squamous Cell Carcinoma of the Ovary

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1 THE KURUME MEDICAL JOURNAL Vol. 41, p , 1994 Cell Carcoma Ovary A Case Report KAZUHIDE SHIMAMATSU, AKIHIRO IEMURA, OSAMU NAKASHIMA, JUN TAGUCHI, MICHIRO INOUE, KOICHI HIGAKI, MASAMICHI KOJIRO, AKIO KATAOKA, TAKASHI NISHIDA AND MICHIAKI YAKUSHIJI Departments Pathology Obstetrics Gynecology*, Kurume University School Medice, Kurume, 830 Japan Received for publication Ocber 1, 1994 Summary: A 68-year-old woman presented a one-month hisry lower abdomal pa weight loss, admitted our hospital. On physical examation, a large hard mass palpated her lower abdomen. An ultrasonograph computed mographic (CT) scan revealed a ovarian that measured 6.9 ~4.9 cm size. A tal hysterecmy bilateral salpgo-oophorecmy performed. posperative diagnosis cell carcoma (SCC). She died fection dissemated travascular coagulation 5 months after surgery. clical aupsy examations did not show primary lesions SCC except. Mature cystic terama, Brenner endometriosis, which are ordary regarded as hisgenesis ovarian SCC, not found, but a few surface epilial clusion cysts metaplasia observed non-cancerous area, contiguous transition from metaplastic cyst wall SCC confirmed by stepwise serial sections. present case suggests that surface epilium could be fourth possibility hisgenesis ovarian SCC. Key words: -ovarian cancer-surface epilial clusion cyst metaplasia- cell carcoma Introduction Primary cell carcoma (SCC) is rare, only few cases have been reported. As hisgenesis this, malignant transformations a mature cystic terama (Kionsky et al. 1972; Sivanesaratnam Lee, 1972; Kaplan, 1977; Gabrielli et al. 1984; Tang et al. 1984; Hirakawa et al. 1989), Brenner (Idelson, 1963; Miles Norris, 1972; Seldenrijk et al. 1986; Tang Kang, 1990) or endometriosis (McCullough et al. 1946; Lele et al. 1978; Chen Weilert, 1982; Tetu et al. 1987; Naresh et al. 1991) have been considered. most common orig this is eir mature cystic ter- Correspondence : Kazuhide Shimamatsu, M.D., First Department Pathology, Kurume University School Medice, 67 Asahi-machi, Kurume, 830 Japan. 177

SHIMAMATSU 178 ama or Brenner. Few cases SCC origatg from ovarian endometriosis have been reported. However, some cases, which hisgenesis cannot be determed, have also been reported (Shglenn et al.

2 SHIMAMATSU 178 ama or Brenner. Few cases SCC origatg from ovarian endometriosis have been reported. However, some cases, which hisgenesis cannot be determed, have also been reported (Shglenn et al. 1974; Marco Johnson, 1983; Chen, 1988; Radhi Awad, 1990), suggestg de novo occurrence SCC. We present a case SCC which primary have origated from epilium Case A 68-year-old a Japanese one-month abdomal Hospital abdomen. computed abdomen adnexal size cystic part irregularly ureter sue. Tumor 19-9, cells ogy no found such utere cervix cancer carci- No limits. vagi- atypical exfoliative carbohydrate Grossly, by a gray-whitish tis- as normal cervix. : replaced surroundg by due abnormalities utere Resected ill-defed two fdgs by scan. dilated performed on Ocber 22, At operation, completely replaced by, fallopian tube omentum also volved. Complete resection impossible because extension rectum, sigmoid colon sacred bone. Serum cell carcoma level immediately after surgery 83.8 ng/ml (normal: below 1.5 ng/ml). She received 4 cycles combation chemorapy consistg Bleomyc, Cisplat, Vblast Mimyc C, but her general condition deteriorated due rapid growth. She died fection dissemated travascular coagulation on March 28, 1994, an aupsy performed. solid alpha-feprote, noembryonic re markers, 125, CT Clically, she diagnosed as havg a primary ovarian cancer classified stage IIIc (International Federation Gynecology Obstetrics [FIGO] classification). A tal hysterecmy bilateral salpgo-oophorecmy Pathologic enhanced extension One solid. contrasted marg density. AL. 6.9 ~4.9 composed or travascular a measured her scan revealed different (CT) pelvis that admission, ultrasonograph mographic areas At palpated An University lower loss, Kurume mass pre- weight Ocber, hard lower cm large woman hisry pa admitted na ovarian surface metaplasia. Report sented a ovarian is considered ET endometrium. cyl- Fig. 1. Gross fdg enlarged irregular. Uterus, tube tact. left. surface Right fallopian

