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Department of Pathology and Laboratory Medicine

Department of Pathology and Laboratory Medicine

Residency Program - Case of the Month

June 2012 - Presented by Rebecca Sonu, M.D.

Clinical history:

The patient is a 64 year-old female with a past medical history of cervical cancer s/p vaginal hysterectomy, hemorrhagic cyst s/p right oopherectomy, hypertension, and recurrent pulmonary emboli. She presented with abdominal pain for two weeks. Computed tomography (CT) showed a multi-cystic pelvic mass.  An exploratory laparatomy was performed revealing a 12 cm tense cystic mass in the pelvis that was adherent to the left pelvic side wall and vaginal cuff. A left salpingo-oopherectomy was performed. Intraoperative frozen section of the mass revealed suspicion for an ovarian malignancy, thus staging (bladder peritoneum, left pelvic side wall biopsy, cul-de-sac biopsy, left pelvic sidewall lymph node and left periaortic lymph node) and an appendectomy were completed.

 

Gross description:

Left fallopian tube and ovary: Received fresh was a 454 gram multiloculated cystic ovary (13.2 x 13.4 x 3.8 cm) with a fimbriated fallopian tube (3.9 x 0.4 x 0.3 cm) segment attached to the outer surface. Cut surfaces of the cystic structure reveal a cyst wall 1.5 cm in maximum thickness. The cystic lining contains pink-purple excrescences partially covered with tan-brown soft material.

Appendix: Received fresh was a vermiform appendix (3.7 cm long x 1.0 cm diameter) with a bent tip. The cut surface of the tip was glistening yellow. The serosa was pink and hyperemic.

 

Microscopic images (Ovary):

 

Figure 1: Ovary

Figure 2: Ovary

Figure 3: Ovary 

Microscopic image 1: Ovary (Click to enlarge) Microscopic image 2: Ovary (Click to enlarge) Microscopic image 3: Ovary (Click to enlarge)

 

 

Microscopic images (Appendix):

 

Fig. 4: Appendix

Fig. 5: Appendix 

Fig. 6: Appendix 

Fig. 7: Appendix 

Microscopic image 4: Appendix (Click to enlarge) Microscopic image 5: Appendix (Click to enlarge) Microscopic image 6: Appendix (Click to enlarge) Microscopic image 7: Appendix (Click to enlarge)

Fig. 8: Appendix

Fig. 9: Appendix 

Fig. 10: Appendix 

Fig. 11: Appendix, Chromagranin

Microscopic image 8: Appendix (Click to enlarge) Microscopic image 9: Appendix (Click to enlarge) Microscopic image 10: Appendix (Click to enlarge) Microscopic image 11: Appendix, Chromagranin (Click to enlarge)

Fig. 12: Appendix, CEA

Fig. 13: Appendix, CK-20

Fig. 14: Appendix, MUC-2

 
Microscopic image 12: Appendix, CEA (Click to enlarge) Microscopic image 13: Appendix, CK-20 (Click to enlarge) Microscopic image 14: Appendix, MUC-2 (Click to enlarge)

 

 

Immunohistochemistry workup

 

IHC/Specimen Ovary Appendix
CK7 + -
CK20 - +
CEA + +
MUC2 - +
Chromagranin not performed +
Synaptophysin - -

 

 

 

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