Gynecologic Pathology
Fatemeh Nili; Soheib Fathi; Mansoureh Tavakoli; Elham Mirzaian; Maryam Lotfi
Abstract
Background & Objective: Clear cell carcinoma (CCC) is an uncommon histopathologic subtype of ovarian and endometrial carcinoma. Due to the morphologic overlapping with other subtypes of ovarian and endometrial carcinomas, an accurate diagnosis is crucial.Methods: In this study, 31 cases of ovarian ...
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Background & Objective: Clear cell carcinoma (CCC) is an uncommon histopathologic subtype of ovarian and endometrial carcinoma. Due to the morphologic overlapping with other subtypes of ovarian and endometrial carcinomas, an accurate diagnosis is crucial.Methods: In this study, 31 cases of ovarian clear cell carcinoma (OCCC), 28 endometrial clear cell carcinoma (ECCC), and 80 non-CCC subtypes (33 high-grade serous carcinomas of the ovary, 2 low-grade serous carcinomas, 10 ovarian endometrioid, 3 serous carcinomas and 29 endometrioid carcinomas of the endometrium) were investigated for immunohistochemical expression of AMACR. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for the distinction of OCCC and ECCC from other histopathologic subtypes were calculated.Results: Positive AMACR staining was seen in 18 OCCCs (58%) and 10 ECCCs (35.7%). In the non-clear cell group, 44 cases of ovarian (98%) and 25 cases of endometrial carcinoma (78%) showed negative results. Only one case of ovarian endometrioid carcinoma and 7 cases (22%) of endometrial endometrioid carcinomas revealed a positive reaction (P<0.05). Collectively, sensitivity, specificity, PPV, and NPV of AMACR expression, for the diagnosis of OCCC were calculated as 58%, 98%, 94.7%, and 77.2%, respectively. The sensitivity, specificity, PPV, and NPV were shown to be as 35.7%, 78.1%, 58.8%, and 58.1%, respectively in the endometrium.Conclusion: AMACR may be a highly specific immunohistochemical marker for the distinction of serous and clear cell carcinoma. A small percentage of endometrioid carcinoma may show positive staining. The sensitivity of this marker may not be higher than the other well-known Napsin-A IHC marker.
Gynecologic Pathology
Fatemeh Samiee Rad; Mehdi Ghaebi; Arezoo Bajelan
Abstract
Pure ovarian neuroendocrine tumors are very rare. Herein, we present a young Iranian woman with a pure primary ovarian neuroendocrine tumor.A 26-year-old female presented with chronic abdominal pain and progressive constipation and was referred to the emergency room. Imaging findings confirmed a mass ...
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Pure ovarian neuroendocrine tumors are very rare. Herein, we present a young Iranian woman with a pure primary ovarian neuroendocrine tumor.A 26-year-old female presented with chronic abdominal pain and progressive constipation and was referred to the emergency room. Imaging findings confirmed a mass in the right adnexa. Following the resectional surgery of the ovarian mass, histopathological and immunohistochemistry results disclosed a mixed type of primary ovarian neuroendocrine tumor. The patient did not experience tumor recurrence afterward.Due to the rarity and low prevalence of primary pure ovarian neuroendocrine tumors, the histopathologic diagnosis should be confirmed by an immunohistochemistry study.
Gynecologic Pathology
Fatemeh Nili; Mansoureh Tavakoli; Narges Izadi-Mood; Hana Saffar; Soheila Sarmadi
Abstract
Background & Objective: Clear cell carcinomas (CCC) differ from other types of ovarian and endometrial carcinomas in biology, behavior and response to chemotherapy. Histopathologic diagnosis may be challenging in some situations which necessitates immunohistochemistary (IHC) assessment. In this study ...
