PMC7555605_01
(A,B) Abdominal enhanced CT showing a giant pelvic-abdominal cyst with an uneven density (7 HU) with peripheral and internal septal enhancement. The giant cyst extended from the pelvic cavity to the level of right renal pelvis, measuring 20 cm x 40 cm, with ascites. (C,D) The final pathology from hematoxylin-eosin staining after laparotomy confirmed the diagnosis of ovarian mucinous borderline cystadenoma with no involvement of the left ovary, omentum, and bilateral adjacent lymph nodes. In (A), arrow indicates the giant pelvic-abdominal cyst with an uneven density (7 HU) with peripheral and internal septal enhancement. CT, computed tomography.
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Abdominal contrast-enhanced CT (Figures 1A,B) and a thorough check-up revealed a giant pelvic-abdominal cyst with an uneven density (7 HU) with peripheral and internal septal enhancement. The final pathology confirmed the diagnosis of ovarian mucinous borderline cystadenoma, intestinal type, with the intestinal epithelium rich in goblet cells and the stratification of cells showing light to moderate atypia in a papillary structure (Figures 1C,D) with no involvement of the left ovary, omentum, and bilateral adjacent lymph nodes.
Follow-up chest CT scans during seven-year monitoring of the pulmonary nodules. (A-C) Detection of the bilateral pulmonary nodules before laparotomy. (D-F) The chest CT scan at the sixth year after laparotomy; the patient was asymptomatic. (G-O) At the seventh year of the follow-up, the patient was referred to the respiratory department and presented with cough and clear sputum without hemoptysis or any other symptoms. Chest CT showed a new irregular nodule at the dorsal segment of the right inferior lobe, and a cavity was observed in the largest original pulmonary nodule. (P-R) After four cycles of chemotherapy, the pulmonary solid metastasis progressed with the development of pleural effusion and pleura thickening, which was later proven to be metastatic adenocarcinoma by pleural biopsy. The patient passed away 4 months later. The arrows indicate one pulmonary nodule with progress during the follow up of 7 years respectively. CT, computed tomography.
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Meanwhile, chest CT showed multiple bilateral cystic nodules without obvious enhancement (Figures 2A-C). Then, the patient was followed closely for the pulmonary nodules on CT scans (Figures 2D-F) and for possible asymptomatic recurrence of the BOT and malignant transformation arising from the BOT. Chest CT showed a new irregular nodule at the dorsal segment of the right inferior lobe, and a cavity was observed in the largest original pulmonary nodule (Figures 2G-O). After four cycles of chemotherapy [AUC (area under the curve): 5 mg/ml/min of carboplatin and 65 mg/m2 of docetaxel per cycle] with 3-week intervals were completed, the pulmonary solid metastasis progressed with the development of pleural effusion and pleura thickening (Figures 2P-R).
(A,B) Transbronchial lung biopsy (TBLB) targeting the new consolidation was performed. The histopathology of the HE staining result indicated papillary mucinous adenocarcinoma. (A) This tumor demonstrates architectural complexity with characteristics of mucinous differentiation. (B) High-power image highlighting prominent epithelial stratification and cytologic atypia. (C-F) Immunostaining suggesting papillary mucinous adenocarcinoma as the malignant transformation arising from the BOT with (C) CA-125(focal+), (D) CK7(+), (E) TTF-1(-), and (F) CDX2(-). (G-J) Immunohistochemical staining of the pleural biopsy showed (G) CK7(+), (H) TTF1(-), (I) CR (-), and (J) VIM (-). CA-125, Carbohydrate antigen 125; CDX2, Caudal type homeobox transcription factor 2; CK7, Cytokeratin 7; CR, Complement receptor; HE, hematoxylin-eosin; TTF-1, Thyroid transcription factor-1; VIM, Vimentin.
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BOT [Cytokeratin(CK)(+), P63(-), CK5/6(-), Napsin-A(-), Transcription Factor-1(TTF-1)(-), Cluster of Differentiation(CD)56(-), Ki-67(15%), CA-125(focal+), Estrogen receptor (ER)(-), paired box gene 8(PAX8)(-), CK7(+), CK20(-), Caudal type homeobox transcription Factor 2(CDX2)(-), and P16(-)] (Figures 3A-F). Breast cancer susceptibility gene (BRCA) mutation was not observed in the tissue of the lung biopsy. Ultrasonic-guided transcutaneous pleural biopsy revealed metastatic adenocarcinoma (Figures 3G-J).