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Short Course 02 - Gynecologic Pathology - Differential Diagnosis of Ovarian Tumors
Sunday, September 17, 2006 14:00 - 17:30
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Moderators:
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Robert H. Young
Massachusetts General Hospital
Harvard Medical School
Boston, MA
Jaime Prat
Hospital de la Santa Creu i Sant Pau
Autonomous University of Barcelona, Spain
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Disclosure:
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In accordance with ACCME guidelines regarding disclosure, the USCAP policy requires that faculty members who have a significant financial or other relationship with a commercial company, entity, or service (which will be discussed in this Short Course) must disclose this to attendees. The Academy also requires that speakers disclose any products that are not labeled for the use under discussion. Faculty members for this Short Course have indicated they have no disclosures to make.
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Clinical histories are displayed below.
Click on the case numbers to display the text and references for each case.
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- Serous Borderline Tumor of the Right Ovary with Noninvasive Implants and Pelvic Lymph Node Involvement
Submitted by: Jaime Prat - Autonomous University of Barcelona, Spain
A 26-year old woman complained of abdominal pain. On ultrasound examination, the pelvis was almost entirely occupied by a large "exophytic" and papillary mass. At laparotomy, 2 liters of straw-color ascitic fluid were drained. The uterus and fallopian tubes were covered by a soft greyish-white and hemorrhagic mass (400 g). The omentum was uninvolved. A total abdominal hysterectomy and bilateral salpingo-oophorectomy, omentectomy, and biopsy sampling of the abdominal peritoneum and pelvic and para-aortic lymph nodes were done. Slides were sent in consultation to an international cancer center and chemotherapy was recommended.
Case 1 - Figure 1a
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Case 1 - Figure 1b
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Serous Borderline Tumor of the Right Ovary with Noninvasive Implants and Pelvic Lymph Node Involvement
- Mucinous Cystadenocarcinoma
Submitted by: Jaime Prat - Autonomous University of Barcelona, Spain
A 43-year old woman was admitted to the hospital because of massive abdominal enlargement and pain. Pelvic ultrasound revealed a large multilocular cystic tumor. CA 12.5: 422 mU/L; CA 19.9: 1260 mU/L. At laparotomy, the right ovary was replaced by a tumor, 38 cm in greatest diameter. The outer surface was grayish-white and smooth with prominent blood vessels, but there was an area of rupture of 9.5 cm in diameter. On section, the tumor was predominantly cystic with a solid component. The cysts, up to 24 cm in diameter contained thick mucinous fluid. The solid tissue was grayish-yellow and exhibited several foci of hemorrhage and necrosis. A total abdominal hysterectomy with bilateral salpingo-oophorectomy, omentectomy, and appendectomy were done.
Case 2 - Figure 1
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Mucinous Cystadenocarcinoma
- Endometrioid Carcinoma Resembling Sex Cord-Stromal Tumor
Submitted by: Jaime Prat - Autonomous University of Barcelona, Spain
A 73-year old woman had vaginal bleeding for 6 months. On pelvic examination she was found to have a left adnexal tumor. Twenty-six years prior to admission she underwent a right salpingo-oophorectomy for an unknown reason. She also had a mastectomy for carcinoma 9 years previously. An endometrial biopsy done a few weeks before admission was reported as "proliferative" endometrium. At laparotomy, the left ovary was replaced by a grayish-white, multinodular tumor, 8.5 cm (285 g) in diameter. A total abdominal hysterectomy with left salpingo-oophorectomy was done. On section, the ovarian tumor was solid. It exhibited a central star-shaped fibrous component surrounded by confluent nodules of fleshy grayish-yellow tissue.
Case 3 - Figure 1
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Endometrioid Carcinoma Resembling Sex Cord-Stromal Tumor
- Primitive Neuroectodermal Tumor of the Ovary
Submitted by: Jaime Prat - Autonomous University of Barcelona, Spain
A 22 year-old woman was admitted to the hospital emergency room because of abdominal pain and swelling. Two months prior to admission she underwent a D&C for retained POC of about 9 weeks of gestational age. At that time pelvic examination was unremarkable. Subsequently, she developed massive abdominal enlargement and pain over a two months period. Abdominal examination revealed a large mobile mass in the left lower quadrant that extended up to 2 cm below the umbilicus. A CT scan showed a cystic and solid heterogeneous tumor (18 x 17 x 14 cm). Serum levels, CA19.9: 100 KU/l (normal range <37); CA125:192 KU/l (normal range <35); b-hCG: 2.2 UI/l; CEA and a-FP were normal. At laparotomy there was a large cystic and solid left ovarian tumor with ruptured capsule (3.5 cm). A left salpingooophorectomy, biopsy of the contralateral ovary and appendectomy were performed.
Case 4 - Figure 1
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Primitive Neuroectodermal Tumor of the Ovary
- Retiform Sertoli-Leydig Cell Tumor
Submitted by: Robert H.Young - Harvard Medical School - Boston, Massachusetts, USA
A 20-year-old woman was found to have a 15 cm left ovarian mass. The tumor had a smooth external surface, and on sectioning was largely cystic, containing abundant, clear, watery fluid. A minor component of nodular tan neoplastic tissue was also present. The tumor was confined to the ovary.
Case 5 - Figure 1
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Retiform Sertoli-Leydig Cell Tumor
- Small Cell Carcinoma of Ovary, Hypercalcemic Type
Submitted by: Robert H.Young - Harvard Medical School - Boston, Massachusetts, USA
A 19-year-old woman with abdominal swelling was found at laparotomy to have a 17 cm left ovarian mass with multiple foci of tumor involving the peritoneal surfaces. The ovarian tumor was predominantly solid and white with some cystic foci.
Case 6 - Figure 1
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Small Cell Carcinoma of Ovary, Hypercalcemic Type
- Clear Cell Struma Ovarii
Submitted by: Robert H.Young - Harvard Medical School - Boston, Massachusetts, USA
A 39-year-old woman was found to have an 8 cm solid tan-white, focally cystic right ovarian mass. The neoplasm was confined to the ovary.
Case 7 - Figure 1
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Clear Cell Struma Ovarii
- Krukenberg tumor
Submitted by: Robert H.Young - Harvard Medical School - Boston, Massachusetts, USA
A 58-year-old woman with abdominal pain was found to have bilateral ovarian tumors with involvement of the bowel serosa. One ovary, from which slide obtained, measured 11 cm and the other 5 cm. The largest neoplasm had a mottled appearance with tan-yellow areas alternating with purple foci. The consistency varied from firm to soft.
Case 8 - Figure 1
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Krukenberg tumor
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