Pancreatic tumor revealed by metastatic bilateral ovarian tumor with virilisation syndrome

We report a case of a 38-year-old patient presenting with both pancreatic and a bilateral ovarian tumor revealed by a virilization syndrome. Clinically, both tumors were conceivably distinct. However, on histological examination, they were found to be morphologically similar, with neuroendocrine features, suggesting that pancreatic tumor was a primitive neoplasm and the ovarian one a metastatic spread of that lesion. The virilization syndrome was due to the functional status of the ovarian tumors that was confirmed by immunohistochemical detection of inhibin.     

Ovarian neuroendocrine carcinoma, non-small cell type, associated with serous carcinoma

BACKGROUND: Neuroendocrine carcinoma of the non-small cell type of the ovary is a rare aggressive tumor, interestingly associated with either a surface epithelial tumor or teratoma. CASE: A 71-year-old woman presented with a pelvic mass and underwent a total abdominal hysterectomy with a bilateral salpingo-oophorectomy. Pathology examination showed a 6.5 cm in greatest dimension ovarian tumor composed of neuroendocrine carcinoma of the non-small cell type and serous carcinoma. Immunohistochemical studies including keratin 7, WT-1, and neuroendocrine markers demonstrated differences in the two components. Microsatellite instability (MSI) analysis using five polymorphic markers also showed a different pattern in the two components. CONCLUSION: This is the first report of an ovarian neuroendocrine carcinoma, non-small cell type, associated with a serous carcinoma. Immunohistochemistry and MSI are very helpful in making a definite diagnosis.     

Hyperandrogenism in a postmenopausal woman presenting with a metastatic ileum endocrine tumor

OBJECTIVE: To elucidate the mechanism of the hyperandrogenism found in a postmenopausal woman presenting an ileum endocrine tumor with ovarian metastases. DESIGN: Case report. SETTING: University hospital. PATIENT(S): A postmenopausal woman was referred for hirsutism. Basal plasma testosterone was high, 6.6 nM/L (normal, 相似文献   

Well-differentiated serous ovarian carcinoma presenting as a breast mass: a case report and flow cytometric DNA study

Ovarian carcinoma metastatic to the breast is uncommon. We report a rare occurrence of ovarian carcinoma that initially presented as a breast mass. Complete examination revealed bilateral ovarian tumors with widespread peritoneal and abdominal disease. One of the ovarian tumors was a papillary serous tumor of low malignant potential, and the other was a well-differentiated papillary serous carcinoma. Although the neoplasm within the breast resembled serous ovarian carcinoma with psammoma bodies, the initial presentation and the presence of an apparent intraductal component created a potential for its misdiagnosis as a primary breast carcinoma. Using DNA flow cytometry, we demonstrated the relationship between the breast, lymph node, and peritoneal metastases and the serous carcinoma, thereby supporting the histologic diagnoses.     

Ovarian malignant luteinized thecoma--an unusual tumor in an adolescent

Malignant luteinized thecoma is an extremely rare ovarian tumor. The fifth reported case of this tumor presenting in a 13-year-old epileptic child on anticonvulsant therapy with a rapidly enlarging pelvic-abdominal mass is discussed. At laparotomy, bilateral ovarian involvement, massive ascites, and omental and bowel serosal metastases were present. The pathological diagnosis was difficult with initial diagnoses of ovarian edema, endodermal sinus tumor, and ovarian fibrosarcoma. The final diagnosis of malignant luteinized thecoma was made by recognizing the presence of lutein cells with foamy vacuolated cytoplasm and intracytoplasmic staining for oil red O. Electron microscopy also demonstrated vacuolated cells with multiple fat globules. After surgical debulking the patient was treated with combination chemotherapy with complete response. The similarities of this case to three previously reported bilateral thecomas presenting in children on anticonvulsant therapy is discussed.     