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Background & Objective: Clear cell carcinomas (CCC) differ from other types of ovarian and endometrial carcinomas in biology, behavior and response to chemotherapy. Histopathologic diagnosis may be challenging in some situations which necessitates immunohistochemistary (IHC) assessment. In this study we investigated the diagnostic utility of Napsin-A in diagnosis of ovarian and endometrial CCCs. Methods: Ovarian and endometrial CCC samples from 2013 to 2018 in 3 general and women’s hospital in Tehran were re-evaluated by 2 expert pathologists. Forty-two samples were included as case and 42 non-clear cell carcinomas (Non-CCC) of ovary and endometrium were selected as control group. Based on IHC study tumors with sum intensity and percentage score ≥2 (at least 1+ staining in more than 1% of tumor cells) were considered positive. Result: The prevalence of endometrial and ovarian CCC in the case group were 15 and 27 respectively. The tumors in the control group included 22 cases of endometrioid, 2 high grade papillary serous carcinoma (HGSC) of endometrium, 6 endometrioid and 12 HGSC of ovary. Napsin-A positivity was observed in 35 (83%) of CCCs while 7 (17%) samples including 3 out of 15 endometrial and 4 out of 27 ovarian CCCs were Napsin-A negative. No positive reaction was seen in control group. The overall accuracy, specifity and sensitivity of Napsin-A for diagnosis of ovarian and endometrial CCCs were 83%, 100% and 83%, respectively. Sensitivity for ovarian and endometrial CCCs were 85% and 80%, orderly. Conclusion: Napsin-A is an accurate and reliable marker for distinction of CCCs from non-CCCs in ovary and endometrium. A panel of antibodies may yield the highest diagnostic accuracy.
Gynecologic Pathology
Fatemeh Nili; Azadeh Sedighi moghadam pour; Hedieh Moradi Tabriz; Parisa Sedighi Moghadam Pour; Hana Saffar
Volume 13, Issue 4 , October 2018, , Pages 467-470
Abstract
Peripheral primitive neuroectodermal tumor (pPNET) is a highly aggressive small round cell tumor belonging to PNET/Ewing sarcoma family. Ovarian tumors composed of primitive neuroectodermal elements are extremely rare. Herein we reported two cases of peripheral primitive neuroectodermal tumors of ovary ...
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Peripheral primitive neuroectodermal tumor (pPNET) is a highly aggressive small round cell tumor belonging to PNET/Ewing sarcoma family. Ovarian tumors composed of primitive neuroectodermal elements are extremely rare. Herein we reported two cases of peripheral primitive neuroectodermal tumors of ovary in two patients with different clinical presentations. Definite diagnoses were made based on the histomorphology and immunohistochemistry results. With respect to different clinical behaviors, treatment modalities and prognosis of peripheral primitive neuroectodermal tumors compared to other known ovarian neoplasms, it is essential to consider this entity as a differential diagnosis in ovarian tumors especially in young patients.
Gynecologic Pathology
Srilatha Parampalli Srinivas; Archana Shivamurthy; Lakshmi Rao; Rajeshwari Gurumoorthy Bhat
Abstract
Hepatoid variant of yolk sac tumor of ovary is an unusual tumor with an aggressive behavior. It is usually observed in young females, presents with abdominal complaints and is associated with raised α-fetoprotein (AFP) levels. It should be differentiated from other hepatoid tumors involving the ...
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Hepatoid variant of yolk sac tumor of ovary is an unusual tumor with an aggressive behavior. It is usually observed in young females, presents with abdominal complaints and is associated with raised α-fetoprotein (AFP) levels. It should be differentiated from other hepatoid tumors involving the ovary. A complete patient evaluation with gross, microscopy, and immunohistochemistry can identify the site of origin to administer appropriate treatment. The current study reported the case of a 30-year-old married parous female presenting with abdominal distention and pain of two months duration. She had regular menstrual cycles. Based on lab investigations her serum AFP level was markedly raised to 34,244 ng/mL (normal range: 0-9 ng/mL). Computerized tomography (CT) scan showed large lobulated heterogeneous mass in both ovaries and omental, gall bladder, and lung metastasis. A CT guided biopsy of the ovarian mass was done. On histopathology, a differential diagnosis of hepatoid variant of yolk sac tumor, hepatoid carcinoma of ovary and hepatoid tumor arising from gall bladder metastasizing to the ovary were observed. Patient underwent surgery. Per operatively gross ascites with bilateral ovarian mass, extensive omental, pelvic, and gall bladder deposits were observed. Bilateral salpingo-oophorectomy with omental deposit biopsy was conducted. Histopathology along with immunohistochemistry confirmed a diagnosis of hepatoid variant of yolk sac tumor in both ovaries with widespread intra-abdominal metastasis.
