[Clinicopathologic analysis of primary carcinoid of the ovary].

Objective: To describe the clinicopathologic features, diagnosis and differential diagnosis of ovarian carcinoid tumors. Methods: A retrospective chart review was performed of all patients diagnosed with primary ovarian carcinoid tumors at Fudan University Shanghai Cancer Centre from 2007 to 2017. Results: The histologic analysis of these carcinoid tumors revealed 3 were insular, 1 was trabecular, 1 was mucinous, and 10 were strumal. Histologic features of insular and trabecular carcinoid were similar to other parts of the neuroendocrine tumor. Strumal carcinoid was composed of thyroid tissue intimately admixed with carcinoid tumor, showing trabecular pattern. Mucinous carcinoid was resembles Krukenberg tumor. Most ovarian carcinoid tomours were diffusely positive with at least one neuroendocrine marker, especially synaptophysin (14/14) and CD56(9/10). The median follow-up time was 53 months, 1 patient with squamous-cell carcinoma of cervixrecur rence in vaginal after 37 months, and only 1 patient died of disease. The remaining patients were disease-free survival. Conclusions: Primary carcinoid of the ovary is a very rare low grade malignant monodermal teratomas and somatic-type tumours arising from a dermoid. The diagnosis and differential diagnosis mainly relies on the histopathologic characteristics and the immuno-phenotype. Primary ovarian carcinoid almost always exhibit a benign clinical behavious except mucinous carcinoid.

[Morphology and immunohistochemical studies of ovarian strumal carcinoid].

INTRODUCTION: Teratomas are tumors derived from pluripotent germ cells, and they appear most frequently in ovaries. Strumal carcinoid belongs to the group of monodermal teratomas. Strumal carcinoid is characterized by the presence of carcinoid tumor, intermingled with thyroid tissue. CASE REPORT: A 52-year-old postmenopausal woman was referred to the Department of Gynecology and Obstetrics, Clinical Center of Vojvodina, Novi Sad with complex right adnexal mass for surgery. Laparotomy revealed tumor arising from the right ovary, of firm consistency and intact capsule. On gross examination, yellowish brown tumor was 26 x 17 x 10 cm, with vague nodularity. The cut sections revealed predominantly solid mass with two cystic areas, and one of the cysts showed a tuft of hair. On histopathological examination, the cystic spaces were lined with skin and mucinous epithelium. The solid areas showed a population of monomorphic cells with eosinophilic cytoplasm and nuclei with "salt and pepper" chromatin, arranged in acinar and trabecular patterns, respectively. In addition, focally follicular structures with central eosinophilic colloid-like material were seen. Based on the presence of these two components, a diagnosis of Strumal Carcinoid was made and confirmed on immunohistochemistry. The tumor cells were diffusely immunopositive for synaptophysin, chromogranin, and the follicles including the central coIloid were immunopositive for thyroglobulin and Thyroid transcription factor-1. Neither proliferative or mitotic activity nor capsular or angiolymphatic invasion were noticed. At 3 year follow up the patient was disease free. CONCLUSION: In order to diagnose this rare tumor a team, consisting of a pathologist, surgeon and radiologist, is needed. Diagnosis of strumal carcinoid has to be confirmed on immunohistochemistry.

Ovarian cystic tumor composed of Brenner tumor and struma ovarii.

Ovarian tumor composed only of Brenner tumor and struma ovarii is very rare; only 6 cases have been reported in the English literature, to the best of the author's knowledge. A 66-year-old woman underwent right oophorectomy because of torsion of right ovarian cyst. Macroscopically, the ovarian cyst was hemorrhagic and red. Cystic content was hemorrhagic fluid. Microscopically, the cyst walls were composed only of Brenner tumor (50% in area) and struma ovarii (50% in area). Hemorrhage and ischemic changes were seen. Other elements were not recognized. No malignant transformation was noted. These two elements were separately present, and no mergers between them were recognized. Immunohistochemically, the Brenner tumor element was positive for cytokeratins (AE1/3 and CAM5.2) and Ki67 (labeling=3%), but negative for thyroglobulin, TTF-1, p53, CA125, and vimentin. The struma ovarii element was positive for cytokeratins (AE1/3 and CAM5.2), thyroglobulin, TTF-1 and Ki67 (labeling=5%), but negative for p53, CA125 and vimentin. The findings suggests that there were cases of ovarian cyst composed only of Brenner tumor and struma ovarii, that such a case may be monodermal mature cystic teratoma or the Brenner tumor element was derived from surface epithelium in the preexisting struma ovarii, and that such a tumor manifest as cystic torsion.

Simultaneous strumal ovarii and lymphoma with emphasis on the diagnostic usefulness of immunohistochemical stains.

Strumal ovarii has been rarely associated with other tumors, such as carcinoid tumor, carcinoma, and primary ovarian malignant lymphoma. We report the coexistence of a strumal ovarii and ovarian involvement by malignant lymphoma in a 70-year-old woman. The tumors were detected 10 years following exposure to ionizing radiation during the Chernobyl nuclear tragedy.

Immunochemical and ultrastructural studies of an ovarian strumal carcinoid.

An ovarian strumal carcinoid which synthesized peptide hormones, but did not induce the carcinoid syndrome, was analysed histochemically, immunohistochemically and ultrastructurally. Dot-immunobinding assays were performed in order to determine the endocrine gene expression. The amylase resistant colloid was found to be PAS-positive in the follicular portions of the tumour. Carcinoid cells showed Grimelius positive argyophilic granules in the subnuclear position. The Fontana-Masson argentaffin reaction was negative. Immunohistochemistry for adrenocorticotropic hormone (ACTH) revealed strong reactivity in the follicular areas of the carcinoid. The immunoreactivity for somatotropic release inhibiting factor (SRIF) was found positive in the trabecular portion of the carcinoid tumour, thyroglobulin in the follicles. Neuron-specific enolase, protein S-100 A/B, synaptophysin and chromogranin A evoked weak cytoplasmic immunostaining of the tumor cells. Dot-immunobinding assays substantiated these immunohistochemical results, except for the thermolabile protein S-100 A/B. Electron microscopy of tumor cells showed numerous electron-dense cytoplasmic granules, 250 to 350 nm in diameter, both in follicular and trabecular areas of the tumor. Plasma levels of tumor-associated ACTH, SRIF and thyroglobulin were measured by radioimmunoassay and were found to be within the normal range.