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LETTER TO EDITOR Table of Contents   
Year : 2010  |  Volume : 53  |  Issue : 4  |  Page : 883-884
Multinucleate (histiocytic) giant cells in endometrioid adenocarcinoma of the ovary: A rare finding


Department of Pathology, Tata Memorial Hospital, Dr. Ernest Borges Road, Parel, Mumbai - 400 012, India

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Date of Web Publication27-Oct-2010
 

How to cite this article:
Deodhar KK. Multinucleate (histiocytic) giant cells in endometrioid adenocarcinoma of the ovary: A rare finding. Indian J Pathol Microbiol 2010;53:883-4

How to cite this URL:
Deodhar KK. Multinucleate (histiocytic) giant cells in endometrioid adenocarcinoma of the ovary: A rare finding. Indian J Pathol Microbiol [serial online] 2010 [cited 2020 Nov 24];53:883-4. Available from: https://www.ijpmonline.org/text.asp?2010/53/4/883/72035


Sir,

Surface epithelial ovarian carcinomas are a heterogeneous group of neoplasms, serous carcinoma being the commonest type. It is often difficult to distinguish between high-grade serous and high-grade endometrioid adenocarcinoma of the ovary. The presence of multinucleate tumor cells is one of the points favoring serous carcinoma. The finding of multinucleate giant cells in an endometrioid adenocarcinoma of the ovary is a very rare finding; one such case is described here.

A 74-year-old lady underwent hysterectomy, bilateral salpingo-oophorectomy, and omentectomy for a suspected right adnexal malignancy. The specimen was referred to our institution.

Grossly, the right ovary was enlarged and measured 17 × 14 × 7 cm. The external surface was smooth. The cut section showed a solid and cystic tumor with areas of necrosis. Both the tubes, left ovary, uterus, and cervix were grossly unremarkable.

Microscopy showed a high-grade adenocarcinoma of the right ovary. Areas of necrosis and dystrophic calcification were seen. Multinucleate giant cells were seen on the luminal aspect of the malignant glands. The tumor cells were positive for CK7 and vimentin while were negative for CK20 and WT1. The giant cells were positive for C68 and CD163, suggesting histiocytic lineage, and were negative for vimentin, WT1, and CK7 [Figure 1]. The uterus showed adenomyosis. The cervix, left ovary, and both tubes were unremarkable. The omentum showed metastatic carcinoma.
Figure 1: (a) Tumor with multinucleated giant cells (H and E, ×200). (b) Negative WT1 on immunohistochemistry (IHC, ×200). (c) Positive CD68 staining on immunohistochemistry (IHC, ×200). (d) Positive CD163 staining on immunohistochemistry (IHC, ×200)

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The distinction between a high-grade serous and endometrioid adenocarcinoma of the ovary is difficult. Rounded punched out spaces, and findings of endometriosis, squamous areas, and adenofibromatous areas favor endometrioid adenocarcinoma whereas, slit-like spaces, psammoma bodies, and tumor giant cells favor serous carcinoma. Tumor giant cells and psammoma bodies are rare in endometrioid adenocarcinoma. [1] In fact, it is possible that, since, the presence of multinucleate giant cells is taken in favor of serous carcinoma, we hardly come across any case of endometrioid adenocarcinoma of the ovary showing giant cells.

On immunohistochemistry, serous carcinomas show diffuse positivity with WT1, P53, and P16, while endometrioid tumors show negative or focally positive staining. Vimentin and nuclear beta catenin positivity favor endometrioid than serous carcinoma. [1]

The giant cells in serous carcinomas are tumor giant cells, while those seen here are histiocytic in origin. Histiocytic giant cells are seen, as a reaction, not uncommonly in relation to keratin in endometrioid adenocarcinomas. But in this case, they are located in the intraluminal aspect and not seen in the vicinity of keratinous differentiation. Here, they may represent a response to the luminal necrotic material.

Unusual morphological patterns like sex-cord like formations, [2] oxyphil cells, [3] are described in endometrioid adenocarcinoma of the ovary; but histiocytic giant cells do not find a mention in the standard text books. [4],[5]

The clinical implication is interesting. Admittedly, the modality of primary therapy will depend on the stage, and both types of tumors are given platinum based chemotherapy (PBC). However, recently, Storey et al.[6] have suggested that endometrioid histology is associated with better survival compared with serous adenocarcinoma of the ovary even with stage III or poorly differentiated tumors.Hence making this distinction may be worthwhile.

Follow up: The patient decided not to take the prescribed postoperative chemotherapy and is alive with recurrence 18 months after the surgery. Currently, she has been prescribed palliative low dose chemotherapy.


   Acknowledgment Top


I thank Dr. Joseph Sequeira, surgical oncologist, Mumbai, for referring the case for opinion.

 
   References Top

1.McCluggage WC. My approach to and thoughts on the typing of ovarian carcinomas. J Clin Pathol 2008;61:152-63.  Back to cited text no. 1
    
2.Young RH, Prat J, Scully RE. Ovarian endometrioid carcinomas resembling sex cord stromal tumours. A clinicopathological analysis of 13 cases. Am J Surg Pathol 1982;6:513-22.  Back to cited text no. 2
    
3.Pitman MB, Young RH, Clement PB, Dickersin GR, Scully RE. Endometrioid carcinoma of the ovary and endometrium, oxyphil cell type: A report of nine cases. Int J Gynecol Pathol 1994;13:290-301.  Back to cited text no. 3
    
4.Zaloudek CF. In: Fletcher CD, editor. Diagnostic histopathology of the tumours. 3rd ed. Philadelphia. Churchil Livingston Elsevier; 2007. p. 579-81.  Back to cited text no. 4
    
5.Rosai J. In: Rosai J, editor. Rosai and Ackerman's Surgical Pathology. 9 th ed, Vol. 2. Missouri. Mosby Elsevier; 2004. p. 1667-9.   Back to cited text no. 5
    
6.Storey DJ, Rush R, Stewart M, Ryer T, Naffussi AA, Williams AR, et al. Endometrioid epithelial ovarian cancer: 20 years of prospective collective data from a single. Cancer 2008;112:2211-20.  Back to cited text no. 6
    

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Correspondence Address:
Kedar K Deodhar
Department of Pathology, Tata Memorial Hospital, Dr. Ernest Borges Road, Parel, Mumbai - 400 012
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.72035

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