PMC3862215_01
Serous borderline tumor with microinvasion and metastatic low grade papillary serous carcinoma. (A) Initial biopsy of back mass shows a papillary epithelial tumor with confluent glandular pattern and multiple calcified psammoma bodies (H&E stain, 20X). Low nuclear grade and positivity for PAX8 and WT1 indicate a metastatic low grade papillary serous carcinoma. (B) Subsequent excision of ovarian masses shows bilateral serous borderline tumor with microinvasion on the left side (H&E stain, 4X). Note the complex papillary growth with surrounding clear spaces within the fibrovascular core of one of the borderline tumor stalks. (C) Core needle biopsy of breast lesion (WT1 immunohistochemical stain, 20X). WT1 staining is positive in tumor cells and negative in adjacent benign ductal epithelium excluding a primary papillary lesion of the breast and confirming metastasis from pelvic low grade papillary serous carcinoma. (D) Excision of abdominal lesion two years following primary diagnosis demonstrates increased nuclear grade within the metastatic tumor (H&E, 20X).
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The mass was excised and was identified as a low-grade papillary serous carcinoma consistent with an ovarian origin (Fig. 1A). The pathology of these specimens revealed bilateral serous borderline ovarian tumors with microinvasion on the left (Fig. 1B), an omental implant indefinite for invasion, and positive peritoneal cytology. The patient also reported a new breast mass which, on core biopsy, demonstrated a papillary lesion confirmed to be low-grade papillary serous carcinoma consistent with metastatic disease by immunohistochemical staining for PAX8 and WT1 (Fig. 1C). Three months later, the patient underwent resection of the metastatic mass in her anterior abdominal wall, which demonstrated pathologic changes consistent with low-grade papillary serous carcinoma of the ovary with increased cytologic atypia compared to the primary tumor (Fig. 1D).
CT image of right mediastinal mass compressing the right atrium.
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On further investigation, a CT scan identified an irregularly-shaped calcified chest mass along the right cardiac border, multiple pulmonary nodules, and a pelvic mass measuring 6 x 7 cm (Fig. 2).