3 SQUAMOUS CELL CARCINOMA OF THE OVARY Fig. 2. Hislogical polygonal cells. observed Fig. ~ 25) 10 ~12 ~8 Inclusion High. 3. size.. cyst a: eos, ~40) (hemaxyl power irregular surroundg fallopian b: view metaplastic eos Pearl composed formation solid sheets tercellular bridge, ~200) metaplasia (hemaxyl epilium eos, (hemaxyl eos, ~200) proment. (Fig. Inset: cm fdg (hemaxyl 179 tubes surface connective uterus, left found vasion tissue be normal 1). Hislogically, composed a proliferation polygonal cells arranged a sheet pattern keratization (Fig. 2). A few surface epilial clusion cysts, which led by a sgle layer columnar epilium metaplasia part, found

4 SHIMAMATSU ISO ET AL. Fig. 4. Transition between epilium clusion metaplasia SCC. (hemaxyl eos, X 100) ovarian cortex where did not filtrate (Fig. 3). Stepwise serial sections disclosed that nests contiguous epilium clusion cyst showg metaplasia (Fig. 4). diagnosed as well-differentiated cell carcoma arisg from epilium surface clusion cysts metaplasia. re no volvement utere cervix endometrium. Aupsy At vaded tases nodes. fdgs aupsy, ureter, vesicovagal re residual ileum metas- septum, mesenteric no iliac evidence tive possibility that occurred or organs. rectum, lymph sugges- SCC primarily cyst Discussion Ovarian cancer has a great variety hislogical types, but SCC is rare. Most reported cases are metastatic SCC, which account for a mere 2.5% ovarian metastases (Webb et al. 1975). Of se, are metastatic s from cervix. most cases utere Primary SCC usually arises from cystic terama Brenner. Hirakawa et al. (1989) reported 28 cases SCC arisg from mature cystic terama described that SCC did not origate from a direct transition from ordary epidermis teramaus sk tissue but from a columnar epilium or from a metaplastic epilium. Among 10 cases ovarian SCC reported by Kashimura et

5 SQUAMOUS CELL CARCINOMA OF THE OVARY 181 al. (1989), 3 not associated cystic terama, but metaplasia glular epilium present 2 m. Tang Kang (1990) studied 6 SCCs arisg Brenner s, ultrastructurally, described that hislogic features s resemble those nonkeratized SCC utere cervix. Ultrastructural. features cluded numerous desmosomenilament complexes, specific for epilium. In general, transitional cell carcoma, adenocarcoma, SCC or a mixture m are common hislogic features malignant Brenner. ir study may support possibility that SCC arisg Brenner is also related surface epilium metaplasia. To our knowledge, only 5 cases primary SCC associated endometriosis have been reported (McCullough et al. 1946; Lele et al. 1978; Chen Weilert, 1982; Tetu et al. 1987; Naresh et al. 1991). As transition between benign endometriosis carcoma proven only 2 cases (Lele et al. 1978; Chen Weilert, 1982). Extensive samplg is mary clarify orig advanced cases. Four de novo ovarian SCC have been reported (Shglenn et al. 1974; Marco Johnson, 1983; Chen, 1988; Radhi Awad, 1990), 2 m (Shglenn et al. 1974; Chen, 1988) associated carcoma situ utere cervix. This may suggest that careful observation by multiple sections is necessary rule out possibility metastasis from microvasive carcoma cervix. In present case, mature cystic terama, Brenner, endometriosis not found, but clusion cysts metaplastic epilium found. Furr, a contiguous transition between nests metaplastic epilium confirmed. Thus, it is strongly suspected that present case might be malignant transformation clusion cyst metaplasia. Scully (1982) reported a case primary ovarian SCC which had arisen from ovarian surface epilium Miuerian differentiation. In general, clusion cyst is led by columnar epilium mesolial orig. Thus, it is suggested that surface epilium could be also one orig SCC. References CHEN, K.T.K. WEILERT, M. (1982). Squamous cell carcoma arisg endometriosis. Diagn. Gynecol. Obstet. 4, CHEN, K.T.K.(1988). Squamous cell carcoma (letter). Arch. Pathol. Lab. Med. 112, GABRIELLI, M., MELISSARI, M., CALTABLANO, M. MANSANI, F.E. (1984). Squamous cell carcoma arisg a dermoid cyst. Clical pathological report a case. Eur. J. Gynaecol. Oncol. 5, HIRAKAWA, T., TSUNEYOSHI, M. ENJOJI, M. (1989). Squamous cell carcoma arisg mature cystic terama. Clicopathologic pographic analysis. Am. J. Surg. Pathol. 13, IDELSON, M.G. (1963). Malignancy Brenner s, comments on hisgenesis possible estrogen production. Obstet. Gynecol. Survey 18, KAPLAN, E. (1977). Squamous cell carcoma arisg a dermoid cyst : A case report. S. Mr. Med. J. 52,

