Clear cell carcinoma (mesonephroma) of the ovary. Case report.
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Adenocarcinoma↗
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[Embryonic carcinoma of the yolk sac. Mesonephroma of the ovary. (Endodermal sinus tumor].
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Adolescent↗
Cervical adenocarcinoma arising in florid mesonephric hyperplasia: report of a case with immunocytochemical studies.
A case of mesonephric adenocarcinoma of the uterine cervix arising in florid mesonephric hyperplasia is reported. The reviewed literature contained many cases of cervical "mesonephroma" but only a few of these were considered to be demonstrably of mesonephric origin. These tumors were usually associated with proliferating mesonephric remnants in the cervix. Similar tubuloglandular mesonephric proliferations without formation of a frankly malignant tumor have also been described in the cervix, most recently as florid mesonephric hyperplasia. This latter entity appears to be benign. Carcinoembryonic antigen (CEA) was focally positive in this cervical adenocarcinoma, suggesting that CEA may not be useful in distinguishing this variant from the more common mullerian adenocarcinoma of the cervix.
Carcinoembryonic Antigen↗
Endodermal sinus tumor.
Three cases of Endodermal Sinus Tumor are presented and its difference from tumors of the mesonephroma type and associations with the embryoma are pointed out. The three cases were "pure" types and the patients died within 5 months in spite of surgical treatment and chemotherapy. Autopsy showed extensive involvement of peritoneum, diaphragm and pleura.
Adolescent↗
Ultrastructure of clear cell carcinoma of the ovary. Case report and review of the literature.
The fine structure of an ovarian clear cell carcinoma in a 65 year old woman was analysed. The tumor cells were of both clear and "hobnail" types. Both were characterized by the presence of short microvilli, abundant glycogen granules, a well-developed granular endoplasmic reticulum and Golgi apparatus, scanty lysosomes and very few lipid bodies. The tubules and gland-like spaces were always separated from the stroma by a basement membrane. At ultrastructural level the tumor cells do not resemble at all those of cleaar cell renal carcinomas. On the other hand, their submicroscopic features are strongly similar to those of the clear cell tumors found elsewhere in the female genital tract, emphasizing therewith their very probable müllerian origin. It is recommended to eliminate the term "mesonephroma ovarii" to designate the clear cell carcinomas of the ovary.
Adenocarcinoma↗
[A peculiar abnormality of the fallopian tube: induced by embryonic kidney tumor?].
A 17-year-old female with severe pain of the midabdomen was found to have a retroperitoneal cystic tumor, an ectopic ovary and a fallopian tube without fimbriated end. An attempt is made to determine whether these early embryonic malformations could be traced to a common origin. This is possible provided that the tumor is regarded as a mesonephroma. A histological study of the normal development of the Mullerian duct was performed utilizing human embryonic series. Previous development theories and more recent investigations are discussed. Malformations of the tube described in the literature and possible etiologies are summarized.
Adolescent↗
[Clinical application of magnetic resonance imaging in gynecology].
Thirty-five women were examined with female pelvic magnetic resonance imaging (MRI). 5 cases demonstrated normal pelvis structures, 3 had physiological atrophic changes, and one had an underdeveloped uterus. The other 26 cases consisted of 8 leiomyoma of uterus, 11 ovarian benign tumor, 3 ovarian cancer, 2 cervical and 2 endometrial carcinoma. Images of normal uterus as well as those pathological conditions mentioned above were depicted, and compared with the operative findings. By means of MRI, we were able to demonstrate the origin of most of the pelvic masses, number, size and location of leiomyoma, myometrial penetration, parametrial extension and lymph node metastasis of endometrial carcinoma. Cervical malignancy could be accurately staged, and serous cyst was possibly distinguished from hemorrhagic cyst. However, one case of mucinous cystadenoma was misdiagnosed as dermoid cyst; one myoma, 1 cm in diameter, in same density as the uterine muscle was overlooked and one mesonephroma of 0.3 cm in diameter situated deep in the cervical fibrous tissue was not detected.
Adolescent↗
Paraneoplastic hypercalcemia in ovarian tumors.
