Mixed Epithelial and Germ Cell Ovarian Cancer: A Case Report

Margaret Storm, Hanna G. Kaspar, John D. Nash, Radhika Gogoi and Ashlee L. Smith*

Mixed Epithelial and Germ Cell Ovarian Cancer: A Case Report.

One,  a mixed epithelial tumor accounting for approximately 70 percent of the mass; the other a germ cell tumor positive for malignant-high grade carcinoma. The mixed clear cell carcinoma and
yolk sac tumor were present in the left ovary with a single metastatic nodule to the sigmoid
mesentery and positive washings. Final staging was consistent with International Federation of
Gynecology and Obstetrics (FIGO) Stage IIB (IIC by old staging criteria) ovarian carcinoma.
Colleagues at the Brigham and Women’s Hospital confirmed the pathologic diagnosis.

Rather than foregoing the final cycle of BEP, the patient’s fourth cycle of chemotherapy excluded Bleomycin.  AFP levels have fallen from 106 ng/Ml 1 month post-operatively to 1.4 ng/mL approximately 7 months after surgery. On recent follow up one year after surgery the patient’s CA-125 and AFP reference readings were 4.1 and 1.4, respectively.

Pathologic investigation identified two distinct histologic and immunohistochemical patterns consistent with a mixed epithelial, accounting for roughly 70% of the tumor, and germ cell tumor. Gross examination of the left ovary demonstrates a 22.5 × 15.0 × 8.0 cm and 1020 gram tumor with a dull, pink-tan, and smooth, intact surface. The cut section shows predominantly solid and necrotic areas with cystic spaces filled by hemorrhagic, gelatinous debris. The right ovary, uterus, fallopian tubes and omentum were free of tumor.

The H & E microscopic sections from the ovarian tumor and from the mesenteric nodule demonstrate a tumor with biphasic morphology and immunophenotype. The clear cell carcinoma component is positive for PAX-8, EMA, and HNF-1β, and negative for SALL-4 and Glypican-3.

Women Health Open J. 2015; 1(2): 45-47. doi: 10.17140/WHOJ-1-107