doi:10.1016/j.ygyno.2006.11.008 
Copyright © 2006 Elsevier Inc. All rights reserved.
Case Report
Ovarian neuroendocrine carcinoma, non-small cell type, associated with serous carcinoma
Yoo Duk Choia, Ji Shin Leea, Chan Choia, Chang Soo Parka and Jong Hee Nam
, a, 
aDepartment of Pathology, Chonnam National University Medical School, 5 Hak-dong, Dong-gu, Gwangju, 501-749, Republic of Korea
Received 20 June 2006.
Available online 16 January 2007.
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Abstract
Background.
Neuroendocrine carcinoma of the non-small cell type of the ovary is a rare aggressive tumor, interestingly associated with either a surface epithelial tumor or teratoma.
Case.
A 71-year-old woman presented with a pelvic mass and underwent a total abdominal hysterectomy with a bilateral salpingo-oophorectomy. Pathology examination showed a 6.5 cm in greatest dimension ovarian tumor composed of neuroendocrine carcinoma of the non-small cell type and serous carcinoma. Immunohistochemical studies including keratin 7, WT-1, and neuroendocrine markers demonstrated differences in the two components. Microsatellite instability (MSI) analysis using five polymorphic markers also showed a different pattern in the two components.
Conclusion.
This is the first report of an ovarian neuroendocrine carcinoma, non-small cell type, associated with a serous carcinoma. Immunohistochemistry and MSI are very helpful in making a definite diagnosis.
Keywords: Ovary; Neuroendocrine carcinoma; Serous carcinoma
Fig. 1. (A) The tumor showing a mixture of neuroendocrine carcinoma of the non-small cell type and serous carcinoma. (B–C) Low-power view of neuroendocrine carcinoma of the non-small cell type showing solid and a trabecular pattern. (D) High-power view of neuroendocrine carcinoma of the non-small cell type showing mildly variable tumor cells with oval nuclei showing fine, evenly distributed chromatin and inconspicuous nucleoli, and numerous mitotic figures. (E) Low-power view of serous carcinoma showing papillary and tubule structure and psammoma bodies. (F) High-power view of serous carcinoma showing the tumor cells with enlarged nuclei and prominent nucleoli.
Fig. 2. Immunohistochemical staining. (A) Keratin 7 was expressed as diffuse membranous pattern in serous carcinoma, but not in neuroendocrine carcinoma. (B) Neuroendocrine carcinoma was positive for synaptophysin. (C) Neuroendocrine carcinoma was positive for CD56. (D) WT-1 was expressed as nuclear staining pattern in serous carcinoma, but not in neuroendocrine carcinoma. (E) Pan-keratin was expressed as dot-like pattern in neuroendocrine carcinoma, while as diffuse membranous pattern in serous carcinoma. (F) Alpha-inhibin was not expressed in both serous and neuroendocrine carcinoma components.
Fig. 3. Microsatellite analysis comparing normal DNA. DNA from the serous carcinoma, and DNA from the neuroendocrine carcinoma. In the DNA of serous carcinoma component, an additional band can be detected at D17S-250. In the DNA of neuroendocrine carcinoma component, an additional band can be detected at BAT-25, BAT-26, and D2S-123.
Table 1.
Immunohistochemical differences in both neroendocrine and serous carcinomas
EMA: epithelial membrane antigen.
WT: Wilims' tumor.
Table 2.
Clinicopathologic features of ovarian neuroendocrine carcinoma of the non-small cell type with surface epithelial neoplasm
DOD: death of disease.
Abstract
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