Two cases of paraneoplastic hypercalcemia secondary to ovarian tumors are presented. Both cases were secondary to ectopic parathormone (PTH) production. Other mediators postulated to cause this syndrome are prostaglandins, vitamin D-like sterols, non-vitamin D sterols, vitamin A, cortisol, and "osteoclast-activating factor.' The key treatment modalities for acute hypercalcemia are hydration and diuresis with furosemide; phosphates, steroids, antiprostaglandins, and hemodialysis may also be of value. Calcitonin is theoretically the most attractive treatment modality, but the rapid development of resistance limits its use to acute management. Mithramycin is most effective for long-term palliation of hypercalcemia if tumor-directed therapy is unsuccessful. Review of the literature confirms the previously made observation that mesonephromas are disproportionaately represented in association with this syndrome.
Adolescent↗
Clear cell carcinoma of the ovary: light and electron microscopic studies.
Twelve cases of ovarian clear cell carcinoma were studied histologically. Four cases were examined electron microscopically and compared with other conditions. Five tumors were directly connected with ovarian endometriosis. They were histologically classified into a tubular type with hobnail cells and a solid type without tubular pattern or hobnail cells. Electron microscopic figures of the tumor cells are identical having large nuclei, abundant glycogen, lamellated RER, few lipid droplets, and sparse but well-developed microvilli. The basophilic dark cells frequently encountered in the tubular type are morphologically quite similar to clear cells excepting for sparsity of glycogen and lipid droplets. Alveolar arrangement of 6 to 10 tubular structures (honeycomb structure) resembling alveolate structure seen in late secretory endometrium was found in tumor cells of one case. Ultrastructural feature of clear cell carcinoma closely resemble those of Arias-Stella endometrium and clear cell carcinoma of endocervix suggesting their Muellerian origin.
Adenocarcinoma↗
Malignant mixed tumor of the vagina probably arising in mesonephric rests.
An exceedingly rare tumor arising in the upper lateral vagina is described histologically, histochemically, and ultrastructurally. It is compared to the lesion reported by Okagaki et al. which is considered to represent the same type of tumor. Comparison with synovial sarcomas indicates that the lesion is similar, but the reasons why it should not be so classified are discussed. Evidence is presented for the origin of these tumors in mesonephric rests (Gartner's duct).
Adult↗
A human embryonal-yolk sac carcinoma model system in athymic mice.
Two new human cell lines (1411H and 1411HRQmet) have been established from a patient with metastatic testicular cancer whose primary and metastatic histology included seminoma, teratoma, embryonal carcinoma (EC), and yolk sac tumor (YST). In vitro, the cells have been maintained for more than 70 passages, produce alpha-fetoprotein (AFP) and human chorionic gonadotropin (hCG), and have a human karyotype. When 2 X 10(7) cells of either line are inoculated into athymic mice, 87.5% of the animals (21/24) develop tumors. Initially 80% to 90% of the mass is EC, whereas the central portion is YST. After 90 to 390 days in vivo, the tumors achieve a large volume (2.13 +/- 0.97 cm3), become cystic, and undergo histologic change. The peripheral rim of the mass remains EC, but the central 80% to 90% becomes YST. The sera of tumor-bearing mice were positive for hCG and AFP in 11% and 38% of animals, respectively. Tumor cyst fluid was positive for hCG and AFP in 87% and 59% of animals, with mean values of 108 mIU/ml and 2,478 ng/ml, respectively. Tumor cyst fluid also contained placental alkaline phosphatase and human fibronectin. These two cell lines are useful for studies on the interrelationship of EC and YST and the differentiation of human germ cell cancer.
Adolescent↗
Vincristine, dactinomycin, and cyclophosphamide in the treatment of malignant germ cell tumors of the ovary. A Gynecologic Oncology Group Study (a final report).
Seventy-six patients with malignant germ cell tumors of the ovary received vincristine, dactinomycin, and cyclophosphamide (VAC) postoperatively. Fifty-four were treated after removal of all gross disease. The majority of these remain disease-free. Indeed, only 15 (28%) have failed, including 11 of 24 with pure endodermal sinus tumor, 3 of 11 (27%) with mixed germ cell tumor containing endodermal sinus elements, and only 1 of 20 with immature teratoma grade 2 or 3, a patient seen initially with recurrent disease. Postoperative VAC therapy, however, did not appear to be effective in patients with unresectable or incompletely resected germ cell tumors of the ovary. Fifteen of 22 patients (68%) with incompletely resected germ cell tumors failed VAC therapy, including 4 of 7 with pure endodermal sinus tumor, 5 of 5 with mixed germ cell tumors containing endodermal sinus elements, 2 of 2 with embryonal carcinoma, and 4 of 8 with immature teratoma. In failing, patients' median time to progression was 8 months. Dose-limiting toxicity was seen in 30% of the entire group. Combined cisplatin, vinblastine and bleomycin therapy now is being tested in this group of tumors.
