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Carcinosarcoma in dermoid cyst of ovary: An extremely rare malignant transformation

Year: 2013

Type: article

Abstract: We report here a case of carcinosarcoma arising from dermoid cyst of ovary comprising of squamous cell carcinoma and pleomorphic sarcoma with focal myogenic differentiation.A 52-year-old female presented with left lower abdominal pain and a large pelvic mass. Ultrasonography revealed a large left adnexal cystic mass with fluid level and a small solid nodule [Figure 1]. Patient underwent total hysterectomy with bilateral salpingo-oophorectomy. The ovarian tumor was large measuring 18  12 10 cm. It was unilocular cystic mass filled with hair and yellow colored cheesy material. The thickness of cyst wall was 0.5-1.5 cm and a solid area measuring 3 cm in diameter was seen in one pole [Figure 2]. The left ovary appeared normal. The uterus was atrophic with keratinized cervix. Histopathological examination of the cyst wall showed a stratified squamous epithelial lining with focal dysplastic change and transition to infiltrating carcinoma with underlying dermal appendages. Hematoxylin and eosin stained sections from the solid area showed a malignant tumor with two distinct components. One of the components was epithelial showing diffuse squamous differentiation with extensive keratinization [Figure 3]. There was nuclear anaplasia and atypical mitosis. The other component revealed features of pleomorphic spindle cell sarcoma with marked pleomorphism and hyperchromasia, [Figure 3] frequent mitoses and necrosis. The epithelial and mesenchymal components were closely intermixed without well-demarcated boundaries. On immunohistochemistry, the malignant epithelial cells were reactive for high molecular weight keratin [Figure 4a] and P63 protein [Figure 4b] while the pleomorphic spindle cell sarcomatous component showed diffuse positivity for vimentin [Figure 4c] and focally for smooth muscle actin [Figure 4d]. Desmin, S100 protein and CD10 were negative in both components.The present case was a large ovarian cyst with characteristic squamous epithelial lining as described by Arora and Haldane who found adenocarcinoma in combination with sarcoma in dermoid cyst of ovary.

Source: Indian Journal of Pathology and Microbiology

DOI: 10.4103/0377-4929.118691

Authors: Asaranti Kar, Tushar Kar, Kaumudee Pattnaik, Priyadarshini Biswal

Institution: Sriram Chandra Bhanja Medical College Hospital

Language: English

Topic: Ovarian cancer diagnosis and treatment

Subfield: Oncology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $200