title: Massive intra-abdominal undifferentiated carcinoma derived from an endometrioid adenocarcinoma in a "normal-sized" ovary.
abstract: We report a case of massive intra-abdominal undifferentiated carcinoma derived from a tiny well-differentiated endometrioid adenocarcinoma of the ovary. The patient, a 56-year-old woman, who presented with a large intra-abdominal mass, underwent cytoreductive surgery with hysterectomy and bilateral salpingo-oophorectomy. Macroscopically, the intra-abdominal mass was composed of fragile and solid tumor components with extensive necro-hemorrhagic areas, mimicking a primary peritoneal tumor. Both ovaries were apparently normal in size, but a cut section of the right ovary revealed a 2-cm solid and cystic tumor showing focal rupture to the peritoneal surface. The intra-abdominal tumor consisted of pleomorphic cells without specific differentiation, showing diffuse sheet-like proliferation. The right ovarian tumor was a histologically well-differentiated endometrioid adenocarcinoma. Both the intra-abdominal undifferentiated tumor and the ovarian adenocarcinoma cells were immunohistochemically positive for keratin AE1/3, Ber-EP4, and CD10. Epithelial membrane antigen was positive only in the ovarian adenocarcinoma component, and vimentin was diffusely positive only in the intra-abdominal undifferentiated tumor component. Calretinin was negative in both tumor components. Allelotype analysis using 24 polymorphic markers located on 12 chromosomal arms showed that the intra-abdominal undifferentiated carcinoma and ovarian adenocarcinoma components had a high concordance rate (88%) of allelic patterns including identical allelic loss patterns at 7 chromosomal loci, suggesting a common genetic lineage. These data suggest that ovarian endometrioid adenocarcinoma, even when small in size, can give rise to a massive undifferentiated carcinoma filling the peritoneal cavity.
authors.affiliation: Department of Basic Pathology, National Defense Medical College, Tokorozawa, Saitama, Japan.
authors.forename: Kosuke
authors.initials: K
authors.lastname: Miyai
authors.forename: Sohei
authors.initials: S
authors.lastname: Yamamoto
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Aida
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Shimazaki
authors.forename: Masashi
authors.initials: M
authors.lastname: Takano
authors.forename: Kazuya
authors.initials: K
authors.lastname: Kudoh
authors.forename: Kenichi
authors.initials: K
authors.lastname: Furuya
authors.forename: Seiichi
authors.initials: S
authors.lastname: Tamai
authors.forename: Osamu
authors.initials: O
authors.lastname: Matsubara
mesh_terms: D000483:Alleles; D014408:Biomarkers, Tumor / Q000032:analysis / Q000378:metabolism; D064032:Calbindin 2; D018269:Carcinoma, Endometrioid / Q000378:metabolism / Q000556:secondary* / Q000601:surgery; D004273:DNA, Neoplasm / Q000737:chemistry / Q000235:genetics; D005260:Female; D006801:Humans; D053564:Keratins, Hair-Specific / Q000378:metabolism; D008875:Middle Aged; D018396:Mucin-1 / Q000378:metabolism; D015260:Neprilysin / Q000378:metabolism; D010051:Ovarian Neoplasms / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D010534:Peritoneal Neoplasms / Q000378:metabolism / Q000556:secondary* / Q000601:surgery; D016133:Polymerase Chain Reaction; D064030:S100 Calcium Binding Protein G / Q000378:metabolism; D014746:Vimentin / Q000378:metabolism; D000951:Antigens, Neoplasm
chemical_list: D014408:Biomarkers, Tumor; D064032:Calbindin 2; D004273:DNA, Neoplasm; D053564:Keratins, Hair-Specific; D018396:Mucin-1; D015260:Neprilysin; D064030:S100 Calcium Binding Protein G; D014746:Vimentin; C576764:CALB2 protein, human; C489804:KRTAP1-3 protein, human; C115012:human epithelial antigen-125; D000951:Antigens, Neoplasm