PMC4795582_01
Magnetic resonance imaging of the tumor on admission.. Notes: (A) Magnetic resonance imaging (T2) displayed a less uniform mass signal with a size of 110x116x125 mm, with visible low nodular signal inside the tumor. (B) Magnetic resonance imaging (T2) showed a tumor with less clear boundary between the conjunction of the uterus and the tumor oppressing the uterus and other pelvic organs.
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Pelvic magnetic resonance imaging revealed a less uniform mass signal the size of 110x116x125 mm, with visible low nodular signal inside the tumor and a less clear boundary between the conjunction of the uterus and the tumor (Figure 1).
Pathological characteristics.. Notes: The tumor displayed a nodular appearance with a diameter of ~12 cm, and cross-section showed white appearance and medium texture, with a loculus of 1.2 cm in diameter filled with a pale yellow fluid.
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The right ovary increased approximately to the size of 12x10x10 cm with a hard, uneven, and vascular surface (Figure 2).
The changing of serum calcium and urea nitrogen levels.. Notes: The serum calcium levels sharply decreased after complete excision (on September 6, 2013); hence, extra calcium had to be taken to increase levels back to normal. The urea nitrogen levels indicated revised renal function.
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After surgery, serum calcium decreased rapidly, and on day 8 calcium levels had to be brought back up to normal levels by taking extra calcium (Figure 3). The patient was in a good clinical condition, and serum calcium and urea nitrogen were found to be at normal levels during regular follow-ups (Figure 3), with no recurrence or metastasis by the latest follow-up on September 20, 2015.
Pathological characteristics.. Notes: (A) The tumor cells were arranged in a solid distribution and nodules splitted by fiber bundles with scattered pseudoglandular or follicular-like cavities (H&E staining; magnification x200). (B) The tumor had medium to large cells, eosinophilic cytoplasm, and round or oval vesicular nucleus, with increased karyoplasmic ratio and pathologic mitosis (H&E staining; magnification x400). (C) Electron microscope revealed the cell junction and inserted basement membrane without neurosecretory granules.. Abbreviation: H&E, hematoxylin and eosin staining.
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Microscopically, the tumor cells were arranged in a solid distribution, nodular, and pseudoglandular cavity patterns, with medium to large cells, eosinophilic cytoplasm, round or oval vesicular nucleus, increased karyoplasmic ratio, and pathologic mitosis (Figure 4A and B). The most striking ultrastructural features revealed no neuroendocrine granules, while visible inserted basement membrane and cell junction could be seen, suggesting tumors of an epithelial origin (Figure 4C).