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Case Reports
. 2018 Sep 3;11(1):77.
doi: 10.1186/s13048-018-0449-1.

Anaplastic carcinoma in ovarian seromucinous cystic tumor of borderline malignancy

Toshiyuki Okumura  1   2 , Etuo Muronosono  3 , Masahiko Tsubuku  4 , Yasuhisa Terao  5 , Satoru Takeda  5 , Masanori Maruyama  3
Affiliations
Case Reports

Anaplastic carcinoma in ovarian seromucinous cystic tumor of borderline malignancy

Toshiyuki Okumura et al. J Ovarian Res. .

Abstract

Background: The mortality rate of ovarian cancer is the highest among all gynecological malignancies in Japan. Ovarian tumors are classified as benign, borderline malignant, or malignant. Anticipating the histological subtype with imaging only is often difficult because of several histological subtypes of epithelial ovarian tumors (such as serous, mucinous, endometrioid, clear cell, and Brenner tumors). In addition, the majority of mucinous tumors in the ovary are metastatic. Furthermore, mucinous tumors belong to one of the two different subclasses (i.e., intestinal and seromucinous types). Ovarian seromucinous cystic tumors of borderline malignancy are infrequent and only rarely coexist with other malignant tumors.

Case presentation: We have reported a 53-year-old Japanese woman with anaplastic carcinoma in an ovarian seromucinous cystic tumor of borderline malignancy. Her MRI and CT analysis revealed an ovarian tumor with a mural nodule, ascites, and peritoneal dissemination. Enhanced MRI revealed that the mural nodule was enhanced. Enhanced CT analysis revealed that the lymph nodes were not swollen. Intriguingly, the mural nodule crossed the cyst wall into the cavity and onto the surface. Her laboratory data revealed high serum CA 125 level. Cumulatively, these results suggested ovarian malignancy. The patient underwent hysterectomy with bilateral salpingo-oophorectomy, omentectomy, and resection of the disseminated lesions. Lymph node biopsy was omitted because of the suggestion of enhanced CT image findings and palpation during surgery. Her postoperative specimen examination determined FIGO at least stage IIIB, and accordingly, adjuvant chemotherapy was prescribed. After 3 years of the operation, the patient is presently alive without clinical tumor recurrences.

Conclusion: Imaging studies with pathognomonic findings contributed to ovarian cancer diagnosis in this case. To the best of our knowledge, this is the first study in English literature to report detailed classification of mucinous borderline malignancy, seromucinous cystic, and anaplastic carcinoma in an ovarian seromucinous cystic tumor of borderline malignancy.

Keywords: Anaplastic tumor; Case report; Immunohistochemical; Mural nodule; Ovarian tumor; Seromucinous borderline malignancy.

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Conflict of interest statement

Ethics approval and consent to participate

This report was approved by the Ethics Committee of Maruyama Memorial General Hospital (No. 2017–2).

Consent for publication

Written informed consent was obtained from the patient for publication of this case report and any accompanying images.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Statistical analysis. a Gynecological malignancy incidence rate in Japanese women by year. b Gynecological malignancy mortality rate in Japanese women by year. c Percentages of ovarian borderline malignancies in Japanese women by histological classification
Fig. 2
Fig. 2
Image analyses. a Gadorinium-enhanced T1-weighted magnetic resonance imaging showing a mural nodule that was enhanced and the mural nodule crossed the cyst wall into the cavity and onto the surface (arrow). b Enhanced computed tomography showing ascites in the pelvis and intraperitoneal malignant dissemination (arrowhead)
Fig. 3
Fig. 3
Gross findings of isolated preparations. a Chocolate-like cyst contents. Medial and lateral mural nodule enlargement (arrow). b Brown color of a part of the mural nodule (arrow head)
Fig. 4
Fig. 4
Microscopic and immunohistochemical cyst wall findings. a Hematoxylin and eosin-stained section showing epithelium with papillary hyperplasia in the cyst wall. The epithelium is mucinous and shows dysplasia. b Cyst wall showing negative immunohistochemical staining for WT-1. c Cyst wall showing positive immunohistochemical staining for estrogen receptor. d Cyst wall showing positive immunohistochemical staining for vimentin
Fig. 5
Fig. 5
Microscopic and immunohistochemical mural nodule findings. a Hematoxylin and eosin-stained section showing dense, undifferentiated, polymorphic, and eosinophilic cells with hyperplasia in the mural nodule. b Mural nodule showing positive immunohistochemical staining for CAM5.2. c Mural nodule shows positive immunohistochemical staining for AE1/AE3. d Mural nodule showing positive immunohistochemical staining for vimentin
See this image and copyright information in PMC

References

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