Ovarian Carcinosarcoma and Its Association with Mature Cystic Teratoma and Primary Tubal Carcinoma

Isolated splenic metastasis from primary fallopian tube carcinoma and the application of laparoscopic splenectomy: a case report and literature review

Metastases to the spleen from various non-hematologic malignancies are generally not a common clinical event and usually indicate the late dissemination of disease. Solitary splenic metastases from solid neoplasm are extremely uncommon. Furthermore, solitary metastasis to the spleen from primary fallopian tube carcinoma (PFTC) is extremely rare and has not been reported previously. We report a case of isolated splenic metastasis in a 60-year-old woman, occurring 13 months after a total hysterectomy, a bilateral salpingo-oophorectomy, a pelvic lymphadenectomy, a para-aortic lymphadenectomy, an omentectomy, and an appendectomy were performed for PFTC. The patient's serum tumor marker CA125 was elevated to 49.25 U/ml (N < 35.0 U/ml). An abdominal computed tomography (CT) scan revealed a 4.0 × 3.0 cm low-density lesion in the spleen that was potentially malignant, with no lymphadenectasis or distant metastasis. The patient underwent a laparoscopic exploration, and one lesion was found in the spleen. Then, a laparoscopic splenectomy (LS) confirmed a splenic metastasis from PFTC. The histopathological diagnosis showed that the splenic lesion was a high-differentiated serous carcinoma from PFTC metastasis. The patient recovered for over 1 year, with no tumor recurrence. This is the first reported case of an isolated splenic metastasis from PFTC. This case underlines the importance of serum tumor marker assessment, medical imaging examination, and history of malignancy during follow-up, and LS seems to be the optimal approach for isolated splenic metastasis from PFTC.

Genetic Analysis and Combined Therapy of Surgery and Chemotherapy for the Progression-Free Survival of a Patient with Ovarian Carcinosarcoma: A Case Report and Literature Review

Carcinosarcoma, also known as malignant Mullerian mixed tumour, is a rare and aggressive ovarian malignant tumour. The prognosis of ovarian carcinosarcoma is very poor, accounting for the vast majority of ovarian cancer deaths. Due to the rarity of ovarian carcinosarcoma, no unified treatment plan exists at present. Here, we report the case of a 69-year-old patient with stage IC ovarian carcinosarcoma. She underwent right salpingo-oophorectomy and R0 resection, inclouding extrafascial hysterectomy, left salpingo-oophorectomy, omentectomy, appendectomy, right pelvic lymph node dissection and multipoint biopsy. Full-exome sequencing was performed with normal ovarian tissue, cancer tissue, sarcoma tissue and carcinosarcoma tissue, and the results showed that the sarcoma and carcinosarcoma tissue shared more mutated genes. A TP53 mutation occurred in the cancer tissue and carcinosarcoma tissue. By analysing the lychee tree, we found that the sarcoma tissue and carcinosarcoma tissue shared more subclones and determined that they were more closely related; the cancer tissue carried fewer subclones and was the main clone. The sarcoma may have evolved from the cancer tissues. Six rounds of postoperative chemotherapy (carboplatin + paclitaxel + ifosfamide (IFO) (paclitaxel 200 mg, D1 + carboplatin 600 mg, D1 + IFO 2G, D1-D3)) were administered. The patient has been followed up for six years and is currently in good health. In conclusion, the disease was diagnosed in the early stage, and the use of a R0 resection + a three-drug combination chemotherapy may have contributed to the patient’s long-term disease-free survival. The results of the gene study suggested that the sarcoma component may be differentiated from the cancer component. We thus speculated that the origin of this case may have been the fallopian tube.

Renal Tumors with Oncocytic and Papillary Features: A Phenotypic and Genotypic Study

The occurrence of kidney oncocytic lesions with an admixed papillary component is not unusual in routine pathology practice. These neoplasms with dual morphology are classically recognized as collision tumors with variable malignant potential. Using immunohistochemistry, we investigated fluorescent in situ hybridization and next generation sequencing of the genetic and phenotypic profiles in the two components of 11 kidney tumors with colliding oncocytic and papillary features. The oncocytic component was CD117 positive, CK7 negative, and AMACR negative; the papillary component was CK7 positive, AMACR positive, and CD117 negative in all cases. Fluorescence in situ hybridization (FISH) results were inconsistent. Next generation sequencing (NGS) analysis demonstrated that the mutations identified in the two tumor components were identical and displayed an allelic frequency of approximately 50%, strongly suspicious for genetic polymorphisms. The two oncocytic and papillary tumor counterparts shared the same genetic profile and did not harbor pathogenic mutations. Clinical confirmation of the biological benign features of these tumors is required. The term collision tumor is not suitable for these neoplasms, and we propose the term oncopapillary tumor for this histological entity.