Case 644 -- A 51 year-old female with diffuse abdominal mass

Contributed by Kotaro Sasaki, MD, Fiona Craig, MD and Larry Nichols, MD

CLINICAL HISTORY

This 51 year-old white female had been in good heath except for morbid obesity when she was hospitalized with severe abdominal pain, severe constipation and thirst. Computerized tomography of the abdomen showed extensive peritoneal carcinomatosis, bilateral adnexal masses and right pleural effusion. Before biopsy could be performed, the patient developed acute dyspnea and expired.

PATHOLOGIC FINDINGS

Autopsy Gross Pathology:

Massive pulmonary thromboembolism.
Bulky tumor in peritoneum and omentum (Figure 1), ovaries, fallopian tubes and uterine serosa (Figure 2A), small intestine (Figure 2B), appendix, mesentery, abdominal lymph nodes, right pleura and right lung.

Microscopic features:

H&E stain of tumor shows diffuse transmural involvement of small intestine (A), mesenteric fat (B), and left ovary (C) (4X). Tumor involving left ovary consists of sheets of intermediate sized blast-like cells with scant cytoplasm and round nuclei, which occasionally manifest convolution of the nuclear membrane. The nuclear chromatin is finely stippled; nucleoli are inconspicuous. Frequent mitotic figures are noted. (40X) (D). Immunohistochemical stains on left ovarian tumor mass shows negative staining for CD20 (E), Cyclin D1, CD5 and TdT, along with diffuse strong positive staining for CD22 (F), CD10 (G) and CD79a (H) (40X).

FINAL DIAGNOSIS