Ovarian primary neuroendocrine carcinoma of non-small cell type: report of an extremely rare neoplasm

Paraffin block sections of a uterus and ovarian mass from a 31 year old female were sent for second opinion to the Pathology Laboratory of Aga Khan University. Histologic examination and immunohistochemical features gave a diagnosis of primary neuroendocrine carcinoma of non-small cell type admixed with benign mucinous cystadenoma. This is a rare tumour with only eight being reported in literature.

Ultrastructural study of benign, low-malignant potential (LMP), and malignant ovarian tumors

Ultrastructural characteristics of benign, low-malignant potential (LMP), and malignant ovarian tumors were investigated, considering the aspects of histologic subtypes and histologic grading. In addition, the histogenesis of ovarian cancer was histologically investigated in an attempt to elucidate whether malignant tumor was generated from benign or LMP tumor, or whether it was generated de novo from normal tissues. Although all the benign, LMP, and malignant tumors appeared to be derived from Mullerian duct in serous tumors, the origin of endometrioid or mucinous tumor could not be ultrastructurally clarified. However, there was ultrastructural similarity between benign and malignant tumors among serous, endometrioid, and mucinous tumors, and it was suggested that benign adenoma may be the developmental origin of malignant tumors regardless of the histologic subtype. In addition, the investigation of endometrioid tumors revealed that the differences of histologic grading in malignant tumors reflected the ultrastructural differences, and that G1 tumor had an ultrastructure that was more similar to that of benign and LMP tumors than to that of G2 tumor.

[Imaging diagnosis of mucinous cystic neoplasms of the pancreas]

OBJECTIVE

To assess the imaging findings in mucinous cystic neoplasms (MCNs) of the pancreas.

METHODS

The imaging manifestations of 18 cases with pathologically proven MCNs were analyzed retrospectively.

RESULTS

The cystic features of MCNs could be demonstrated by ultrasonography (US), computed tomography (CT), or magnetic resonance imaging (MRI). Compared with US, CT and MRI are appropriate for localizing diagnosis (100%). One half of the cases have classic imaging findings of the MCNs, where as the diagnosis of remaining cases could be supported by clinical findings.

CONCLUSIONS

Imaging technique plays an important role in the diagnosis of MCNs.

Prognostic importance of the nucleolar organizer region score in ovarian epithelial tumors

OBJECTIVE

The score of the silver-stained nucleolar organizer region (AgNOR) is frequently found to be high in malignant tumors. We studied AgNOR in ovarian epithelial tumors diagnosed in our hospital between 1993 and 1998.

MATERIALS AND METHOD

In our study 67 ovarian epithelial tumors (18 cystadenoma, 16 borderline type, 34 cystadenocarcinoma) were stained using the method previously described by Crocker. One-way ANOVA and logistic regression tests were used to find the statistical relationship between grade, recurrence, mortality rates and AgNOR scores in tumors (p values of <0.05 were considered statistically significant).

RESULTS

The mean AgNOR scores of 28 mucinous and 39 serous ovary tumors were calculated. The lowest AgNOR score of 1.33 was found in cystadenomas and the highest AgNOR score of 4.92 was found in serous and mucinous cystadenocarcinomas. In addition the relationship between mortality rate, recurrence and AgNOR score in carcinomas were studied.

CONCLUSION

AgNOR scores in carcinomas were found to be higher than adenomas, and the highest AgNOR score was found in grade-III carcinomas. This shows that the AgNOR score can be used as a prognostic index in malignancies.

Expression of metallothionein and nuclear size in discrimination of malignancy in mucinous ovarian tumors

Metallothioneins (MTs) are low molecular weight proteins that control cell proliferation via their metalloregulatory function. Several studies in various tumors have shown their influence in determining response to chemotherapy and prognosis. Because there has been no such study pertaining to ovarian tumors, we investigated MT expression and nuclear size in mucinous ovarian neoplasms (12 benign, 6 borderline, and 8 malignant). The percentage of MT-positive stained cells was significantly higher in the borderline than in the benign tumors, but lower than in the malignant tumors. Single layers of cells in the borderline tumors showed mild immunostaining in 50% of the cells and moderate staining in the remaining 50%, while 83.3% of cells within multilayered epithelium showed moderate to strong immunostaining. In the carcinomas, 87.5% of tumors showed moderate to strong staining in single-layered epithelium and moderate to strong staining of all the cells in multilayered epithelium. Morphometry measurements showed that the mean nuclear area of cells in the carcinomas was significantly larger than in the borderline or benign tumors. The nuclear area of cells in the carcinomas with early recurrence or metastasis was also significantly larger than in carcinomas without recurrence or metastasis. It is concluded that MT protein expression and nuclear size are possible markers for the evaluation of the progression of malignancy in mucinous ovarian tumors.

