The Cytoreductive Effect of Radiotherapy for Small Cell Ovarian Carcinoma of the Pulmonary Type: A Case Report and Review of the Literature

Abstract

Small cell ovarian carcinoma of the pulmonary type is a rare and highly aggressive tumor for which a suitable treatment strategy has not been established. A 45-year-old woman presented with abdominal swelling, and primary ovarian carcinoma was suspected. The postoperative pathological diagnosis was small cell ovarian carcinoma of the pulmonary type. She also had complicated grade 1 endometrioid carcinoma of the uterine corpus. Three courses of cisplatin and etoposide therapy were administered as adjuvant chemotherapy. Because the tumor was chemotherapy resistant, she underwent palliative abdominal irradiation at a dose of 26 Gy in 13 fractions, which induced cytoreduction and provided symptomatic relief. She died 4 months after surgery. Lactate dehydrogenase was a useful tumor marker during treatment. Here, we present an extremely rare case of a patient with small cell ovarian carcinoma of the pulmonary type treated with radiotherapy after surgery and chemotherapy.

Figure 1

(a) Macroscopic findings: an irregular, white, and solid tumor of the right ovary. ((b)–(d)) Microscopic findings. (b) Tumor cells are round to ovoid with hyperchromatic nuclei, scant cytoplasm, abundant mitosis, and apoptosis with conspicuous necrosis (hematoxylin-eosin stain (HE), ×300). (c) Endometrial carcinoma grade 1 in uterine corpus (HE, ×30) with less than half myometrial invasion and no vascular invasion. ((d), (e)) Tumor cells are positive for synaptophysin and neuron-specific enolase (immunostaining, ×300).

Figure 2

(a) Enhanced abdominal computed tomography (coronal section) reveals the remaining tumor is approximately 20.3 cm in diameter before irradiation. (b) After radiation therapy, the tumor size decreased to 15.3 cm.

Figure 3

The graph shows the time course of the levels of serum lactate dehydrogenase (LDH), cancer antigen 125 (CA125), and neuron-specific enolase (NSE). The patient underwent surgery (S) on day 21; chemotherapy (C) on days 43, 65, and 86; and abdominal irradiation (R) from day 120 to day 140. She died on day 157 (D). The solid line shows levels of LDH, the dashed-line shows levels of CA125, and the dashed-dotted line shows levels of NSE.