A case of granulosa cell tumor of the ovary detected from metastatic foci.

The authors report a case of granulosa cell tumor of the ovary that followed a rare clinical course, where the primary focus did not appear as a mass, and disseminated foci grew in the abdominal cavity. In 2008, a 70-year-old patient, gravida 6 and para 3, was diagnosed with a perihepatic mass, peritoneal dissemination, and an abdominal wall mass as confirmed by computed tomography (CT) scanning. There was no mass lesion in the pelvis. The pathological diagnosis based on the resected mass in the abdominal wall was malignant mesothelioma. During follow-up, abdominal bloating developed from April 2009. CT scans indicated growth of the intraperitoneal lesions. Therefore, the patient received two cycles of combination therapy with cisplatin and pemetrexed. The treatment was discontinued due to lack of efficacy. The intraperitoneal lesions grew but the clinical course was slow and inconsistent with that of malignant mesothelioma. Central pathological review was requested in April 2011, and a granulosa cell tumor was diagnosed. The patient was referred to the department for detailed examination and treatment. The patient underwent incision of the intraperitoneal tumors, simple total hysterectomy, bilateral salpingo-oophorectomy, and omentectomy. The final pathological diagnosis was normal-size adult-type granulosa cell tumor originating from the left ovary. It was a case of granulosa cell tumor without ovarian enlargement where growth of the metastatic foci was the major observation. As complete surgical resection was achieved and no additional therapy was given, the subject was followed on an outpatient basis and no recurrence was identified.

Can malignant transformation in mature cystic teratoma be preoperatively predicted?

PURPOSE OF INVESTIGATION: The study aimed to determine whether malignant transformation of mature cystic teratoma (MCT) can be preoperatively predicted by presenting two cases of MCT with malignant transformation and comparing their clinical factors with those of benign MCT encountered at around the same time. MATERIALS AND METHODS: Age, maximum tumor diameter, tumor marker levels (serum squamous cell carcinoma (SCC) and carbohydrate antigen (CA) 19-9, the presence of solid tumor masses, and the presence or absence of contrast enhancement in pelvic magnetic resonance imaging (MRI) were investigated in two cases of MCT with malignant transformation and 76 cases of benign MCT in which surgery was performed and a pathological diagnosis given by the department from 2004 to 2010. RESULTS: The mean ages of the two cases with malignant transformation and the cases of benign MCT were 42.5 years and 34.2 years, respectively. The mean maximum diameter of the two tumors with malignant transformation and the cases of benign MCT were 130 mm and 73.6 mm, respectively. The mean serum levels of SCC in the two cases with malignant transformation and the cases of benign MCT were 31.5 ng/ml and 0.92 ng/ml, respectively. Contrast enhancement and the presence of solid masses in images of MCT with malignant transformation were apparent. CONCLUSION: In order to accurately detect malignant transformation of MCT, the authors found it to be important to determine whether tumors larger than 100 mm in diameter were present and to check for the presence of solid masses enhanced in pelvic MRI examination, as well as to measure at least serum SCC and CA19-9 even in relatively young patients.

Efficacy of a methyl ester of 5-aminolevulinic acid in photodynamic therapy for ovarian cancers.

