PMC5822781_01
(a) Macroscopic findings: an irregular, white, and solid tumor of the right ovary. ((b)-(d)) Microscopic findings. (b) Tumor cells are round to ovoid with hyperchromatic nuclei, scant cytoplasm, abundant mitosis, and apoptosis with conspicuous necrosis (hematoxylin-eosin stain (HE), x300). (c) Endometrial carcinoma grade 1 in uterine corpus (HE, x30) with less than half myometrial invasion and no vascular invasion. ((d), (e)) Tumor cells are positive for synaptophysin and neuron-specific enolase (immunostaining, x300).
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fig1
She underwent an urgent laparotomy, which revealed that a white and solid tumor of the right ovary had spontaneously ruptured in the intra-abdominal cavity (Figure 1(a)). The pathological diagnosis was SCOCPT (Figure 1(b)) and grade 1 endometrioid carcinoma of the uterine corpus (Figure 1(c)).
(a) Enhanced abdominal computed tomography (coronal section) reveals the remaining tumor is approximately 20.3 cm in diameter before irradiation. (b) After radiation therapy, the tumor size decreased to 15.3 cm.
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fig2
A total dose of 26 Gy was given in 13 fractions, and the tumor size decreased to 15.3 cm with improved symptoms (Figure 2).
The graph shows the time course of the levels of serum lactate dehydrogenase (LDH), cancer antigen 125 (CA125), and neuron-specific enolase (NSE). The patient underwent surgery (S) on day 21; chemotherapy (C) on days 43, 65, and 86; and abdominal irradiation (R) from day 120 to day 140. She died on day 157 (D). The solid line shows levels of LDH, the dashed-line shows levels of CA125, and the dashed-dotted line shows levels of NSE.
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During the course of treatment, serum LDH levels repeatedly decreased soon after the chemotherapy but increased during drug holidays (Figure 3).