Contributed by Nicole N. Esposito, M.D. and Gregory J. Naus, M.D.
Published on line in March, 2005
The patient is a woman in her mid-40s who presented to her primary care physician complaining of menorrhagia. In addition to uterine leiomyomas, radiologic work-up revealed a right complex ovarian cystic lesion, measuring approximately 4.5 cm in greatest dimension. The patient had no personal or family history of breast or ovarian cancer. She subsequently underwent a total abdominal hysterectomy and bilateral salpingooopherectomies.
The right ovary was received previously opened and was noted to express sebum-like material intraoperatively. The ovary, measuring 4.8 x 3.6 x 0.8 cm, was largely composed of a unilocular cystic structure, measuring 4.2 x 3.7 x 0.9 cm, lined by tan-pink tissue with multiple papillary excrescences. Adjacent to and abutting this cyst was an additional smaller cyst, measuring 1 x 1 x 0.9 cm, partially filled with sebum-like material and lined by tan-white tissue (Fig. 1). The remaining ovarian tissue was rubbery white and unremarkable.
Sections of the larger cyst revealed an intracystic (Figs. 2 and 3) proliferation of cells arising from thick, fibrotic papillary stalks (Fig. 4), forming complex, non-hierarchical filigree (Fig. 5) and cribriform (Fig. 6) patterns. The cells were cohesive and somewhat monomorphic with high nuclear-to-cytoplasmic ratios, evenly distributed chromatin, and prominent nucleoli (Figs. 7 and 8). There was no evidence of invasion into the underlying ovarian stroma.
Sections of the smaller cyst revealed an unremarkable keratinizing squamous epithelial lining (Figs. 9 and 10). No definite continuity between the lining of the larger cyst and that of the smaller cyst could be made (Fig. 11).