A Case of Hypercalcemic-Type Stage IVB Small-Cell Carcinoma of the Ovary in a Young Woman

Abstract

A 38-year-old nulliparous woman with severe obesity (BMI 66) and hypertension presented with constipation, fatigue, weakness, and poor appetite that had progressively worsened over the prior two to three weeks. Upon admission, the patient was found to have significant hypercalcemia, leukocytosis, and lactic acidosis. Computed tomography (CT) scan of the chest, abdomen, and pelvis revealed an adnexal mass with extensive lesions throughout her pelvis, abdomen, and chest. An ultrasound-guided omental core biopsy was performed, which was confirmatory for metastatic ovarian small cell carcinoma. Given her poor prognosis and clinical status, chemotherapy was likely to provide minimal benefit and ultimately the patient decided to pursue a comfort-oriented plan of care and passed away on day 9 of admission.

Keywords: malignancy related hypercalcemia; ovary cancer; rare cancers; small cell carcinoma of the ovary; young woman.

Figure 1. CT chest, abdomen, and pelvis (CT CAP) revealing an adnexal mass with extensive lesions

A: 8.8 cm adnexal mass of soft tissue density in right hemipelvis (CT A/P). B: Extensive peritoneal metastases and omental caking (CT A/P). C: Innumerable bilateral metastatic lung nodules (CT chest). A/P: abdomen and pelvis.

Figure 2. Pathology slide images of omental core biopsy

A: Needle core biopsy specimen, completely replaced by high-grade malignant neoplasm (H&E @ 100x mag). B: Neoplastic cells are monotonous, with a moderate amount of cytoplasm, uniform round nuclei, and prominent nucleoli (H&E @ 400x mag). C: Tumor cells express PAX 8 nuclear reactivity. D: Tumor cells with focal wide-spectrum cytokeratin reactivity.