Kosin Med J.  2022 Sep;37(3):249-254. 10.7180/kmj.22.026.

A rare case of pure-type embryonal carcinoma in a 75-year-old woman mimicking epithelial ovarian carcinoma

• Jo HB
• Kim ET
• Lee NK
• Choi KU
• Kim EJ
• Shin YJ
• Kim KH
• Suh DS

• KMID: 2538805
• DOI: http://doi.org/10.7180/kmj.22.026

Abstract

Embryonal carcinoma, a very rare ovarian germ cell tumor, involves pure and mixed phenotypes. Pure-type embryonal carcinoma has never been reported in postmenopausal women. The current case was, thus, misdiagnosed as an epithelial ovarian carcinoma based on radiologic findings. Herein, we describe the case of ovarian embryonal carcinoma in a 75-year-old woman along with a literature review. Magnetic resonance imaging findings were suggestive of epithelial ovarian malignancy associated with endometrioma, including ureteral invasion. The patient underwent complete surgical staging, and a pathologic diagnosis of pure-type embryonal carcinoma was made. The patient’s postoperative course was uneventful, and adjuvant chemotherapy was administered. Embryonal carcinoma in the postmenopausal woman is a clinical challenge owing to the possibility of its misdiagnosis as epithelial ovarian carcinoma. To the best of our knowledge, this is the first report of pure-type ovarian embryonal carcinoma in a postmenopausal woman, with a description of the clinicopathologic characteristics and review of the relevant literature.

Keyword

Case reports; Embryonal carcinoma; Neoplasms, germ cell and embryonal; Postmenopause

Figure

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  Fig. 1. Magnetic resonance images. Axial T1-weighted (A) and T2-weighted (B) images showing a septated hemorrhagic cystic mass with papillary projections (arrow) of the left ovary (ORADS 5). High T1 signal intensity with the T2 dark spot sign, suggestive of epithelial ovarian cancer associated with endometrioma (e.g., clear cell carcinoma or endometrioid carcinoma). (C) Contrast-enhanced axial T-weighted image shows enhancement (arrow) of the papillary projections in the left ovarian tumor. (D) Axial T2-weighted imaging revealed left hydronephrosis (arrow), showing abrupt narrowing at the ovarian mass level suggestive of ureteral invasion. ORADS, Ovarian-Adnexal Reporting & Data System.

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  Fig. 2. Pathologic findings. (A) Tumor showing a predominantly solid pattern of highly anaplastic tumor cells and numerous mitotic figures (H&E, x200). (B) The tumor cells tested positive for CD30, a specific marker of embryonal carcinoma (x200). (C) Gross findings. A 12- to 15-cm cystic and solid mass was confined to the ovary with an intact capsule. (D) Cutting sections of the tumor.

Reference

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