Immunohistochemical analysis using cell block technique leads accurate diagnosis of ovarian malignant lymphoma: A case report.

INTRODUCTION: Ovarian malignant lymphoma is a rare gynecologic disease and some patients show marked ascites, similar to that observed in advanced ovarian cancer. Although radical surgery improves prognosis of ovarian cancer, treatment of lymphoma is based on chemotherapy, therefore, differential diagnosis is crucial. PRESENTATION OF CASE: A 65-year-old woman presented with a 1-month history of abdominal distention. Pelvic ultrasonography showed an 11-cm solid mass in the pelvis. Computed tomography and magnetic resonance imaging revealed bilateral (mainly left) ovarian masses in the pelvis and multiple metastases. Laboratory examination revealed that serum CA125 levels were elevated, suggesting the existence of advanced ovarian cancer. To confirm the diagnosis, the ascites was removed via abdominocentesis. Although no malignant epithelial cells were observed, atypical lymphoid cells dispersed in the ascites were detected in the cytological analyses. Thus, for accurate diagnosis, we performed re-abdominocentesis and immunohistochemical (IHC) analysis using cell block technique. Cell block analysis showed negative staining for CD3 and positive staining for CD20 in large atypical lymphoid cells, suggesting the existence of large B-cell lymphoma. Repeat blood examination showed that the serum sIL-2R level was elevated. We decided to perform biopsy to make the final treatment decision. Histologically, the tumor demonstrated diffuse proliferation of large atypical lymphoid cells. IHC analysis showed CD3(-), CD5(+), and CD20(+). In addition, IHC analysis also showed CD79a(+), CD10(-), bcl-2(+), and cyclin D1(-). The final diagnosis was diffuse large B-cell lymphoma. DISCUSSION AND CONCLUSION: Here, we present the case of a patient with ovarian malignant lymphoma that was diagnosed using cell block analysis.

Phase I study on pegylated liposomal doxorubicin in combination with docetaxel for patients with platinum-resistant or partially platinum-sensitive epithelial ovarian cancer: The Kansai Clinical Oncology Group study.

CONTEXT: In platinum-resistant ovarian cancer, single-agent chemotherapy is recommended for the reduction of adverse events. However, in clinical practice, some patients can tolerate drug-specific adverse events. AIMS: We assessed the safety of pegylated liposomal doxorubicin (PEG-LD) and docetaxel regimen in the first cycle of ovarian cancer. SETTINGS AND DESIGN: We performed a phase I study to evaluate the combination therapy of PEG-LD and docetaxel. MATERIALS AND METHODS: We recruited five patients with recurrent ovarian cancer within 12 months of first-line platinum-based chemotherapy. All patients had measurable disease severity. PEG-LD and docetaxel were intravenously administered on day 1 and every 21 days using three dose levels: 25 mg/m2 PEG-LD and 50 mg/m2 docetaxel; 30 mg/m2 PEG-LD and 50 mg/m2 docetaxel; and 30 mg/m2 PEG-LD and 60 mg/m2 docetaxel. STATISTICAL ANALYSIS USED: We defined the maximum tolerated dose of the combination therapy based on the modified Fibonacci method. RESULTS: Five patients were enrolled in this study. The median treatment-free interval was 5.5 months. Two dose-limiting toxicities (Grade 4 neutropenia) were observed in two patients. One complete response, one partial response, one stable disease, and two progressive disease cases were observed. The overall response rate was 2/5, and the disease control rate was 3/5. The median overall survival was 7.4 months. CONCLUSIONS: We determined that 25 mg/m2 of PEG-LD and 50 mg/m2 of docetaxel were safe and effective doses. This preliminary efficacy and safety data should be further investigated in a Phase II trial.