Authors: Seiji Isonishi Asako Ogura Takako Kiyokawa Michiko Suzuki Shiro Kunito Masanori Hirama Toshiaki Tachibana Kazuhiko Ochiai Tadao Tanaka
Publish Date: 2009/02/20
Volume: 14, Issue: 1, Pages: 70-73
Abstract
Apart from typical yolk sac tumors ovarian tumors with elevated alfafetoprotein AFP are uncommon and the differential diagnosis needs to consider the hepatoid pattern of a yolk sac tumor hepatocellular carcinoma metastatic to the ovary hepatoid carcinoma and other epithelial ovarian tumors We report here an AFPproducing ovarian tumor with uncertain pathological diagnosis which was extremely responsive to chemotherapy A 59yearold Japanese woman presented with lower abdominal distension and was found to have a left ovarian mass on pelvic examination and magnetic resonance imaging MRI scan Laboratory tests showed serum AFP 73 687 ng/ml carbohydrate antigen 125 CA125 1599 U/ml and carcinoembryonic antigen CEA 139 ng/ml Total hysterectomy with bilateral salpingooophorectomy partial omentectomy and low anterior resection of the rectum was performed without any residual macroscopic tumor Microscopically the tumor was characterized by a hepatoid carcinomatous component composed of solid sheets of large eosinophilic cells with pleomorphic nuclei The pathological stage was pT2N0M0 Tumor cells were diffusely immunoreactive for AFP and cytokeratin CAM52 but monoclonal CEA and CA199 were focally positive in the cytoplasm while CA125 was negative The patient was treated postoperatively with three cycles of chemotherapy consisting of bleomycin etoposide and cisplatin with this regimen serum AFP decreased to 16 ng/ml from 12 600 ng/ml just before the initiation of chemotherapy The patient received secondary cytoreductive surgery of systemic lymphadenectomy which revealed no evidence of residual tumor
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