Anaplastic carcinoma showing rhabdoid features combined with ovarian mucinous borderline cystadenoma: a case report and literature review

Abstract

Anaplastic carcinoma in an ovarian tumor (ACOT) is rare. There have been a few controversial cases illustrating the clinical characteristics and prognostic factors of ACOT, which are not well known. A 60-year-old Chinese woman presented with a large pelvic tumor. A transvaginal ultrasound examination showed a large single ovarian cystic tumor with mural nodules and ascites. A gross ovarian mass with a size of approximately 20 × 10×15 cm³ was found. The content of the ovarian cyst was light yellow and chocolate-like, and a large grayish mural nodule of approximately 10 cm was found on the cyst wall. Histological diagnosis of ovarian mucinous borderline cystadenoma with a mural nodule of anaplastic carcinoma showing rhabdoid features and International Federation of Gynecology and Obstetrics (FIGO) stage IIIa was made. Fifteen months after surgery, the patient had received six courses of paclitaxel and carboplatin. She is still alive without any recurrence of the tumor. Findings from the present case suggest that patients with ACOT and FIGO stage IIIa would benefit from surgery and chemotherapy of paclitaxel and carboplatin. We also review the clinical features and survival rate of patients with ACOT using the Surveillance, Epidemiology, and End Result database, and summarize previously reported treatments.

Keywords: Anaplastic carcinoma; chemotherapy; immunohistochemistry; mural nodule; ovarian mucinous borderline cystadenoma; ovarian neoplasm.

Figure 1.

Ultrasonic image of an ovarian tumor with an unclear boundary and irregular shape. The tumor contains anechoic and solid areas. An abundant blood flow signal can be seen in a solid nodule (green box), showing a low resistance arterial spectrum (resistance index = 0.17).

Figure 2.

Ovarian borderline mucinous cystadenoma with anaplastic carcinoma (hematoxylin–eosin staining). (a) The bulk of the tumor is composed of borderline mucinous cystadenoma where proliferation of glandular architecture can be seen (4×). (b) The anaplastic carcinoma (rhabdoid pattern) is composed of large anaplastic cells with an ample eosinophilic cytoplasm and prominent nucleoli (4×; insert: 40×).

Figure 3.

Microscopic and immunohistochemical mural nodule findings. (a) Hematoxylin–eosin stained section showing dense, undifferentiated, polymorphic, and eosinophilic cells with hyperplasia in mural nodules. (b) Mural nodule showing positive immunohistochemical staining for cytokeratin. (c) Mural nodule showing positive immunohistochemical staining for epithelial membrane antigen. (d) Mural nodule showing positive immunohistochemical staining for vimentin. (e) Mural nodule showing positive immunohistochemical staining for integrase interactor 1. (f) Mural nodule showing weak positive immunohistochemical staining for desmin.

Figure 4.

Levels of tumor biomarkers during treatment. (a) Cancer antigen (CA) 125 levels during treatment; (b) CA19-9 levels during treatment.

Figure 5.

Kaplan–Meier estimates of the overall survival curve in 133 patients with anaplastic carcinoma in an ovarian tumor stratified by the International Federation of Gynecology and Obstetrics stage (four groups). Stage II vs. I, P = 0.013; stage III vs. I, P < 0.001; stage IV vs. I, P = 0.003; stage III vs. II, P = 0.055; stage IV vs. II, P = 0.475; and stage IV vs. III, P = 0.183.