Abstract
An 86-year-old Japanese woman underwent an examining laparoscopy for removing the huge pelvic tumor. At laparoscope examination, the cystic tumor was found within the left broad ligament, while the ovaries, fallopian tubes and uterus showed almost normal appearance. The tumor was removed together by total laparoscopic hysterectomy and bilateral salpingo-oophorectomies after the suction of serous content in the broad ligament. Cytological findings of the ascites suggested serous carcinoma. The resected ovaries and fallopian tubes were grossly and histologically normal. Histological examination of the solid part of broad ligament tumor, closely next to the fallopian tube, revealed a serous adenocarcinoma. Immunohistochemically, the tumor cells were strongly positive for CK7, WT-1, estrogen receptor, AE1/AE3 and EMA, and negative for CK20, D2-40 and calretinin. Also, they were negative for progesterone receptor and p53. The authors diagnosed the primary tumor as being a serous cystadenocarcinoma of the broad ligament [pTIC3NxM0, as modified and adapted to post-surgical staging of ovarian cancer (FIGO 2014)]. The patient has been receiving 6 cycles of adjuvant chemotherapies with one course with paclitaxel (PTX) and carboplatin (CBDCA) and five with PTX, CBDCA and Bevacizumab, and has no signs of recurrence and metastasis six months after the operation.
Highlights
Primary tumors in the uterine broad ligament are rare [1], especially malignant tumors, either epithelial or non-epithelial [1] [2] [3] [4] [5], the secondary involvement of the broad ligament by the malignant tumor is common
The authors diagnosed the primary tumor as being a serous cystadenocarcinoma of the broad ligament [pTIC3NxM0, as modified and adapted to post-surgical staging of ovarian cancer (FIGO 2014)]
Serous cystadenocarcinoma was only recognized in the solid part of the huge cystic mass of the broad ligament, and macroscopically and histologically no other lesions could be found in the both ovaries and fallopian tubes
Summary
Primary tumors in the uterine broad ligament are rare [1], especially malignant tumors, either epithelial or non-epithelial [1] [2] [3] [4] [5], the secondary involvement of the broad ligament by the malignant tumor is common. The developmental origin of some broad ligament tumors was described to be Wolffian origin, others identified as having a Mullerian origin on their immunohistochemical and histologic features [6] [7]. Malignant tumors of the broad ligament have been extremely rare and only under 30 cases have been reported [8] [9], their epidemiology, pathogenesis, standard care/treatment, follow-up strategy and prognoses are still uncertain. The authors report here a case of primary serous cystadenocarcinoma in an 86-year-old woman, with cytological and immunohistochemical findings
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