Medial hypertrophy of the ovarian vein: a novel manifestation of vascular injury associated with a primary ovarian carcinoid tumour

Abstract

A 69-year-old female presented with congestive cardiac failure due to carcinoid valvular disease. Subsequent imaging studies demonstrated a left ovarian tumour, 130×90×70mm, with positive gal-lium-68 uptake. She underwent tricuspid valve replacement followed by bilateral salpingo-oophorectomy. The left ovarian vessels had an unusual firm and thickened appearance intra-operatively. Histological examination of the left ovary showed a pure carcinoid tumour of insular type. The left ovarian vein exhibited marked medial thickening due to fibromuscular hypertrophy. There was no vascular elastosis. Carcinoid syndrome is a rare but well documented complication of ovarian carcinoid tumour. The cardiovascular effects are mediated by secreted peptides including serotonin, PDGF, TGF-β and β-FGF which act on smooth muscle cells to induce hyperplasia, fibrosis and elastosis. It is well-recognised that intestinal carci-noid tumours may be associated with vascular elastosis, but to our knowledge the marked venous medial hypertrophy seen in the present case has not been described previously in association with carcinoid tumours arising in the ovary or at other sites. It seems likely that the vascular injury was analogous to that occurring in carcinoid valvular disease and mediated by vasoactive amines secreted by the tumour.