PMC5834310_01
Tissue from a frozen section control of a mediastinal lymph node showed sheets of poorly differentiated carcinoma consisting of malignant cells with marked pleomorphism and a moderate amount of cytoplasm (a); GATA-3 immunostain showed patchy strong positivity (b); similar tumour cells were seen in the pericardial specimen (c); Pax-8 stain was strongly positive (d).
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figure1
Interestingly, the IHC staining profile of the fluid revealed tumour cells with classic findings for an ovarian serous carcinoma, which were later confirmed in the patient's resection specimen and not consistent with a primary breast carcinoma (Figures 1 and 2).
Total abdominal hysterectomy and bilateral salpingo-oophorectomy specimen showed a slightly enlarged left ovary with few cysts and was otherwise unremarkable (a); low-power microscopy (4x) of the left ovary showed tumour within ovarian parenchyma (b) and high-power (40x) magnification shows similar cells to those seen in the previous specimens (b, inset); the right ovary also showed areas of tumour with a classic papillary appearance (c); a WT-1 stain was diffusely positive (d); a BRST-2 stain was negative (e); brain metastases showed highly pleomorphic cells with features of serous carcinoma extending into adjacent glial tissue (f).
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figure2
Interestingly, the IHC staining profile of the fluid revealed tumour cells with classic findings for an ovarian serous carcinoma, which were later confirmed in the patient's resection specimen and not consistent with a primary breast carcinoma (Figures 1 and 2).
PET/CT body showing diffuse enhancement of disease. Axial views of the body on PET/CT demonstrating (a) intrathoracic lymphadenopathy and FDG avid right pleural thickening. Coronal view of demonstrating axillary lymphadenopathy, intrathoracic lymphadenopathy, right pleural thickening, FDG-avid caking on ascending colon and right lateral abdominal wall implant (b).
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figure3
The patient underwent further imaging with a positron emission tomography (PET)/CT scan that revealed extensive lymphadenopathy, diffuse peritoneal implants, and omental caking in the absence of obvious evidence of adnexal or uterine disease (Figure 3).
MRI brain demonstrating metastases to brain. Axial (a) and coronal (b) views of the brain demonstrating the presence of brain metastasis.
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New brain metastases near the hypothalamus with surrounding vasogenic oedema were detected on magnetic resonance imaging (MRI) scans of the brain (Figures 4 and 5).
MRI brain showing leptomeningeal disease. (a) T1 axial MRI with contrast depicting new enhancement along superior cerebellar folia compatible with leptomeningeal disease. (b) Abnormal leptomeningeal enhancement along posterior margin of splenium of corpus callosum.
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figure5
New brain metastases near the hypothalamus with surrounding vasogenic oedema were detected on magnetic resonance imaging (MRI) scans of the brain (Figures 4 and 5).