. The chromatin was finely granular; one or two nucleoli were conspicuous. To our knowledge, this is the fifteenth reported case of adenosarcoma of the ovary, and there have been no prior reports describing the cytological features of ascitic fluid cells in adenosarcoma of the ovary.     

Cytologic features of pulmonary metastasis from a granulosa cell tumor diagnosed by fine-needle aspiration: A case report

We report on a case of a granulosa cell tumor of the ovary metastatic to the lung and diagnosed by fine-needle aspiration. The patient was a 70-yr-old woman who was diagnosed with a granulosa cell tumor of the ovary 17 yr previously. She subsequently developed abdominal metastases and received several cycles of chemotherapy. A 0.5-cm right upper lobe pulmonary nodule was found on a routine chest radiograph and subsequent computerized tomography scan. Aspiration cytology of this pulmonary nodule demonstrated small, relatively uniform neoplastic cells with nuclear grooves and indentations consistent with a granulosa cell tumor. The differential diagnosis of granulosa cell tumors from other metastatic and pulmonary lesions is reviewed. Diagn. Cytopathol. 16:341–344, 1997. © 1997 Wiley-Liss, Inc.     

Coexisting Brenner tumor and struma ovarii in the right ovary: case report and review of the literature

A bilateral ovarian tumor composed of mixed Brenner tumor and struma ovarii in the right ovary and mature cystic teratoma in the left ovary, is described. Mixed Brenner tumor and struma ovarii is rare; eight cases are reviewed. In this case, in addition to the typical Brenner tumor and struma ovarii, some nests composed of both Brenner tumor and struma ovarii in one nest were found in the right ovarian tumor. Immunohistochemically, the struma ovarii is stained for thyroglobulin, and Brenner nests showed various degrees of positive stain for thyroglobulin, which is a specific finding. Brenner tumor, in this case, may produce thyroglobulin or have a receptor to thyroglobulin or analog of thyroglobulin. The origin of mixed Brenner tumor and struma ovarii may be germ cell, as described in some literature, or the Brenner tumor may be of a metaplastic nature, although the Brenner tumor is fourfold the size of struma ovarii in the case presented.     

Coexistence of squamous cell carcinoma with dermoid cyst of ovary

A 40-year-old female presented with pain and enlargement of abdomen since last 6 months. A mass was felt over right iliac fossa. Ultrasonography showed partly cystic and solid area in mass arising from ovary. A tooth-like structure was also seen. Dermoid cyst was the diagnosis offered. Laparotomy was performed. Ovarian mass with hair, a tooth and putty-like material was present. Solid white area with thickened wall was found. Histopathology confirmed the findings of dermoid cyst and the thickened area showed squamous cell carcinoma with areas showing keratinous material and giant cell reaction which was also seen at the periphery of tumor areas. Left ovary was normal and no deposits of tumor were seen. Postoperative period was uneventful.     

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.     

Bowel loop in an ovarian tumor: Grossly visible, completely developed intestinal loop in mature cystic teratoma of malignant mixed germ cell tumor

Although a gastrointestinal-type epithelium is observed in 7–13% of mature cystic teratoma cases, the occurrence of a grossly visible, organized gastrointestinal loop formation is very rare. Presented here is the case of a 14-year-old girl with malignant mixed germ cell tumor in the ovaries. In her left ovary a grossly visible, intestinal loop, 9 cm long, with hanging mesentery attached to the cystic wall of a mature cystic teratoma associated with a yolk sac tumor was observed, and in her right ovary another mature cystic teratoma was observed. Microscopy of the intestinal loop indicated a well-organized, intact layer of small intestinal wall. The yolk sac tumor predominantly had a polyvitelline pattern. Previously, gastrointestinal wall or epithelium that was identified on microscopy has been reported. To the authors' knowledge this is the first case report of the formation of a grossly visible, completely developed intestinal loop in a malignant mixed germ cell tumor.     

Paraganglioma: report of a rare case with ovarian involvement

We report a well-documented case of paraganglioma involving right ovary, which was initially misdiagnosed as a Sertoli-Leydig cell tumor and recurred one year later. The right ovarian tumor measured 105x90x60 mm and was associated to a subdiaphragmatic tumor measuring 80x60x35 mm, a peritoneal and a preureteral nodules measuring 10 mm either. Microscopically, tumor cells were arranged in trabeculae and cords separated by a delicate stroma. Their cytoplasm was abundant granular and eosinophilic. Their nuclei were enlarged and regular in size with coarse chromatine and a large nucleolus. The tumor expressed neuroendocrine markers (chromogranin, synaptophysin) epithelial membrane antigen and focally cytokeratin 7 and E-cadherin. Pathological ovarian paraganglioma diagnosis could be difficult but one should be aware of its bona fide existence. The clinical course is favourable in most of the cases.     

