Ovarian Dysgerminoma Associated With Fibrosarcoma: A Case Report

Dysgerminoma of the Ovary: An Analysis of 140 Cases Emphasizing Unusual Microscopic Findings and Resultant Diagnostic Problems

One-hundred fourty pure dysgerminomas were evaluated with particular focus on the microscopic features as seen in 125 cases with available slides. The patients ranged from 8 to 59 years of age (mean, 24.1 y). The tumors, bilateral in 4% of the cases and with a mean tumor diameter of 13 cm, were typically soft, lobulated, homogeneous, and creamy white to tan to yellow but necrosis was found in 13%, hemorrhage in 20%, and focal cystic change in 15%. On microscopic examination, the patterns and other notable features encountered, including their frequency, were as follows: an alveolar pattern resulting from delicate fibrovascular septa (51%), diffuse (33%), macronodular (14%), insular (26%), cords (28%), solid tubular (17%), microspaces (sometimes simulating glands) (12%), follicle-like spaces (5%), prominent fibrous bands (65%), stromal edema (56%), stromal luteinization (9%), granulomatous infiltrate (46%), lymphocytic infiltrate (100%), Langhans cell type giant cells (35%), syncytiotrophoblast giant cells (6%), prominent population of cells with pale to clear cytoplasm (73%), cells with amphophilic to eosinophilic cytoplasm (53%) and vacuolated occasionally signet ring-like cells (7%). Various constellations of the above findings often resulted in an appearance different from that usually portrayed in the literature and certain tumors of very different nature being in the differential such as undifferentiated carcinoma not otherwise specified, small cell carcinoma of hypercalcemic type, and malignant lymphoma. The correct diagnosis can be arrived at by considering the usual relative youth of the patient, often rather characteristic gross features, and most crucially careful attention to the microscopic features and awareness of variant morphologic findings. Those that are particularly problematic based on this study are diffuse growth with inconspicuous fibrovascular septa, macronodules, cords, solid tubular formations, spaces ranging from small to large, and mimicking glands or follicles, prominent fibrous to edematous stroma, and cells with amphophilic to eosinophilic cytoplasm. According to the degree of difficulty and confidence of the interpreter, well-known immunohistochemical features of dysgerminoma, which largely differ from those of other neoplasms in the differential, will aid if felt indicated.

Nuclear Atypia Is a Necessary Factor for Diagnosis of Primary Ovarian Fibrosarcoma: A Case Report and Literature Review

INTRODUCTION

Primary ovarian fibrosarcoma is a rare malignant tumor with few case reports. The current opinion in diagnosis preferring mitotic activity was questioned as there is a large amount of heterogeneity in prognosis between cases. We report a case of primary ovarian fibrosarcoma, and a literature review was performed according to the latest diagnostic trends. This is the first study to review the prognostic factors of primary ovarian fibrosarcoma according to the latest trend in diagnosis.

CASE PRESENTATION

A 50-year-old woman with primary ovarian fibrosarcoma is reported. The patient was admitted to the hospital due to increasing abdominal girth. Physical examination and CT scan showed a giant mass from the suprapubic area to the xiphoid region which filled her entire abdominopelvic cavity. Frozen sections were performed during an operation to resect, and the pathology report indicated a high degree of malignancy. Because of the degree of malignancy, a bilateral salpingo-oophorectomy and omentectomy were performed. Histopathological examination and immunohistochemical staining confirmed the diagnosis of primary ovarian fibrosarcoma. During the operation, the tumor ruptured, which placed the patient in a FIGO stage IC1. After surgery, the patient received 6 courses of combination chemotherapy, consisting of etoposide, bleomycin, and cisplatin. The patient has been free from disease without evidence of recurrence at 5 months after the initial diagnosis.

CONCLUSIONS

Herein we report a case of primary ovarian fibrosarcoma and reviewed all published cases in English. Following the latest trend of diagnosis, multiple prognostic factors were used to determine survival prognosis. These included nuclear atypia, FIGO stage, mitotic counts, treatment methods, and tumor size. Only nuclear atypia was found to be associated with patient prognosis (p < 0.05). FIGO stage (p = 0.383), mitotic count per 10 hpfs (p = 0.155), treatment methods (p = 0.185), and tumor size (p = 0.972) were not found to be associated with survival prognosis. Nuclear atypia was an important factor in prognosis of patients. Using surgery with adjuvant medical treatment was inconclusive regarding patient survival.