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Mixed angiosarcoma, clear cell adenocarcinoma and mature teratoma elements in an ovarian tumor: A case report and literature review
Author(s) -
Takahashi Hiroyuki,
Chaopotong Pattama,
Kajita Sabine,
Hashimura Miki,
Yamazaki Hitoshi,
Saegusa Makoto
Publication year - 2012
Publication title -
pathology international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.73
H-Index - 74
eISSN - 1440-1827
pISSN - 1320-5463
DOI - 10.1111/j.1440-1827.2012.02831.x
Subject(s) - cuboidal cell , pathology , ovary , angiosarcoma , biology , cd31 , ovarian teratoma , clear cell , adenocarcinoma , malignant transformation , teratoma , cancer , medicine , epithelium , immunohistochemistry , endocrinology , genetics
Malignant transformation of a mature teratoma in the ovary is a rare event, with an approximate rate of only 1–2%. Here, we report an ovarian tumor with a unique combination of epithelial and non‐epithelial malignant components, including mature teratoma elements. A 59 year‐old postmenopusal woman underwent total hysterectomy and bilateral salpingo‐oophorectomy to remove a huge solid mass of the right ovary. The ovarian tumor was 16 × 12 × 4.5 cm in dimensions, composed of red‐brown and greyish‐white tissue with several cystic areas. Microscopically, atypical cells immunopositive for both CD31 and CD34 formed irregular ectatic vascular patterns with a high MIB‐1 labeling index in red‐brown areas. In contrast, tubule‐cystic and papillary structures were lined by HNF‐1β‐immunopositive atypical cuboidal and hobnail cells with clear cytoplasm in greyish‐white areas. In addition, normal‐looking epithelial and stromal components, including mature squamous, cuboidal and ciliated epithelial cells, and adipose tissues, were observed in red‐brown areas, suggesting an ovarian tumor combining angiosarcoma, clear cell adenocarcinoma, and mature teratoma features. We could demonstrate identical X‐chromosome inactivation patterns among all three components by human androgen receptor gene (HUMARA) assays, pointing to complex inter‐relationships regarding their pathogenesis. These observations suggest that a malignant tumor composed of two characteristic phenotypes arose in mature teratoma.