Ankita Goel; Nandam Rao; Vissa Santhi; Syam Byna; Bhavana Grandhi; Jyothi Conjeevaram
Abstract
Background & Objective: The common epithelial ovarian tumors are classified into serous, mucinous, clear cell, endometrioid, the Brenner, mixed, and undifferentiated types. Cytoskeleton intermediate filament composition of ovarian tissues indicates that the cytokeratin and vimentin are observed in ...
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Background & Objective: The common epithelial ovarian tumors are classified into serous, mucinous, clear cell, endometrioid, the Brenner, mixed, and undifferentiated types. Cytoskeleton intermediate filament composition of ovarian tissues indicates that the cytokeratin and vimentin are observed in ovarian surface epithelium along with the common ovarian epithelial tumors. The current study aimed at investigating the cytokeratin and vimentin expression in epithelial ovarian tumors to establish a diagnostic relevance. Methods: Sixty-six common epithelial ovarian tumors were studied using anti-cytokeratins (Monoclonal Mouse Anti-Human Cytokeratin Clones AE1/AE3; DAKO, Denmark,) and anti-vimentin (Monoclonal Mouse Anti-Vimentin, Clone V9; DAKO, Denmark,) to ascertain the intermediate filament profiles in formalin-fixed and paraffin-embedded surgical pathology materials. Results: All ovarian epithelial tumors expressed cytokeratin in a uniform fashion. Vimentin was coexpressed with high intensity in 62.5% of serous carcinomas, mild intensity in 25% of mucinous adenocarcinoma, and moderate intensity in single case of endometrioid adenocarcinoma. Vimentin decoration in mucinous carcinoma had a focal involvement, whereas malignant endometrioid and serous decoration tended to involve larger areas. There was a significantly increased expression of vimentin in serous cystadenoma and serous carcinoma, compared with their mucinous counterparts. Also, vimentin expression and histologic grade of serous tumors showed a positive correlation. No association was found between vimentin expression and degree of differentiation in mucinous, endometrioid, and Brenner tumors. Conclusion: The current investigation emphasized the efficiency of immunohistochemistry (IHC) typing as a tool for a more precise characterization of the origin and differentiation of human neoplasms.
Gynecologic Pathology
Savita Agarwal; Megha Ralli; Pinki Pandey; Shruti Singh
Abstract
Ovarian small cell carcinoma is a rare and highly malignant tumor with poor prognosis. It usually presents in younger females with features of hypercalcemia. The exact histogenesis of the tumor is unclear and it may present as an undifferentiated tumor. In such cases, immunohistochemistry (IHC) plays ...
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Ovarian small cell carcinoma is a rare and highly malignant tumor with poor prognosis. It usually presents in younger females with features of hypercalcemia. The exact histogenesis of the tumor is unclear and it may present as an undifferentiated tumor. In such cases, immunohistochemistry (IHC) plays an important role to confirm the diagnosis. Limited treatment options are available and mainly include radical surgery followed by adjuvant therapy in advanced stages. The current report was a rare case of small cell carcinoma of ovary presenting no symptoms of hypercalcemia diagnosed on histopathological examination and IHC findings.
Katayoun Ziari; Kamyab Alizadeh
Volume 11, Issue 1 , January 2016, , Pages 61-65
Abstract
Ovarian hemangiomas are benign and rare tumors of female genital tract with less than 60 reported cases in the literature. A 38- yr- old woman was admitted to Be’sat Hospital, Tehran, Iran in 2012, due to severe abdominal pain. Ultrasound evaluation revealed a 6 cm left ovarian cystic mass and ...
