Mixed Endometrioid Clear Cell Carcinoma of the Ovary: A Case Report

Article ID: e040523216503 Pages: 4

  • * (Excluding Mailing and Handling)

Abstract

Background: Despite the high percentage of pure forms of epithelial ovarian cancers (EOC), mixed epithelial cancer of the ovary is extremely rare and accounts for less than 1% percent of all epithelial ovarian cancers. Because of the low prevalence; there are only a few cases of mixed epithelial cancers published in the literature. This study presents the case of a mixed endometrioid (EC)/clear cell carcinoma (CCC), diagnosed in a woman with a complaint of low back pain and a history of infertility.

Case Report: We report the case of a 35-year-old woman who came to our clinic complaining of progressive back pain and a history of infertility. Imaging showed a left ovarian mass that was compatible with malignant tumors. The patient underwent open surgery and a frozen section evaluation of the tumor was done during the operation. The pathology result demonstrated mixed CCC/EC histology in the left ovary. We decided to perform a total abdominal hysterectomy as well as right salpingooophorectomy, omentectomy, bilateral pelvic lymphadenectomy, and para-aortic lymphadenectomy. Adjuvant chemotherapy was administrated postoperatively.

Conclusion: Although epithelial cancers account for more than 90% of all ovarian cancers (OC), developing mixed forms of epithelial cancers is extremely rare, and there are little data available in the literature about their presentation and histopathological features. The main purpose of this article was to report a mixed CCC/EC and to discuss different aspects of this rare histologic type of OC. More research is needed to determine metastatic potential as well as the likelihood of recurrence of these unique neoplasms.

Graphical Abstract

[1]
Torre, L.A.; Trabert, B.; DeSantis, C.E.; Miller, K.D.; Samimi, G.; Runowicz, C.D.; Gaudet, M.M.; Jemal, A.; Siegel, R.L. Ovarian cancer statistics, 2018. CA Cancer J. Clin., 2018, 68(4), 284-296.
[http://dx.doi.org/10.3322/caac.21456] [PMID: 29809280]
[2]
Mackenzie, R.; Talhouk, A.; Eshragh, S.; Lau, S.; Cheung, D.; Chow, C.; Le, N.; Cook, L.S.; Wilkinson, N.; McDermott, J.; Singh, N.; Kommoss, F.; Pfisterer, J.; Huntsman, D.G.; Köbel, M.; Kommoss, S.; Gilks, C.B.; Anglesio, M.S. Morphologic and molecular characteristics of mixed epithelial ovarian cancers. Am. J. Surg. Pathol., 2015, 39(11), 1548-1557.
[http://dx.doi.org/10.1097/PAS.0000000000000476] [PMID: 26099008]
[3]
Gadducci, A.; Multinu, F.; Cosio, S.; Carinelli, S.; Ghioni, M.; Aletti, G.D. Clear cell carcinoma of the ovary: Epidemiology, pathological and biological features, treatment options and clinical outcomes. Gynecol. Oncol., 2021, 162(3), 741-750.
[http://dx.doi.org/10.1016/j.ygyno.2021.06.033] [PMID: 34247767]
[4]
Tang, H.; Liu, Y.; Wang, X.; Guan, L.; Chen, W.; Jiang, H.; Lu, Y. Clear cell carcinoma of the ovary. Medicine, 2018, 97(21), e10881.
[http://dx.doi.org/10.1097/MD.0000000000010881] [PMID: 29794794]
[5]
Emil Capilna, M.; Szabo, B.; Puscasiu, L.; Toma, A.; Rugina, C. Endometriosis and gynecological cancer. Curr. Womens Health Rev., 2012, 8(2), 150-157.
[http://dx.doi.org/10.2174/157340412800194867]
[6]
McGowan, L.; Norris, H.J.; Hartge, P.; Hoover, R.; Lesher, L. Risk factors in ovarian cancer. Eur. J. Gynaecol. Oncol., 1988, 9(3), 195-199.
[PMID: 3391190]
[7]
Mosgaard, B.J.; Lidegaard, Ø.; Kjaer, S.K.; Schou, G.; Andersen, A.N. Infertility, fertility drugs, and invasive ovarian cancer: A case-control study. Fertil. Steril., 1997, 67(6), 1005-1012.
[http://dx.doi.org/10.1016/S0015-0282(97)81431-8] [PMID: 9176436]
[8]
Brain, K.E.; Smits, S.; Simon, A.E.; Forbes, L.J.; Roberts, C.; Robbé, I.J.; Steward, J.; White, C.; Neal, R.D.; Hanson, J.; Module, I.C.B.P. Ovarian cancer symptom awareness and anticipated delayed presentation in a population sample. BMC Cancer, 2014, 14(1), 171.
[http://dx.doi.org/10.1186/1471-2407-14-171] [PMID: 24612526]
[9]
Czernobilsky, B.; Silverman, B.B.; Mikuta, J.J. Endometrioid carcinoma of the ovary. A clinicopathologic study of 75 cases. Cancer, 1970, 26(5), 1141-1152.
[http://dx.doi.org/10.1002/1097-0142(197011)26:5<1141:AID-CNCR2820260526>3.0.CO;2-R] [PMID: 5476794]
[10]
Bai, H; Sha, G; Xiao, M; Gao, H; Cao, D; Yang, J The prognostic value of pretreatment CA-125 levels and CA-125 normalization in ovarian clear cell carcinoma: A two-academic-institute study. Oncotarget, 2016, 7(13), 15566-15576.
[11]
Valenzuela, P.; Ramos, P.; Redondo, S.; Cabrera, Y.; Alvarez, I.; Ruiz, A. Endometrioid adenocarcinoma of the ovary and endometriosis. Eur. J. Obstet. Gynecol. Reprod. Biol., 2007, 134(1), 83-86.
[http://dx.doi.org/10.1016/j.ejogrb.2006.06.008] [PMID: 16844279]
[12]
Check, J.H.; Coates, T.E.; Nowroozi, K. Extreme elevation of serum CA-125 in two women with severe endometriosis: Case report. Gynecol. Endocrinol., 1991, 5(3), 217-220.
[http://dx.doi.org/10.3109/09513599109028444] [PMID: 1776508]
[13]
Kurman, R.J.; Craig, J.M. Endometrioid and clear cell carcinoma of the ovary. Cancer, 1972, 29(6), 1653-1664.
[http://dx.doi.org/10.1002/1097-0142(197206)29:6<1653:AID-CNCR2820290633>3.0.CO;2-E] [PMID: 5031251]
[14]
Fujiwara, K.; Shintani, D.; Nishikawa, T. Clear-cell carcinoma of the ovary. Ann. Oncol., 2016, 27(Suppl. 1), i50-i52.
[http://dx.doi.org/10.1093/annonc/mdw086] [PMID: 27141072]
[15]
Cobb, L.P.; Gershenson, D.M. Treatment of rare epithelial ovarian tumors. Hematol. Oncol. Clin. North Am., 2018, 32(6), 1011-1024.
[http://dx.doi.org/10.1016/j.hoc.2018.07.015] [PMID: 30390757]