Strumal Carcinoid of the Ovary: An Immunohistochemical and Electron Microscopic Study

Prostatic acid phosphatase in strumal carcinoids of the ovary. An immunohistochemical study

BACKGROUND

Strumal carcinoids (SC) are ovarian tumors containing thyroid parenchyma admixed with carcinoid elements. Microscopically, the carcinoid component of SC usually presents a ribbon or trabecular pattern similar to the pattern exhibited by hindgut carcinoids. The authors designed an immunohistochemical study to ascertain further similarities of the carcinoid component of SC to rectal carcinoids.

METHODS

Five cases of SC were examined by light microscopic study with hematoxylin and eosin and immunoperoxidase staining with a group of neurohormonal peptides, thyroglobulin, prostatic acid phosphatase, and prostate specific antigen.

RESULTS

All tumors were positive for thyroglobulin, chromogranin, prostatic acid phosphatase (PAP), and glucagon. They were consistently negative for prostate specific antigen and variably positive to the other antibodies.

CONCLUSIONS

The consistent positivity of the carcinoid component of SC to PAP immunostaining is a further similarity of these tumors to rectal carcinoids, in which positive immunostaining to PAP has been observed. The similarity is not well understood, however, as all evidence points to the origin of SC from germ cells in mature cystic teratomas without any embryologic relationship to the hindgut.

Peptide tyrosine tyrosine-positive ovarian carcinoid tumor arising from a dermoid cyst

A case of ovarian carcinoid tumor of the trabecular type is presented. The small carcinoid tumor was found incidentally in a resected dermoid cyst. Histologically, the tumor was surrounded by a smooth muscle layer with focal stromal invasion. Non-carcinoid papillary mucosa and a few small glands, simulating the mucosa of the fallopian tube and remnant müllerian glands, respectively, were also present adjacent to the carcinoid tumor and enclosed by the same smooth muscle layer. The tumor cells revealed argyrophilia, and were positive for peptide tyrosine tyrosine (PYY) in the cytoplasm and for CEA in part of the luminal surface. This case was considered to be a rare ovarian carcinoid tumor arising from a dermoid cyst, without association of struma ovarii. PYY may be a potential marker for determining the histogenesis of ovarian carcinoid tumors.

Strumal carcinoid of the ovary. Ultrastructural and immunohistochemical study

Strumal carcinoid of the ovary with mucinous cystadenoma of borderline malignancy is reported. A colloid-like material in the follicular structure contained thyroglobulin which was immunohistochemically demonstrated to confirm the thyroid element, whereas the carcinoid component, which showed argyrophilia and displayed neurosecretory granules, revealed an insular or trabecular structure. This confirmed the presence of colloid filled thyroid epithelium intimately admixed with the carcinoid. Electron microscopy revealed carcinoid cells expanding toward the inner layer of the follicles but thyroid epithelium almost always stretched its thin cytoplasmic processes to cover the colloidal lumen. No calcitonin was demonstrated but CEA was seen in some cells of the carcinoid. No amyloid was detected.

Ovarian strumal carcinoid tumor with amyloid stroma--report of a case with 20-year follow-up

We report a case of strumal carcinoid tumor arising in the left ovary of a 20-year-old woman. Histologically, microfollicular, solid, and trabecular areas were present, and amyloid stroma was demonstrated. Many cells contained argyrophilic granules, and thyroglobulin and calcitonin were demonstrated immunohistochemically in several areas. Ultrastructurally the cells resembled thyroid follicular cells and contained neurosecretory granules. It is concluded that strumal carcinoid is of endodermal origin, and shows evidence of thyroid and C-cell differentiation.