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Ovarian hemangiomas are benign and rare tumors of female genital tract with less than 60 reported cases in the literature. A 38- yr- old woman was admitted to Be’sat Hospital, Tehran, Iran in 2012, due to severe abdominal pain. Ultrasound evaluation revealed a 6 cm left ovarian cystic mass and serum tumor markers were normal. Then, left salpingo-oophorectomy was performed for the patient. Microscopic examination revealed a follicular cyst and an incidental cavernous hemangioma consisting thin-walled vascular channels filled with blood that lined with flatten endothelial cells. In IHC staining strong immunoreactivity for CD31 and CD34 were seen, finally, the diagnosis of primary ovarian hemangioma, cavernous-type was made. The clinicopathologic presentation of this unusual benign tumor is discussed.
Shweta Rana; Manmeet Kaur Gill; Shivani Kalhan; Rahul N Satarkar; Ashok Sangwaiya; Pawan Singh
Volume 11, Issue 1 , January 2016, , Pages 66-70
Abstract
Malignant mixed germ cell tumors,though rare overall, are the most common type of malignant ovarian neoplasms in young and adolescent girls. These tumors are rapidly growing and can metastasize. We report a case of 13-yr-old girl who presented at SHKM GMC, Nalhar, Mewat, Haryana, India in December 2013 ...
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Malignant mixed germ cell tumors,though rare overall, are the most common type of malignant ovarian neoplasms in young and adolescent girls. These tumors are rapidly growing and can metastasize. We report a case of 13-yr-old girl who presented at SHKM GMC, Nalhar, Mewat, Haryana, India in December 2013 with huge abdominal lump of a malignant mixed germ cell tumor comprising both immature teratoma and embryonal carcinoma. This report illustrates the aggressiveness of this tumor and emphasises the need of early diagnosis and treatment.
Maliheh Khoddami; Maryam Barangi
Volume 7, Issue 2 , April 2012, , Pages 121-124
Abstract
Ovarian borderline serous tumors are uncommon. Combination of borderline serous adenofibromatous tumor and prominent micro papillary architecture is not previously reported. We report a case of borderline papillary serous adenofibromatous tumor (also called serous adenocarcinofibroma) with extensive ...
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Ovarian borderline serous tumors are uncommon. Combination of borderline serous adenofibromatous tumor and prominent micro papillary architecture is not previously reported. We report a case of borderline papillary serous adenofibromatous tumor (also called serous adenocarcinofibroma) with extensive micropapillary pattern in a 27 year-old married woman. She was infertile and presented with diffuse abdominal pain and dysparonia. Bilateral 5.3 and 4.5 cm solid ovarian masses were detected by sonography. Both masses were ovoid with tan-pink bosselated smooth external surfaces, and solid tan lobular cut surfaces. Microscopically, both tumors showed many papillary structures in a fibrotic stroma and contained multiple psammoma bodies. The papillae had broad hyalinized fibrotic stroma with many micropapillary projections arising from the main papilla, lined by mildly pleomorphic cuboidal cells. Mitotic activity was low with no marked nuclear atypia or stromal invasion. No extraovarian implants or metastases were identified.
Seyed Jaber Mousavi; Farzaneh Mohammadi Zia
Volume 6, Issue 2 , April 2011, , Pages 93-96
Abstract
Human hydatid cyst is a wide spread disease. It is an endemic disease in Iran. Hydatid cyst is extremely rare in the female reproductive organs. This is a case report of ovarian hydatid cyst in a 42-year-old woman. She presented with feeling of enlargement of abdomen and abdominal pain. On physical ...
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Human hydatid cyst is a wide spread disease. It is an endemic disease in Iran. Hydatid cyst is extremely rare in the female reproductive organs. This is a case report of ovarian hydatid cyst in a 42-year-old woman. She presented with feeling of enlargement of abdomen and abdominal pain. On physical examination, a large mass in lower abdomen palpated. Ultrasonography reported a heterogeneous multicystic mass measuring 155×97 mm in hypo gastric area. The CT-scan with IV contrast reported a huge cystic lesion, containing multiple septi that could be due to ovarian lesion. After surgery, histopathological examination showed typical laminated &germinative layers with hexagonal scolecies of hydatid cyst. Since the common sites of hydatid cyst are liver, lung, etc and the imaging studies are highly diagnostic for hydatid cysts; this illustrated case is interesting for uncommon site, not suggested by imaging studies and with clinical (surgical) impression of malignant ovarian tumor.