Unilateral ovarian metastases of gastric adenocarcinoma simulating primary ovarian yolk sac tumours

Transcription

1 Unilateral ovarian metastases of gastric adenocarcinoma simulating primary ovarian yolk sac tumours Francisco F Nogales, Elvira Stacher (*), Ovidiu Preda, Pablo Goyenaga, José Aneiros-Fernandez, Farid Moinfar (*) and Alina Nicolae. From the departments of Pathology, San Cecilio University Hospital, Granada, Spain and Medical University, Graz, Austria (*).

2 Problem case 1 44-year-old Main symptom: left 20cm ovarian mass apparent FIGO Ia stage elevated serum AFP 3600 ng/ml solid white mass with areas of hemorrhage and necrosis

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7 CK7 negative CK20 focal

8 AFP

9 GLP3

10 SALL4

11 CDX2

12 HepPar1

13 Problem case 2 26-year-old pregnant patient Main symptom: large ovarian mass apparent FIGO Ia stage solid white mass with areas irregular cystic spaces filled with mucoid secretion

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21 Am J Surg Pathol 29: ;2005

22 Chromogranin fdgs.consistent with a mucinous

23 CDX2

24 Glypican3

25 SALL4

26 CK7 and CK20 focal

27 In brief Unilateral abdominal tumours Young and mature patients Tumour was first manifestation Histologically, clear cell, solid hepatoid, tubular YST. Usual (microcystic) patterns absent Immuno characteristic for YST except for weak AFP posivities

28 A real duck??? It moves like one Quacks like one

29 Case 1

30 Case 2

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33 Subsequent image staging studies revealed extensive primary gastric tumours in both cases

34 Case 1

35 Clear-cell, alpha-fetoprotein-producing gastric carcinoma with hepatoid differentiation.

36 Histopathology. 2010;56: Glypican 3 has a higher sensitivity than alpha-fetoprotein for testicular and ovarian yolk sac tumour: immunohistochemical investigation with analysis of histological growth patterns. Zynger DL, McCallum JC, Luan C, Chou PM, Yang XJ. Am J Surg Pathol. 2008;32: Oncofetal protein glypican-3 distinguishes yolk sac tumor from clear cell carcinoma of the ovary. Esheba GE, Pate LL, Longacre TA. Am J Clin Pathol Aug;130(2): Expression of glypican 3 in ovarian and extragonadal germ cell tumors. Zynger DL, Everton MJ, Dimov ND, Chou PM, Yang XJ. Am J Surg Pathol Dec;30(12): Glypican 3: a novel marker in testicular germ cell tumors Zynger DL, Dimov ND, Luan C, Teh BT, Yang XJ. Histopathology Jan;58(2):312-4; Glypican 3 is a sensitive, but not a specific, marker for the diagnosis of yolk sac tumours. Preda O, Nicolae A, Aneiros-Fernández J, Borda A, Nogales FF. Cancer Sci. 2009;100: Glypican 3-expressing gastric carcinoma: distinct subgroup unifying hepatoid, clear-cell, and alpha-fetoproteinproducing gastric carcinomas. Ushiku T, Uozaki H, Shinozaki A, Ota S, Matsuzaka K, Nomura S, Kaminishi M,Aburatani H, Kodama T, Fukayama M. Int J Gynecol Pathol. 2007;26: Glypican-3 expression in primary and recurrent ovarian carcinomas Stadlmann S, Gueth U, Baumhoer D, Moch H, Terracciano L, Singer G Histopathology Nov;49(5): Hepatocellular oncofetal protein, glypican 3 is a sensitive marker for alpha-fetoprotein producing gastric carcinoma. Hishinuma M, Ohashi KI, Yamauchi N, Kashima T, Uozaki H, Ota S, Kodama T, Aburatani H, Fukayama M.

37 Am J Surg Pathol Jun;33(6): SALL4 is a novel sensitive and specific marker of ovarian primitive germ cell tumors and is particularly useful in distinguishing yolk sac tumor from clear cell carcinoma. Cao D, Guo S, Allan RW, Molberg KH, Peng Y. Am J Surg Pathol. 2009;33: SALL4 is a novel diagnostic marker for testicular germ cell tumors. Cao D, Li J, Guo CC, Allan RW, Humphrey PA. Am J Surg Pathol. 2009;33: Diagnostic utility of SALL4 in extragonadal yolk sac tumors: an immunohistochemical study of 59 cases with comparison to placental-like alkaline phosphatase, alpha-fetoprotein, and glypican-3. Wang F, Liu A, Peng Y, Rakheja D, Wei L, Xue D, Allan RW, Molberg KH, Li J, Cao D. Am J Surg Pathol Apr;34(4): SALL4 represents fetal gut differentiation of gastric cancer, and is diagnostically useful in distinguishing hepatoid gastric carcinoma from hepatocellular carcinoma. Ushiku T, Shinozaki A, Shibahara J, Iwasaki Y, Tateishi Y, Funata N, Fukayama M. Am J Surg Pathol May;34(5): Diagnostic utility of novel stem cell markers SALL4, OCT4, NANOG, SOX2, UTF1, and TCL1 in primary mediastinal germ cell tumors. Liu A, Cheng L, Du J, Peng Y, Allan RW, Wei L, Li J, Cao D.

38 Cancer Sci. 2009;100: Glypican 3-expressing gastric carcinoma: distinct subgroup unifying hepatoid, clear-cell, and alpha-fetoproteinproducing gastric carcinomas. Ushiku T, Uozaki H, Shinozaki A, Ota S, Matsuzaka K, Nomura S, Kaminishi M,Aburatani H, Kodama T, Fukayama M. Am J Surg Pathol. 2010;34: SALL4 represents fetal gut differentiation of gastric cancer, and is diagnostically useful in distinguishing hepatoid gastric carcinoma from hepatocellular carcinoma. Ushiku T, Shinozaki A, Shibahara J, Iwasaki Y, Tateishi Y, Funata N, Fukayama M. /SALL4

39 No cases included in the series as clear-cell gastric or with hepatoid differentiations. Only 2 cases had vacuolated morphology similar to lipid-rich Sertoli cell tubules.

40 Original caption: Figure 10 Sertoli cell tumour (lipid rich)-like FAKE GLANDULAR YST

41 Original caption: Figure 4 cystic dilatations FAKE POLYVESICULAR

42 Take home messages H&E morphology always first: typical YST patterns are always present in real primaries Be very critical with immuno results, however sophisticated or specific they can be Always think of metastases in cases with unclear clinical presentation and morphology If nothing else works, kindly read clinical history