Abstract
Introduction. Carcinosarcoma is an uncommon form of ovarian cancers, classified as being part of the group of mixed epithelial and mesenchymal tumors. The occurrence of carcinosarcoma in association with a mature cystic teratoma and synchronous tubal carcinoma is very rare. Case Report. A 69-year-old woman presented with a pelvic mass. An abdominal computerized tomographic scan detected a 15 cm right pelvic mass which was suggestive of malignant transformation of a dermoid cyst. Intraoperative, bilateral ovarian masses (left 10 cm and right 12 cm) with diffuse peritoneal metastatic nodules were identified. Histologically, the left ovarian mass was composed of 2 components including carcinosarcoma and mature cystic teratoma, whereas the right ovarian mass represented a mature cystic teratoma with serosal surface involvement of high-grade serous adenocarcinoma. The left fallopian tube was macroscopically unremarkable but contained a 5.0 mm focus of high-grade serous adenocarcinoma in the distal part, with adjacent serous tubal intraepithelial carcinoma. Conclusion. As the fallopian tube has recently been proposed to be an origin for a majority of pelvic or ovarian high-grade serous adenocarcinomas, tubal carcinoma may be the origin for ovarian carcinosarcomas through an epithelial-mesenchymal transition. The coexistence of ovarian carcinosarcoma and teratoma in the present case should represent a collision tumor.
Highlights
Carcinosarcoma is an uncommon form of ovarian cancers, classified as being part of the group of mixed epithelial and mesenchymal tumors
The left ovarian mass was solid-cystic and composed of 4.5 cm cyst with a sebaceous content admixed with hairs connecting to a 5.5 cm multinodular solid mass
The epithelial component was high-grade serous adenocarcinoma characterized by solid sheets and complex papillary architecture with slit-like and glandular arrangements
Summary
Carcinosarcoma is an uncommon type of ovarian cancers, accounting for 1–4% of patients [1,2,3]. Primary epithelial carcinoma of the tube accounts for only 0.1–1.8% of all gynecologic cancer cases [3, 6]. It has been proposed that the precursor lesion of tubal cancer, known as serous tubal intraepithelial carcinoma (STIC), is a possible origin for ovarian serous adenocarcinoma which is the most common histologic type of ovarian cancer [7]. The occurrence of ovarian carcinosarcoma in association with tubal carcinoma has rarely been described [1, 8]. We present a case in which ovarian carcinosarcoma coexisted with dermoid cyst and tubal carcinoma, the presentation of which mimicked advanced stage malignant transformation of an ovarian teratoma
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