Robotic-assisted laparoscopic cytoreductive surgery for lobular carcinoma of the breast metastatic to the ovaries

The first case of robotic-assisted laparoscopic cytoreductive surgery for a metastatic malignant ovarian tumor is described. A 65-year-old woman who was treated for breast cancer 13 years earlier presented with a deep venous thrombosis in the right leg and a pelvic mass. Imaging tests showed bilateral solid ovarian tumors and an enlarged lymph node at the level of the right common iliac vessels but no evidence of any other tumor metastases. The patient was offered and accepted to undergo a da Vinci robotic-assisted bilateral adnexectomy with hysterectomy and pelvic lymph node sampling. The surgery took 200 minutes, and the patient was discharged uneventfully on the third postoperative day. Histologic examination showed strongly estrogen receptor-positive metastatic lobular carcinoma of the breast in both ovaries and fallopian tubes. She was further treated with adjuvant exemestane and is currently doing well. It is possible to treat selected patients with malignant ovarian tumors by robotic-assisted laparoscopy.     

Adenocarcinoid tumor of the ovary diagnosed during pregnancy. A case report

BACKGROUND: Adenocarcinoid tumors are uncommon neoplasms with dual morphology, showing components of a neuroendocrine tumor with carcinoid features and an adenocarcinomatous component composed of glands lined with mucin-containing cells, some of which are goblet type. CASE: A 36-year-old woman had a left adnexal mass found during the second week of pregnancy. Sonography showed it to be increasing in size and eventually to become associated with pelvic pain. During the 20th week of gestation, an exploratory laparotomy was performed, and the left ovary and fallopian tube were excised. A diagnosis of adenocarcinoma was rendered by intraoperative frozen section. A staging procedure was then performed that included removal of the contralateral adenexa, pelvic lymph node sampling, peritoneal biopsies and partial omentectomy. The vermiform appendix and gastrointestinal tract appeared unremarkable. The patient was discharged. Permanent sections of the left ovary revealed an adenocarcinoid tumor. CONCLUSION: While reports detail ovarian metastases of adenocarcinoid neoplasms from primary appendiceal and other gastrointestinal sites, this case, in the setting of a normal appendix and negative workup for an extraovarian origin, is the fourth documented one of a primary ovarian adenocarcinoid tumor and first diagnosed during pregnancy.     

Progesterone production in adenocarcinoma of the colon metastatic to the ovaries

A 59-year-old woman who presented with bowel obstruction, a large pelvic mass, and marked breast tenderness was found to have strikingly elevated preoperative serum concentrations of estrogen and progesterone. After resection of a primary adenocarcinoma of the colon and bilateral ovarian metastases, her serum progesterone and estradiol concentrations gradually declined. The unusual hormone production in the patient was confirmed by regression of clinical symptoms and by in vitro endocrine assays performed on cells from ovarian tumor grown in tissue culture. The tumor consumed pregnenolone and produced progesterone and estradiol in large quantity.     

Papillary serous adenocarcinoma of the ovary diagnosed after malignant pericardial tamponade and embolic stroke

BACKGROUND: Epithelial carcinomas of the ovary are predominantly an intraperitoneal disease. Reports of epithelial ovarian carcinomas metastatic to the pericardium are rare. CASE: A 43-year-old woman was admitted with symptoms of a pericardial tamponade, as well as an embolic cerebrovascular accident, and transferred to the ICU where a pericardiocentesis was performed. Cytology revealed malignant cells in the pericardial fluid. CT scan of the abdomen and pelvis revealed bilateral pelvic masses. A laparotomy revealed a papillary serous adenocarcinoma of ovarian primary and an infarcted spleen with capsular tumor metastases. The malignant cells in the pericardial fluid were consistent with the ovarian primary. CONCLUSION: Ovarian cancer metastasis to the heart and pericardium presented an aggressive variant of tumor spread with significant morbidity and subsequent mortality.     

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 cancer, diagnosed with PET, with bilateral inguinal lymphadenopathy as primary presenting sign

BACKGROUND: Ovarian cancer groin lymph nodes metastases are rare. Only one case of disease spread isolated to the groins has been reported in the English literature. We report the case of a patient with bilateral inguinal lymphadenopathy due to tumor metastases and in which tumor origin was diagnosed using [(18)F]fluorodeoxyglucose positron emission tomography (PET). CASE REPORT: This is the first case of bilateral groin lymph nodes as sole site of metastases from ovarian cancer. Primary origin was identified using PET. CONCLUSIONS: In rare cases, the ovaries can directly metastasis to the groin even in a relatively initial tumor growth phase. PET may play a role in the diagnosis of occult ovarian tumors.     

