title: Mixed angiosarcoma, clear cell adenocarcinoma and mature teratoma elements in an ovarian tumor: a case report and literature review.
abstract: Malignant transformation of a mature teratoma in the ovary is a rare event, with an approximate rate of only 1-2%. Here, we report an ovarian tumor with a unique combination of epithelial and non-epithelial malignant components, including mature teratoma elements. A 59 year-old postmenopusal woman underwent total hysterectomy and bilateral salpingo-oophorectomy to remove a huge solid mass of the right ovary. The ovarian tumor was 16 × 12 × 4.5 cm in dimensions, composed of red-brown and greyish-white tissue with several cystic areas. Microscopically, atypical cells immunopositive for both CD31 and CD34 formed irregular ectatic vascular patterns with a high MIB-1 labeling index in red-brown areas. In contrast, tubule-cystic and papillary structures were lined by HNF-1β-immunopositive atypical cuboidal and hobnail cells with clear cytoplasm in greyish-white areas. In addition, normal-looking epithelial and stromal components, including mature squamous, cuboidal and ciliated epithelial cells, and adipose tissues, were observed in red-brown areas, suggesting an ovarian tumor combining angiosarcoma, clear cell adenocarcinoma, and mature teratoma features. We could demonstrate identical X-chromosome inactivation patterns among all three components by human androgen receptor gene (HUMARA) assays, pointing to complex inter-relationships regarding their pathogenesis. These observations suggest that a malignant tumor composed of two characteristic phenotypes arose in mature teratoma.
authors: Department of Pathology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan. hiroyuki.takahashi36@gmail.com
authors: Hiroyuki
authors: H
authors: Takahashi
authors: Pattama
authors: P
authors: Chaopotong
authors: Sabine
authors: S
authors: Kajita
authors: Miki
authors: M
authors: Hashimura
authors: Hitoshi
authors: H
authors: Yamazaki
authors: Makoto
authors: M
authors: Saegusa
mesh_terms: D018262:Adenocarcinoma, Clear Cell / Q000235:genetics / Q000378:metabolism / Q000473:pathology*; D014408:Biomarkers, Tumor / Q000378:metabolism; D049109:Cell Proliferation; D017024:Chemotherapy, Adjuvant / Q000379:methods; D004273:DNA, Neoplasm / Q000032:analysis; D005260:Female; D006394:Hemangiosarcoma / Q000235:genetics / Q000378:metabolism / Q000473:pathology*; D006801:Humans; D007044:Hysterectomy; D008875:Middle Aged; D009378:Neoplasms, Multiple Primary; D009852:Omentum / Q000601:surgery; D010051:Ovarian Neoplasms / Q000235:genetics / Q000378:metabolism / Q000473:pathology*; D010052:Ovariectomy; D017698:Postmenopause; D011944:Receptors, Androgen / Q000235:genetics / Q000378:metabolism; D013724:Teratoma / Q000235:genetics / Q000378:metabolism / Q000473:pathology*; D049951:X Chromosome Inactivation
chemical_list: C410798:AR protein, human; D014408:Biomarkers, Tumor; D004273:DNA, Neoplasm; D011944:Receptors, Androgen