Extrauterine (tubal) placental site nodule

AIMS

The clinicopathological and immunohistochemical features of the second case of placental site nodule (PSN) of extrauterine, tubal location are presented.

METHODS AND RESULTS

The lesion was incidentally found in the right tube during a cesarean section and eventual tubal ligation in a 23-year-old women gesta 2 para 1, after an uneventful 39-week intrauterine pregnancy. Grossly, the right Fallopian tube had a 1 cm dilatation filled by necrotic material. Microscopically, the lumen of the Fallopian tube was effaced and replaced by a rim of pleomorphic intermediate trophoblastic (IT) cells with pseudoinvasive parietal features which were positive for human placental lactogen, placental alkaline phosphatase, epithelial membrane antigen and CAM5.2. The Ki67 index was 3%.

CONCLUSION

Due to its bizarre microscopic appearance, this lesion should be included in the differential diagnosis with malignant conditions. Both origins from a previous subclinical extrauterine tubal pregnancy and a possible migration of IT from a uterine implantation are considered.

Adenomas of the rete ovarii

This article reports the clinicopathological and immunohistochemical findings of two cases of adenoma of the the rete ovarii (RO), one unilateral and the other bilateral, presenting with atypical histological features in the right ovary. Both tumors were incidental findings in 62- and 64-year-old patients presenting with metrorrhagia. The predominantly cystic lesions measured 2 cm and 3 cm in diameter and microscopically, they were tubulopapillary proliferations of regular columnar cells with clear cytoplasm. The stroma showed extensive differentiation of polygonal, Leydig-like cells which was associated in both cases with simple endometrial hyperplasia. In both cases rete and hilar mesonephric remnants were found in the vicinity of the lesion. The atypical lesion in one case had a complex papillary proliferation different in pattern and cellularity from a retiform Sertoli-Leydig cell tumor. It showed extensive areas of eosinophilic change, pleomorphism, and a few mitoses but did not invade the adjacent ovarian stroma. Its stroma also had steroidally active cells. The patient was alive and well after a follow-up interval of 3 years. Immunohistochemically, the lesions were diffusely positive for CAM 5.2, vimentin, epithelial membrane antigen, OC 125, OC 125, and progesterone receptors.

Virilizing mature ovarian cystic teratomas

Three further cases of mature benign cystic teratomas of the ovary associated with virilization are added to the three previously reported in the literature. They were found in postmenopausal, obese, diabetic women aged 52, 61, and 67 years. The patients presented with hirsutism and voice changes and clitoromegaly was present in one. Testosterone and androstenedione levels were elevated but promptly regressed after removal of the tumours. Histologically, sheets of stromal luteinized cells were found peripherally at the interface between the neoplasm and ovarian tissue. Luteinization of ovarian stroma induced by an unknown factor related to diabetes mellitus is the origin of the virilization.

Ovarian endometrioid tumors with yolk sac tumor component, an unusual form of ovarian neoplasm. Analysis of six cases

The clinical, morphological, and immunohistochemical findings in six cases of ovarian endometrioid tumors (five endometrioid carcinomas and one carcinosarcoma) with a yolk sac tumor (YST) component are described. The age of the patients ranged from 31 to 73 years (average, 53), and only two patients were premenopausal. Two cases were stage Ia tumors, three stage III, and one stage IV. A substantial postoperative elevation of alpha-fetoprotein (AFP) was seen in two patients and a mild increase in another two. All six patients had surgery and postoperative cisplatin-based chemotherapy regimens, four of whom died of tumor 3 to 14 months after surgery without response to treatment. Only a stage Ia patient is alive and well 1 year after surgery. The tumors were large (average, 17 cm). Benign endometrioid lesions were found in the homolateral ovary in two cases and in the contralateral ovary in another two. All cases had endometrioid ovarian carcinomas (EOC) of various types admixed with typical YST components. Immunohistochemically, EOC areas differed from YST in their positivity for OC 125, CA 19.9, and nuclear estrogen and progesterone receptors and in their negativity for AFP, which was conspicuously positive in the YST areas. The clinicopathological profile of ovarian endometrioid tumors with YST also differs from that of YST in that it occurs in the same age range as EOC, it shows coexistence of benign endometrioid lesions, and it has a poor response to chemotherapy. The histological pattern in transitional areas may be difficult to differentiate from "endometrioid-like" (enteroblastic) YST and clear cell tumors. Ovarian endometrioid tumors with YST component should be considered a variant of endometrial carcinoma. Its recognition is necessary in view of its unusually aggressive behavior and poor prognosis.