Rare late metastasis of a successfully treated advanced ovarian cancer

A case of a 64 year old woman is reported suffering from bilateral inoperable ovarian carcinoma. Seven years before death the carcinoma was histologically confirmed by an explorative laparotomy. At this time even a diffuse peritoneal carcinosis was found. The polychemotherapy yielded to a reduction of tumor mass. This allowed a surgical radical operation two years later. During continued chemotherapy the patient was clinically and cytologically free of tumor. The death was caused by diffuse late metastases in the brain.     

Bilateral ovarian fibromatosis presenting with ascites and hirsutism

BACKGROUND: Ovarian fibromatosis is a very rare nonneoplastic disease. Due to the rarity and atypical clinical presentations, they may give rise to a misdiagnosis of malignancy and unnecessary extensive surgical interventions. Literature lacks definitive data about this rare disease and its preoperative evaluations. MRI together with the intraoperative frozen section may help us to define the benign nature of the disease. In this report, we aimed to review the literature and give a highlight to the gynecologic oncologists about this rare disease. CASE HISTORY: A 19-year-old female patient admitted to our hospital with the complaints of menstrual irregularity, hirsutism, and increased abdominal girth. Physical examination revealed bilateral ovarian mass, hirsutism, and ascites. Serum CA-125 levels were slightly elevated. Preoperative MRI study showed bilateral hypointense lobulated ovarian masses. With the initial diagnosis of ovarian tumor, we performed explorative laparotomy and excised both masses. Final pathology was reported as bilateral ovarian fibromatosis. CONCLUSION: Ovarian fibromatosis commonly presents with ascites and solid pelvic mass and can be misdiagnosed as a malignant ovarian tumor. In young patients, clinicians should consider ovarian fibromatosis in differential diagnosis of pelvic mass. Preoperative MRI findings and intraoperative frozen examination may be used to avoid unnecessary aggressive surgical management.     

Massive anterior chest wall metastasis of ovarian cancer and prolonged survival after treatment: a case report

BACKGROUND: Although previously uncommon, distant metastases of ovarian cancer are now observed with increasing frequency. Late-appearing metastases to the chest wall, however, are extremely rare; management is controversial and the prognosis is poor. CASE: A 51-year-old woman presented with a massive metastatic tumor of the anterior chest wall 10 years after receiving total abdominal hysterectomy and bilateral salpingo-oophorectomy for primary ovarian cancer. The extremely large size of the tumor precluded surgical resection. Following successful chemotherapy and local irradiation, however, this patient has achieved long-term survival. CONCLUSION: This report is the first to describe a case of a massive, inoperable chest wall tumor developing as a late metastasis of ovarian cancer. Systemic chemotherapy combined with local irradiation represents effective treatment for such unusual cases.     

Huge endometriosis presenting like an ovarian tumor: CT appearance

A 32-year-old female with a clinical history of abdominal swelling underwent CT of the abdomen. A huge biloculated cystic mass with a mural nodule in the abdominal and pelvic region was seen. The lesion showed slightly homogeneous enhancement. The imaging findings suggested an ovarian tumor. Histopathological evaluation after surgical resection revealed that the lesion was a bilateral ovarian endometriosis.     

Primary ovarian undifferentiated non-small cell carcinoma, neuroendocrine type

BACKGROUND: Non-small cell neuroendocrine carcinoma (NSCNEC) of the ovary is a rare aggressive neoplasm, characteristically arising in association with a surface epithelial tumor. CASE: A 27-year-old woman with no significant past medical history presented with a 17-cm left ovarian tumor. She underwent an exploratory laparotomy with resection of the pelvic mass. A diagnosis of stage IA non-small cell neuroendocrine carcinoma was rendered. She was subsequently treated with Taxol and Carboplatinum. CONCLUSION: This is a report of a rare primary ovarian non-small cell neuroendocrine carcinoma. In contrast to prior reports, this neoplasm was not associated with a surface epithelial tumor.     

