PMC8018272_01
Image of pelvic tumor and metastasis. (A) Para-aortic lymph nodes and pelvic tumor. (B) Supraclavicular lymph nodes. (C) Sub-diaphragmatic seeding. (D) Lung metastasis.
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There were multiple small peritoneal nodules, multiple enlarged para-aortic and bilateral iliac lymph nodes, and multiple small pulmonary metastases and lymph nodes over the left lower neck and left supra-clavicular regions ( Figure 1 ).
Pathological findings of ovarian adrenocortical carcinoma. (A) A piece of tissue measuring 23 x 17 x 10 cm in size. (B) Sections of the huge ovary and uterine body tumor showing solid sheets and nests of tumor cells with monotonous morphology with large, centrally located nuclei and abundant cytoplasm. Focal tumor necrosis is present. Lymphovascular invasion is prominent. (C) Biopsy sample of the peritoneum cavity. (D) Lymph node metastasis: Lesion cells are arranged in thick trabeculae and in organoid pattern. They contain eosinophilic cytoplasm and small dark nuclei. High prevalence of mitotic figures is seen.
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After consultation and discussion with another pathologist, the final pathological test report 2 months later showed ACC, probably arising from the adrenal cortical rest ( Figures 2  and  3 ).
Immunohistochemistry of ovarian adrenocortical carcinoma. (A) Chromogranin A 100x: negative; (B) Ki-67 200x: high Ki-67-labeling proliferating index (>80%); (C) Alpha-inhibin 100x: positive; (D) Calretinin 100x: focally positive; (E) CD56 100x: focally positive; (F) Synaptophysin 100x: focally positive; (G) TFE-3 100x: positive.
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After consultation and discussion with another pathologist, the final pathological test report 2 months later showed ACC, probably arising from the adrenal cortical rest ( Figures 2  and  3 ).