PMC8504641_01
Upon gross examination, we found that the right ovary was replaced by a dark-red solid tumor measuring 11 x 8 x 8 cm, which showed bleeding, adhesions, and a multiple-nodular surface.
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A right salpingo-oophorectomy was performed for intraoperative pathologic examination, and gross examination revealed that the right ovary was replaced by a dark-red, solid tumor (Figure 1) measuring 11 x 8 x 8 cm that showed bleeding, adhesions, and a multiple-nodular surface.
We observed microscopically that the tumor consisted of two types of trophoblastic cells (H&E x 100): cytotrophoblast cells (a) and syncytiotrophoblast cells (c); with hemorrhaging (b) and intravascular carcinoma thrombus (d). Immunohistochemical staining (x100) showed cancer cells to be positive for CK (e), beta-hCG (f), human placental lactogen (hPL) (g), SALL4 (h), and Ki-67 (with more than 80% of cells staining; (j)), negative for EMA (i).
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The mononuclear cells were medium-sized, polygonal or round, with clear or amphophilic cytoplasm; they exhibited a well-defined cellular border; and the nuclei of these cells were round and hyperchromatic with conspicuous nucleoli and numerous mitotic cells, indicating cytotrophoblast cells (Figure 2(a)). Conversely, the multinuclear giant cells varied in size and were irregularly shaped, with abundant and dense amphophilic or vacuolated cytoplasm, and multiple hyperchromatic nuclei without mitosis, regarded as syncytiotrophoblast cells (Figure 2(c)). The tumor cells were surrounded by massive hemorrhage (Figure 2(b)) and necrosis, and intravascular carcinoma thrombus was observed focally (Figure 2(d)). Immunohistochemical staining showed the cancer cells to be positive for beta-hCG (syncytiotrophoblast cells) (Figure 2(f)), CK (Figure 2(e)), hPL (Figure 2(g)), SALL4 (Figure 2(h)), and Ki-67 (with more than 80% of cells stained) (Figure 2(j)), and negative for EMA (Figure 2(i)), OCT4, AFP, and P63.
STR analysis of the case. DNAs from the normal fallopian tube and ovarian tumor were amplified for 21 loci.. F: fallopian tube; T: tumor.
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We studied the genetic profiles of 21 highly polymorphic STRs (Figure 3).