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LETTERS TO EDITOR  
Year : 2018  |  Volume : 61  |  Issue : 1  |  Page : 162-164
Undiagnosed tubal high-grade serous carcinoma metastatic to synchronous benign ovarian Brenner tumor


Department of Cytology and Gynaecologic Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India

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Date of Web Publication22-Mar-2018
 

How to cite this article:
Chougule A, Garg R, Dey P. Undiagnosed tubal high-grade serous carcinoma metastatic to synchronous benign ovarian Brenner tumor. Indian J Pathol Microbiol 2018;61:162-4

How to cite this URL:
Chougule A, Garg R, Dey P. Undiagnosed tubal high-grade serous carcinoma metastatic to synchronous benign ovarian Brenner tumor. Indian J Pathol Microbiol [serial online] 2018 [cited 2019 Dec 13];61:162-4. Available from: http://www.ijpmonline.org/text.asp?2018/61/1/162/228181




Editor,

The recent paradigm shift in the concepts attributes most of the pelvic non-uterine high- grade serous carcinoma to be of primarily tubal in origin, if the  Fallopian tube More Details shows serous tubal intraepithelial carcinoma or invasive serous carcinoma regardless of the size of ovarian or peritoneal lesion .[1] However, because of non-specific symptoms, non-pathognomonic radiological features, and microscopic nature of most of the tubal carcinomas and their precursors, primary fallopian tubal carcinomas are not correctly diagnosed pre-operatively in most of the cases .[2] A small number of patients with tubal carcinoma can have synchronous tumors in another gynecological site .[3] Brenner tumor is commonly detected incidentally and has been reported to coexist with a variety of other ovarian tumors which include mucinous cystadenoma, mature cystic teratoma, and serous cystadenoma .[4] To the best of our knowledge, this is the first report of coexisting high-grade serous carcinoma of fallopian tube which metastasized to synchronous ovarian benign Brenner tumor.

A 72-year-old female complained of lower abdominal pain for 2 months. Ultrasound and magnetic resonance imaging abdomen revealed a large solid- cystic right adnexal mass measuring 7 cm × 7 cm × 5.5 cm with ipsilateral mild hydrosalpinx. The serum CA 125 level was 366 IU/ml. Right salpingo-oophorectomy and omentectomy were performed, as complete surgery was not possible due to dense adhesions and medical condition of the patient.

Grossly, the right adnexal mass had bosselated outer surface with rubbery, white-tan cut surface [Figure 1]a. The ampullary part of the fallopian tube showed a whitish proliferative growth filling the lumen. Microscopically, the fallopian tube showed a tumor exhibiting complex branching papillary architecture, focally showing glands and solid areas [Figure 1]b with moderately pleomorphic tumor cells [Figure 1]c. The ovarian mass showed a tumor composed of densely fibrous stroma containing nests of transitional epithelium with focal cystic change [Figure 1]d. The tumor cells were polygonal with relatively uniform nuclei, pale chromatin, inconspicuous nucleoli, and abundant clear cytoplasm [Figure 1]e. The center of some of the nests showed mucinous metaplasia. The capsular aspect showed few dilated lymphatics containing tumor emboli composed of nests and micropapillary clusters of cells resembling the tumor cells of fallopian tube carcinoma [Figure 1]d, and [Figure 1]f. There was no evidence of stromal invasion in multiple sections studied and individual tumor deposits were very small indicating surface involvement. Omentum showed multiple tumor deposits [Figure 2]a.
Figure 1: (a) Gross photograph showing fallopian tube with intraluminal growth and rubbery, white-tan cut surface of Brenner tumor, (b) Fallopian tube lumen filled with papillary serous carcinoma, (c) complex branching papillary pattern and high-grade nuclei, (d) benign Brenner tumor of the ovary with cystic change and surface tumor deposits, (e) nests of transitional epithelium with mucinous metaplasia in densely fibrous stroma, (f) higher magnification of surface deposits showing nests and micropapillary clusters of tumor cells with serous morphology

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Figure 2: (a) Omentum with metastatic tumor, nuclear p53. (b) and WT1 (c) expression in serous carcinoma of fallopian tube, (d) WT1 expression in metastatic tumor cells on the surface of Brenner tumor, cytokeratin 7 positivity in transitional cell nests of Brenner tumor

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On immunohistochemistry, the tumor cells of fallopian tube carcinoma showed diffuse and strong nuclear positivity for p53 [Figure 2]b and WT1 [Figure 2]c. Similar immunoprofile was noted in metastatic deposits on the Brenner tumor [Figure 2]d. Transitional cell nests in the Brenner tumor showed diffuse positivity of cytokeratin (CK) 7 [Figure 2]e and were negative for CK20, WT1, p53, and calretinin. Presently, the patient is receiving chemotherapy with cisplatin and paclitaxel.

The radiological features of the fallopian tube carcinoma are non-specific and frequently overlap with ovarian malignancies, leading to their misdiagnosis as hydrosalpinx, tubo-ovarian abscesses, or ovarian malignancy.[5] Even intra-operative gross examination of fallopian tubes by surgeons was perceived as hydro-, hemato-, or pyosalpinx in around 50% of cases in one study.[1] Most of the benign Brenner tumors are asymptomatic being discovered incidentally at surgery for unrelated pelvic conditions.[4] The synchronous occurrence of fallopian tube carcinoma and benign Brenner tumor has not been reported in literature.

In conclusion, we highlighted the difficulties in pre-operative diagnosis of fallopian tube carcinoma. The coexistence of fallopian tube serous carcinoma which metastasized to ipsilateral benign Brenner tumor is a rare finding.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Singh N, Gilks CB, Hirschowitz L, Kehoe S, McNeish IA, Miller D, et al. Primary site assignment in tubo-ovarian high-grade serous carcinoma: Consensus statement on unifying practice worldwide. Gynecol Oncol 2016;141:195-8.  Back to cited text no. 1
    
2.
Alvarado-Cabrero I, Stolnicu S, Kiyokawa T, Yamada K, Nikaido T, Santiago-Payán H, et al. Carcinoma of the fallopian tube: Results of a multi-institutional retrospective analysis of 127 patients with evaluation of staging and prognostic factors. Ann Diagn Pathol 2013;17:159-64.  Back to cited text no. 2
    
3.
Vang R, Wheeler JE. Diseases of the fallopian tube and paratubal region. In: Kurman RJ, Ellenson LH, Ronnett BM, editors. Blaustein's Pathology of the Female Genital Tract. 6th ed. New York: Springer; 2011. p. 529-78.  Back to cited text no. 3
    
4.
Seidman JD, Khedmati F. Exploring the histogenesis of ovarian mucinous and transitional cell (Brenner) neoplasms and their relationship with Walthard cell nests: A study of 120 tumors. Arch Pathol Lab Med 2008;132:1753-60.  Back to cited text no. 4
    
5.
Veloso Gomes F, Dias JL, Lucas R, Cunha TM. Primary fallopian tube carcinoma: Review of MR imaging findings. Insights Imaging 2015;6:431-9.  Back to cited text no. 5
    

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Correspondence Address:
Rashi Garg
Department of Cytology and Gynaecologic Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh - 160 012
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJPM.IJPM_600_16

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