6 I82 SHIMAMATSU ET AL. KASHIMURA M., SHINOHARA, M., HIRAKAWA, T., KAMURA, T. MATSUKUMA, K. (1989). Clicopathologic study cell carcoma. Gynecol. Oncol. 34, KLIONSKY, B.L., NICKENS, O.J. AMORTEGUI, A.J. (1972). Squamous cell carcoma situ arisg adult cystic terama. Arch. Pathol. 93, LELE, S.B., PIVER, MS., BARLOW, J.J. TSUKADA, Y. (1978). Squamous cell carcoma arisg ovarian endometriosis. Gynecol. Oncol. 6, MARCO, MB. JOHNSON, L.A. (1983). Primary ovarian carcoma. A case report review literature. Cancer 52, MCCULLOUGH, K., FROATS, E.R. FALK, H.C. (1946). Epidermoid carcoma arisg endometrial cyst. Arch. Pathol. Lab. Med. 41, MILES, P.A. NORRIS, H.J. (1972). Proliferative malignant Brenner s. Cancer 30, NARESH, K.N., AHUJA, V.K., RAO, CR., MUKHERJEE, G. BHARGAVA, M.K. (1991). Squamous cell carcoma arisg endometriosis. J. Cl. Pathol. 44, RADHI, J.M. AWAD, SM. (1990). Bilateral cell carcoma. Case report. Br. J. Obstet. Gynaecol. 97, SCULLY, R.E. (1982). Squamous cell s. In Tumours maldeveloped gonads, ed. Scully, RE., pp Washgn, DC: Armed Forces Institute Pathology. SELDENRIJK, C.A., WILLIG, A.P., BARK, J.P.A., KUHNEL, R., RAO, BR. et al. (1986). Malignant Brenner : A hislogic, morphometrical, immunohischemical, ultrastructural study. Cancer 58, SHINGLETON, H.M., MIDDLETON, F.F. GORE, H. (1974). Squamous cell carcoma. Am. J. Obstet. Gynecol. 120, SIVANESARATNAM, V. LEE, T.T. (1972). Squamous cell carcoma arisg a dermoid cyst. Aust. N. Z. J. Obstet. Gynaecol. 5, TANG, L.C.H., So, K.F. WONG, R.L.C. (1984). Squamous cell carcoma a cystic terama. Arch. Gynecol. 236, TANG, S. KANG, Y. (1990). Ultrastructure malignant Brenner. Ch. Med. J. 103, TETU, B., SILVA, E.G. GERSHENSON, D.M. (1987). Squamous cell carcoma. Arch. Pathol. Lab. Med. 111, WEBB, M.J., DECKER, D.G. MUSSEY, E. (1975). Cancer metastatic. Obstet. Gynecol. 45,

Minimal Deviation Adenocarcinoma (Adenoma Malignum) of the Uterine Cervix Associated with Mucinous Ovarian Carcinoma

Minimal Deviation Adenocarcinoma (Adenoma Malignum) of the Uterine Cervix Associated with Mucinous Ovarian Carcinoma THE KURUME MEDICAL JOURNAL Vol. 38, p, 265-269, 1991 Mimal Deviation Adenocarcoma (Adenoma Malignum) of Utere Cervix Associated with Mucous Ovarian Carcoma TAKASHI NISHIDA, KIMIO USHIJIMA, TAKAAKI ODA,