Contributed by Jing Yu, MD, PhD, Giuliana Trucco, MD
Published on line in October 2003
The patient is a female in her 70s with pelvic masses and ascites. Her preoperative CA-125 increased to 130 units/ml, but CA19-9 and CEA were normal. She underwent total abdominal hysterectomy, bilateral salphingo-oophorectomy, omentectomy as well as cul-de-sac excisional biopsy.
The left ovary and fallopian tube were distorted by multiple tan-white firm nodules with homogenous cut surface. The right adnexa were completely replaced by tumor masses which were fused with a tubular structure resembling vermiform appendix. Microscopically, the nodules were made up of trabeculae, ribbons and nests of medium to large size polygonal tumor cells, with organoid growth pattern in some areas and pallisading in other areas (Fig. 1). The tumor cells had relatively uniform oval to round, finely granular nuclei, with eosinophilic and granular cytoplasm (Fig. 2 and 3). In the part that was labeled "right adnexa", there was no recognizable ovarian tissue or fallopian tube. Instead, the vermiform appendix was embedded in the tumor masses. There was a luminal, mural and serosal involvement of the appendix by the tumor (Fig. 4 and 5). The tumor nodules extensively invade to the uterine serosa (Fig. 6), mesentery sigmoid colon (Fig. 7), pelvic sidewalls, cul-de-sac and omentum (Fig. 8).
|Chromogranin (Fig. 9)||+||Calcitonin||-|
|Synaptophysin (Fig. 10)||+||CD5||-|
|CK 7 (Fig. 11)||+||ß-HCG||-|
|CK 20 (Fig. 12)||-||ER||-|
|CDX2 (Fig. 13)||-||PR||-|
|TTF-1 (Fig. 14)||+||Her2/Neu||-|
CT scan of chest, abdomen and pelvis
There are a large right pleural effusion and a small left pleural effusion with bibasilar atelectasis. There is a thrombus identified in the left lower lung involving a segmental artery. There are ascites and several areas of rounded soft tissue density in the abdomen and pelvis concerning for metastatic implants.
Peritoneal and Pleural fluids
Positive for malignant cells.
Thyroid nuclear scan
Normal thyroid scan. No evidence for tumor nodules.