Immunohistochemical localization of beta-1,4-galactosyltransferase in human pancreatic tissues

beta-1,4-Galactosyltransferase (GalTase) is the glycosyltransferase in the Golgi apparatus that transfers galactose from UDP-galactose to terminal N-acetylglucosamine residues in glycoconjugates with formation of a beta-1,4 linkage. Neoplasms undergo various changes in the carbohydrate moieties of their glycoconjugates. This process also indicates the possibility of changes in glycosyltransferases themselves. Therefore, we compared the binding pattern of a monoclonal antibody (MAb8628) against GalTase in both normal and neoplastic exocrine pancreatic tissues. Ten normal and 11 neoplastic human exocrine pancreatic tissues obtained from surgery were used. Frozen sections were incubated with this antibody. Supranuclear regions and terminal bars of normal duct cells and acinar cells revealed positive staining for GalTase at the light microscopic level. Centroacinar cells revealed positive staining in their perinuclear region. Neoplastic cells were also stained in their supranuclear regions and terminal bars. Supranuclear regions were well developed in neoplastic cells and intensely stained compared with those in normal cells. The supranuclear regions and the terminal bars corresponded to the trans cisternae of the Golgi apparatus and the junctional complex (i.e., tight junction and adherens junction), respectively, seen at the electron microscopic level. Pancreatic neoplastic changes thus led to an increase in the expression of GalTase in the Golgi apparatus, the increase of which may have an important effect on the intercellular adhesion and communication among pancreatic epithelial cells. Measurement of this enzyme is useful for diagnosis of exocrine pancreatic neoplastic changes from normal tissues.

Ovarian mucinous cystadenoma with mural nodule of anaplastic carcinoma

The occurrence of malignant mural nodule in benign cystic common epithelial tumor of the ovary have been reported in only three cases; the case one was mucinous cystadenoma with a mural nodule of fibrosarcoma and the others were of carcinomas. Our case was another rare case of ovarian mucinous cystadenoma with mural nodule of anaplastic carcinoma in a 42-year-old woman. The cystadenoma had an unilocular cystic cavity and a mural nodule with thick multinodular solid wall. The internal cystic wall was lined with mucinous cystadenoma without any malignant features. The mural nodule showed anaplastic carcinomatous differentiation and its nature was confirmed by immunohistochemistry and electron microscopy. This tumor had metastasized to the right salpinx, uterus, cul-de-sac, periureter and mesentery.

Neuroendocrine carcinoma arising in an ovarian mucinous cystadenoma

A case of neuroendocrine carcinomas arising in the form of a mural nodule in an ovarian mucinous cystadenoma is presented. This represents the third case of neuroendocrine carcinoma arising in an ovarian mucinous tumor. The carcinoma cells were moderately to strongly immunoreactive for enolase, keratin, chromogranin, synaptophysin, and focally, neuron-specific enolase, and contained 130-330 nm neurosecretory granules. The patient presented 9 months after surgery with liver metastases and peritoneal implants. She died of disease within 10 months of initial presentation.

Mucinous borderline and malignant tumors of the ovary. A clinicopathologic and DNA ploidy study of 92 cases

BACKGROUND

The morphologic spectrum of ovarian mucinous tumors is well known, but the features that predict aggressive behavior are still controversial.

METHODS

Ninety-two cases of primary ovarian mucinous tumors with atypical epithelial proliferation and/or stromal invasion were analyzed histologically and by DNA flow cytometry, and the results were correlated with clinical findings.

RESULTS

The authors reviewed 57 intestinal mucinous borderline tumors (IMBT), 3 endocervical-like mucinous borderline tumors (EMBT), 21 noninvasive mucinous carcinomas (NIMC), and 11 invasive mucinous carcinomas (IMC). The 5-year survival rate for Stage I tumors was: IMBT 100%, EMBT 100%, NIMC 94% and IMC 60%. The 5-year survival of Stage II-IV tumors was: IMBT 50%, NIMC 33% and IMC 0%. Forty-four IMBTs were diploid, and 4 were aneuploid. All six high stage IMBTs were diploid. Two EMBTs were diploid, and one was aneuploid. There were seven diploid, four polyploid, and six aneuploid NIMCs. Two of the three lethal NIMCs were aneuploid. Four IMCs were diploid, and four were aneuploid. Of these, only the diploid Stage I IMCs were nonlethal. All NIMCs that recurred or presented with metastases had been sampled inadequately. High stage tumors with pseudomyxoma peritonei (PP)-type lesions often were associated with pseudomyxoma ovarii of the cellular type.

CONCLUSIONS

Mucinous tumors with stromal invasion or presenting with PP had a definite malignant behavior. All other atypical mucinous tumors, when confined to the ovary and optimally sampled, had an excellent prognosis. DNA ploidy analysis may prove useful in determining the risk of progression, especially in Stage I IMCs.

Primary retroperitoneal mucinous cystadenomas with gastric epithelial differentiation

We present two rare cases of retroperitoneal mucinous cystadenomas (RMC) by clinical data, light microscopy, electron microscopy, histochemistry, and immunohistochemistry. Both tumors occurred in women. We excluded attachment to any organ. Additional immunohistochemical examinations were performed for comparison in 10 cases of ovarian mucinous cystadenomas (OMC). Both RMC showed no significant immunohistochemical differences from the OMC. Ultrastructurally and histologically the RMC resemble OMC reported in the literature. Immunohistologically, we proved gastric epithelial differentiation by using one monoclonal antibody (2B5) recognizing gastric mucin and one polyclonal antibody against pepsinogen II (PG II). In spite of this, the histogenesis of RMC in the presented cases in the end remains uncertain.