Atypical endometrioid cystadenofibroma with Meigs' syndrome: ultrastructure and S-phase fraction

The association of benign and malignant ovarian adenofibromas with breast cancer and thyroid disorders

An unexpected association with breast cancer and thyroid disorders was found during a review of 91 cases of benign and malignant ovarian adenofibromas. Sixty-three tumors were benign, 11 had areas of borderline neoplasms, and 17 had a component of carcinoma. Such tumors were divided into glandular/cystic (61 cases) and papillary (30 cases) according to their gross and microscopic appearance. Among the 61 patients with glandular/cystic adenofibromas, 13 (21%) had breast cancer and 19 (31%) also had thyroid disorders. Among the 30 patients with papillary adenofibromas there were no cases of breast cancer and only 2 patients had thyroid disorders. The average age of the patients with ovarian adenofibroma and breast cancer or thyroid disorders was higher (66 years) than that of patients without breast cancer or thyroid disorders (55 years). More patients with breast cancer and thyroid disorders had bilateral adenofibromas than patients without breast cancer or thyroid disorders. We also reviewed the medical records of 100 patients with ovarian cancer without adenofibroma component, 100 patients with breast cancer, and 100 patients with ovarian and breast cancer. Six percent of patients with ovarian cancer had breast cancer and 16% of each one of these groups had thyroid disorders. This unexpected association found between glandular/cystic adenofibromas, breast cancer, and thyroid disorders might be explained by defects common to these organs. Disorders of some of these organs have been linked by common genetic changes and it is known that these organs are under the influence of similar hormones. Mutations of PTEN have been found in breast and thyroid cancer. The thyroid and ovaries are controlled by glycoprotein hormones of the pituitary gland, which have common alpha subunits.

Meigs' syndrome in association with a locally invasive adenocarcinoma of the fallopian tube

A patient with recurrent pleural effusions posed a diagnostic challenge. The pleural aspirate CA-125 assay was markedly elevated which indicated a primary ovarian pathologic process. However, in this case a rare fallopian tube adenocarcinoma was the underlying problem. Meigs' syndrome can resemble a metastatic pelvic carcinoma in its presentation, but the prognosis is much more favourable when the syndrome is associated with a benign ovarian tumour.

Malignant endometrioid cystadenofibroma of the ovary

Malignant endometrioid cystadenofibroma is recognized as a distinct category of epithelial ovarian cancer and yet is rarely reported. Three patients from the University of North Carolina experience are described to emphasize similarities between this unusual tumor and common epithelial ovarian cancer with respect to clinical behavior, surgical staging, and treatment.

Ovarian clear cell adenofibromatous tumors. Benign, of low malignant potential, and associated with invasive clear cell carcinoma

The authors have studied 17 cases of ovarian clear cell tumors having an adenofibromatous pattern and classified them on a histologic basis into three categories: benign, of low malignant potential, and associated with invasive clear cell carcinoma. Clear cell adenofibroma is characterized by orderly tubules and glands lined by uniform epithelium with little or no nuclear atypia set in an abundant stroma with an interlacing pattern resembling ovarian stroma. Clear cell adenofibromatous tumors of low malignant potential had a similar stroma, but exhibited moderate to marked degrees of epithelial proliferation and atypia. In the third category there were cases of invasive clear cell carcinoma in which a distinct portion of the tumor met the criteria for clear cell adenofibroma, or clear cell adenofibromatous tumor of low malignant potential. Cases of invasive clear cell carcinoma exhibiting a desmoplastic reaction or a diffuse fibrous stroma, but lacking typical adenofibromatous areas, were not included in this study. The benign and low malignant potential tumors showed no clinical evidence of aggressive behavior, whereas those associated with invasive clear cell carcinoma often did. Although there have been no recurrences in our small group of patients with tumors of low malignant potential, the histologic similarity of the epithelium in these tumors to that seen in invasive carcinomas justifies such a categorization. Further studies of larger series using the proposed classification should yield more information concerning the biologic behavior of these types of clear cell adenofibromatous tumors.