Bilateral metastatic carcinoma of the breast from primary ovarian cancer

We report a case of ovarian cancer with metastasis to both breasts and axillary lymph nodes and the vaginal cuff. A 41-year-old previously hysterectomized women presented with pelvic mass and malignant pleural effusion. During the courses of chemotherapy; bilateral breast nodules, and bilateral axillary lymphadenopathies and a nodule in the vaginal cuff were identified. The biopsy of both breasts, axillary lymph nodes and the nodule in the vaginal cuff revealed papillary serous cystadenocarcinoma. Immunohistochemical staining of breast specimens were positive for ovarian tumor marker CA-125. Received: 24 February 2000 / Accepted: 9 May 2000     

Leiomyosarcoma of the uterus with focal rhabdomyosarcomatous differentiation.

An unusual myometrial tumor was encountered in a 70-year-old female who presented with lower abdominal fullness and symptoms related to pulmonary metastases. Laparotomy revealed a uterine mass that was removed by total abdominal hysterectomy and bilateral salpingo-oophorectomy. Multiple liver metastases also were noted. Pathologic examination of the hysterectomy specimen revealed a 25-cm, well-circumscribed myometrial mass that had a firm, white-to-yellow, focally whorled, sectioned surface with focal hemorrhage and necrosis. Within the main mass was a discrete, 7-cm, soft, gelatinous, reddish-yellow nodule. The main tumor was a well-to-moderately differentiated leiomyosarcoma, whereas the gelatinous nodule was rhabdomyosarcomatous and contained rhabdomyoblasts that exhibited cytoplasmic cross striations and immunoreactivity for myoglobin. No epithelial elements were detected in the neoplasm. At the time of last follow-up, the patient was undergoing chemotherapy. This is only the second well-documented case of a hybrid leiomyosarcoma-rhabdomyosarcoma of the uterus.     

Bilateral metastatic ovarian tumors (Krukenberg’s tumors) in the course of stomach cancer

Presented is a rare case of bilateral neoplastic metastases to the ovaries (Krukenberg’s tumors) and to the fundus of the uterus which occurred in the course of stomach cancer in a 46-year-old female who was treated surgically in the Department of Obstetrics and Gynecology of the Regional Hospital in Slupsk. The patient was admitted secondary to bilateral ovarian masses. Her past medical history included peptic ulcer disease for a few years, confirmed by gastroscopic biopsy in July of 2000. The surgery performed in our department revealed bilateral ovarian tumors, each measuring about 10 cm in diameter, which were completely removed along with the fundus of the uterus. The intraoperative histologic diagnosis was ovarian cancer. No other macroscopic neoplastic changes were found during the surgery. During surgical removal of the gastrocolic ligament a group of enlarged lymph nodes at the greater curvature of the stomach in the proximity of the spleen was incidentally noticed. The intraoperative histology of the lymph nodes described metastatic neoplasia. Another intraoperative biopsy was also performed of the stomach because of atypical clinical presentation of the ovarian cancer. The pathologic diagnosis was stomach cancer. Upon the consultation with pathologists it was concluded that the primary tumor came from the stomach while the changes in the ovaries and lymph nodes were metastatic. Thus, the surgery consisted of total hysterectomy as well as removal of the stomach along with the spleen, gastrocolic ligament and greater omentum. The distal esophagus was anastomosed with the loop of jejunum. The final result of histologic exam confirmed the location of the primary neoplastic tumor in the stomach with metastases to both ovaries, the body of uterus, and lymph nodes at the greater curvature of the stomach. Received: 16 August 2001 / Accepted: 25 September 2001 Correspondence to Z. Studzinski     

Bronchial metastases from ovarian carcinoma. Report of a case and review of the literature.

A patient with ovarian cystadenocarcinoma developed respiratory insufficiency due to bilateral endobronchial metastases, 6.5 years after treatment of the primary tumor. Ovarian cancers frequently metastasize to the pleura and lung parenchyma. Clinically significant bronchial metastases are rare. Only three cases have been reported previously. As in our patient, bronchial metastases tend to occur after a relatively long interval from diagnosis of the primary tumor, and survival may be prolonged after their appearance.