Aggressive uterine sarcoma with rhabdoid features: diagnosis by peritoneal fluid cytology and absence of INI1 gene mutation

We report a primary uterine sarcoma with classic histologic, immunohistochemical, and ultrastructural features of a malignant extrarenal rhabdoid tumor (MERT). It arose in a 71-year-old woman who presented with postmenopausal bleeding, ascites, and a right pelvic mass. Malignant cells with rhabdoid morphology were identified by cytologic examination of the peritoneal fluid. Exploratory laparotomy revealed a 10-cm right adnexal mass and disseminated peritoneal tumor. Pathologic study showed diffuse expansion of the endometrial stroma by rhabdoid-like cells with transmural infiltration of the myometrium and extensive involvement of uterine serosa and right ovary by tumor. Neoplastic cells were immunoreactive for vimentin, cytokeratin, and epithelial membrane antigen, and cytoplasmic whorls of intermediate filaments were observed by electron microscopy. Fluorescence in situ hybridization (FISH) studies with chromosome 22-specific probes showed no loss of the INI1 gene, and no coding sequence mutation was identified.     

Cushing's syndrome due to ACTH-production of an ovarian carcinoid

Summary The case of a 56-year old woman with severe Cushing's syndrome due to ovarian ACTH-production is described. Both clinical picture and biochemical pattern were consistent with the ectopic ACTH syndrome. ACTH was found by specific immunohistochemical staining in a carcinoid tumor of the patient's right ovary. In contrast, pituitary cells exhibited immunoreactive ACTH to only a minimum extent.Abbreviations ACTH adrenocorticotropic hormone - CT computerized tomography - APUDoma tumor of amine precursor utake and decarboxylation cells     

Ovarian sex cord tumor with annular tubules. Report of a case.

A 23-year-old woman underwent resection of a tumorous right ovary after long-standing irregular genital bleeding. The tumor measured 50 x 30 mm and had a yellowish-white solid cut surface with scattered small cysts. The light microscopic diagnosis was a sex cord tumor with annular tubules. Ultrastructurally, the tumor cells had Charcot-Boettcher filaments and showed vimentin positivity by immunohistochemistry. A three-dimensional reconstruction study proved that the tumor cell nests had a ovoid outer margin and contained blind-ended ellipsoid hyaline bodies. This tumor is presumed to be a variant of sex cord/stromal tumor showing differentiation predominantly to Sertoli cells.     

Lipid Cell Tumor of the Ovary

A 32-year-old nulligravida, with a history of abdominal hysterectomy for multiple leiomyomas of the uterus, was seen initially with signs of masculinization. Normal values for 17-ketosteroids, 17-hydroxycorticosteroids, and plasma cortisol eliminated the adrenal as the source of the excess androgen as well as Cushing syndrome. Increased plasma testosterone and androstenedione levels in the peripheral blood as well as in the right ovarian vein sampling implicated the right ovary, which revealed a lipid cell tumor (0.5 to 1.3 cm in maximum dimension).     

Non-invasive thymoma with widespread blood-borne metastasis

Summary A 49 year-old woman with multiple coin lesions in both lungs died three months after admission to hospital for progressive neurologic manifestations due to increasing intracranial pressure. At autopsy, neoplastic lesions were found in the anterior mediastinum, lungs, spleen, cerebrum, liver, right kidney and right ovary. Microscopically, the tumor was composed predominantly of epithelial cells which were arranged in an hemangiopericytoma-like pattern. Rosette formation was also prominent. This case was diagnosed as a thymoma with widespread blood-borne metastasis. Previous reports of metastasizing thymomas are very uncommon.     

Ovarian Sex Cord Tumor with Annular Tubules: Report of a Case

A 23-year-old woman underwent resection of a tumorous right ovary after long-standing irregular genital bleeding. The tumor measured 50X30 mm and had a yellowish-white solid cut surface with scattered small cysts. The light microscopic diagnosis was a sex cord tumor with annular tubules. Ultrastructurally, the tumor cells had Charcot-Boettcher filaments and showed vimentin positivity by immunohistochemistry. A three-dimensional reconstruction study proved that the tumor cell nests had an ovoid outer margin and contained blind-ended ellipsoid hyaline bodies. This tumor is presumed to be a variant of sex cord/stromal tumor showing differentiation predominantly to Sertoli cells. Acta Pathol Jpn 41: 701–706, 1991.