A case of ovarian carcinosarcoma composed of endometrioid carcinoma and endometrial stromal sarcoma

Abstract

Ovarian carcinosarcoma (OCS) is a rare malignancy accounting for only 1‒4% of all ovarian cancers. A 44-year-old premenopausal woman presented at the Obstetrics and Gynecology Department of the University Hospital of Saga, with the chief complaint of sudden abdominal pain. Tumor markers present in her serum were cancer antigen (CA) 19-9 (103U/mL), and CA 125 (114U/mL). Transvaginal ultrasound examination showed a complex mass (74×71×67mm) with solid and cystic components in the left abdominal area. Abdominopelvic computed tomography images showed a polycystic mass with a long diameter of 94 mm in the left adnexal area. The patient underwent a laparotomy immediately after the appropriate evaluation of examinations, leading to total abdominal hysterectomy, bilateral salpingo-oophorectomy and partial omentectomy. Due to the emergency surgery, intraoperative histological diagnosis for ovarian tumor was not performed. The preoperative evaluation of radiological imaging revealed no evidence of lymph node swelling, therefore lymph node resection was omitted. The left ovarian tumor already showed a partial rupture. Pathological examination following surgery revealed tubular and solid growth of the epithelial component and fascicular growth of spindle-shaped mesenchymal cells. Immunohistochemistry identified the epithelial component as endometrioid carcinoma (EC) and the mesenchymal component as endometrial stromal sarcoma (ESS). Endometriotic tissue was attached to the malignant tumor. The patient was successfully treated with adjuvant chemotherapy (paclitaxel plus carboplatin) after surgery. The patient is still alive without recurrence at 9 months after surgery. Considering the rarity of OCS with EC and ESS, we present an overview of the literature and discuss several histological and clinical issues. The etiology and pathogenesis of such tumors require further investigation (words; 228).