PURPOSE: Photodynamic therapy (PDT) is a new approach to cancer treatment that utilizes photochemical reactions induced by a combination of an oncophilic photosensitizing agent and laser light. With an aim to apply PDT for intraperitoneal disseminated foci of advanced or recurrent ovarian cancers, the present study was conducted to evaluate the antitumor effect of PDT using a methyl ester of 5-aminolevulinic acid (Methyl-ALA) on various types of human ovarian cancer in a subcutaneous xenograft model in nude mice and to elucidate the mechanism of its antitumor effect. METHODS: HTOA, MCAS, and TOV21G cell lines derived from human ovarian serous, mucinous, and clear cell adenocarcinoma, respectively, were used in this study. The mice in the treatment group and in the control group received an intraperitoneal injection of 250 mg/kg of Methyl-ALA and PBS alone, respectively. PDT was administered by 10 min irradiation using a 150 W halogen light, 3 h after Methyl-ALA or PBS injection. Each mouse received PDT twice a week for 3 weeks. RESULTS: Methyl-ALA-PDT significantly suppressed the growth of HTOA tumors as compared to control, whereas there was no significant effect on the growth of MCAS or TOV21G tumors. Methyl-ALA-PDT significantly increased apoptosis in implanted HTOA tumors as well as cultured cells. Western blot analysis showed that amount of expression of milk fat globule-EGF-factor 8, which binds to apoptotic cells and thereby facilitates their phagocytosis, significantly increased in HTOA tumors receiving Methyl-ALA-PDT, compared with untreated HTOA tumors. In addition, reduced vascular endothelial growth factor and CD34-positive microvessel density were found in solid HTOA tumors treated by Methyl-ALA-PDT, suggesting that the antitumor effect of Methyl-ALA-PDT is due to induction of apoptosis and reduction of angiogenesis. In comparison with HTOA cells, HPLC analysis demonstrated a significantly smaller intracellular amount of protoporphyrin IX (PpIX) in MCAS and TOV21G cells. PpIX is readily converted from Methyl-ALA and elicts photocytotoxicity. CONCLUSION: We conclude that Methyl-ALA-PDT could be an effective treatment in ovarian cancer and should be tested to apply intraperitoneally disseminated micro-foci during surgery.

A case of recurrent yolk sac tumor as spindle cell sarcoma of the abdominal wall.

Few studies report on tissue morphology in recurrence of yolk sac tumor. The case of the recurrence of a yolk sac tumor as a spindle cell sarcoma of the abdominal wall is presented. A 27-year-old woman was referred to our hospital due to suspicion of an ovarian tumor. Right salpingo-oophorectomy, partial omentectomy, and extirpation of disseminated foci as fertility-preserving surgery was done since the intraoperative pathological diagnosis was yolk sac tumor. Final pathological examination showed a germ cell tumor of which yolk sac tumor formed the major component including a small area that appeared to be immature nerve tissue. Although residual tumor was not less than 1 cm, clinical complete remission was reached after the sixth course of BEP regimen. However, the recurrence of a yolk sac tumor as an unclassified spindle cell sarcoma of the abdominal wall was found about two years after the initial surgery. Thereafter, the patient expired due to progression of the intraperitoneal disseminated lesions. The mesenchyme-like component of the yolk sac tumor is characterized by spindle cells originating from epithelial elements, and is likely to give rise to a chemoresistant, diversely differentiated sarcoma. This report suggests that the sarcoma reported in the case here also arose when spindle cells of the mesenchyme-like component underwent sarcomatous change during or after chemotherapy, subsequently relapsed as a chemoresistant tumor, and metastasized.

Syndrome of inappropriate secretion of anti-diuretic hormone following carboplatin-paclitaxel administration in a patient with recurrent ovarian cancer.

This is the first report on a syndrome of inappropriate secretion of anti-diuretic hormone (SIADH) in a patient with recurrent ovarian cancer following carboplatin and paclitaxel administration. A 63-year-old woman received chemotherapy combining carboplatin and paclitaxel for recurrent ovarian serous papillary adenocarcinoma. Four days after the chemotherapy, she suffered decreased mental awareness and lost consciousness. Blood chemistry tests showed serum sodium of 109 mmol/l. Plasma osmolarity was reduced to 232 mOsm/kg while urine osmolarity was high at 430 mOsm/kg, strongly suggesting the presence of SIADH. Because hyponatremia was not observed in the subsequent cycle of chemotherapy consisting of weekly paclitaxel and cisplatin, carboplatin was thought to be responsible for the condition. Clinicians should be aware of the possibility that carboplatin may cause SIADH, and should carefully monitor electrolyte balance after chemotherapy.