Case 481 -- A 63-year-old woman with brain mets and diverticulitis

Contributed by Jing Yu, MD, PhD and Raja Seethala, MD
Published on line in October 2006


The patient was a 63-year-old woman who was found to have probable lung cancer and multiple brain metastases, for which she received whole brain radiation and steroids treatment. Three weeks after the therapies were started, she developed gastrointestinal bleeding and underwent colectomy for acute diverticulitis with perforation. During the surgery, the ovaries appeared to be likely involved by metastatic disease, therefore bilateral oophorectomy was also performed. Computed tomography of the pelvis at the time of evaluation for source of metastatic disease did not reveal abnormalities in the ovaries.


Both ovaries were normal in size and grossly hemorrhagic. Microscopic examinations revealed areas of cortical coagulative necrosis with extensive hemorrhage (Figs.1 and 2). Embedded in the necrotic foci were sheets and clusters of enlarged cells with abundant amphophilic cytoplasm, large intranuclear inclusions that form characteristic perinuclear halos, and variable intracytoplasmic inclusions (Fig. 3). These cells appeared to be cortical stromal cells, thecal cells and endothelial cells (Fig. 4). The admixed inflammatory cells were composed of lymphocytes, neutrophils and plasma cells (Fig. 5). Rare lesional stromal cells with a rim of inflammatory cells were observed away from the necrotic foci (Figs. 6 and 7).

In addition, there were prominent post-menopausal restrictive vascular changes throughout the ovary, including markedly thickened arterial wall with deposition of eosinophilic collagenous material (Figs. 8 and 9). Moreover, focal fibrin thrombi were identified within or adjacent to the necrotic areas (Fig. 10). Rare foci of fibrinoid mural necrosis of small to medium sized arteries were also seen. No vascular changes were seen in the colonic mucosa.


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