Adolescent↗
Retroperitoneal germ cell tumors in childhood. A clinical and pathologic study of 11 cases.
During the last 54 years at the Children's Hospital 11 children (10 female, 1 male) had been treated for an extragonadal germ cell tumor arising in the retroperitoneum. There were eight teratomas (five mature, three immature), two endodermal sinus tumors and one tumor with a mixture of both components. Abdominal pain or discomfort was the usual presenting complaint, with the average age at diagnosis being 18 months. On physical examination, each child had a palpable abdominal mass usually localized in the upper quadrants. The finding of calcification, bone or teeth, on radiologic study was most helpful in establishing a preoperative diagnosis of teratoma. The preferred treatment for children with mature and immature teratomas is complete surgical resection; decisions regarding adjuvant therapy for patients with immature tumors must be evaluated on an individual basis. The prognosis remains guarded for children with unresectable primaries or those with endodermal sinus tumor. Of three tumor-related deaths, two were due to metastatic endodermal sinus tumor and one resulted from extensive local growth by immature teratoma. Successful management of children with endodermal sinus tumor requires surgery aimed at debulking or complete resection in combination with aggressive adjuvant chemotherapy.
Child, Preschool↗
Anterior mediastinal endodermal sinus (yolk sac) tumor in a female infant.
The first known case of primary anterior mediastinal endodermal sinus (yolk sac) tumor in a female patient, occurring in a 20-month-old infant, is reported. The child presented with cough, fever, and listlessness. Chest x-ray revealed a right anterior mediastinal mass. At thoracotomy a large anterior mediastinal tumor extending from the neck to the diaphragm was found, and was almost totally resected. Microscopically, the tumor displayed many of the histologic patterns observed in EST. Other neoplastic germ cell elements were not identified. The ultrastructural and immunohistochemical findings further confirmed the diagnosis. Serum alpha-fetoprotein (AFP) level, determined during surgery, was elevated to 65,200 ng/ml, whereas serum beta-human chorionic gonadotropin level was normal. Postoperatively, combination chemotherapy consisting of vinblastine, bleomycin, cisplatin, dactinomycin, cyclophosphamide, and doxorubicin was administered with a maintenance program. After 18 weeks on this regimen all the findings were normal, including serum AFP level. The child is well and disease-free 25 months after diagnosis.
Antineoplastic Combined Chemotherapy Protocols↗
Cisplatin and etoposide salvage therapy and resection of the residual tumor in pretreated germ cell testicular cancer.
Thirty-two consecutive patients with pretreated germinal testis cancer received three to four inductions of cisplatin and etoposide therapy (PE). Patients not pretreated, or only partially pretreated with bleomycin (B), also received this drug for a maximum of 12 doses. Sixteen patients underwent secondary surgery for the removal of residual masses. Twelve (37.5%) entered complete remission (CR) with chemotherapy alone, and an additional 9 cases (28%) were rendered tumor-free by surgery. The 21 disease-free patients (65.5%) received two further inductions and no maintenance. Toxicity was moderate, and 1 of the 16 patients who underwent surgery died postoperatively of pulmonary embolism. After a median follow-up period of 26 months (range, 9-60), 2 patients have died in CR and 15 (47%) are currently alive and have been continuously disease-free. The major determinant of tumor response was prior therapy. Eleven of 14 (78%) patients who were not pretreated with cisplatin achieved a continuous disease-free status versus only 4 of the 18 pretreated patients (22%, P less than 0.01). In this set of cases, complete responders to prior PVB therapy did better than incomplete responders treated for tumor progression. It can be concluded that normal-dose PE +/- B therapy, followed by surgical resection of the residual tumor, is a satisfactory salvage therapy in patients not pretreated with cisplatin and is also active in complete responders to prior PVB therapy.
Adolescent↗
Ovarian endodermal sinus tumor with intestinal differentiation.
A 12-year-old girl was admitted to the hospital for evaluation of an abdominal mass. A preoperative computed tomography scan showed a large tumor in the pelvis. The serum alpha-fetoprotein level was 2,170,000 ng/ml. A 3000-g left ovarian neoplasm was resected. It was encapsulated and showed focal microcystic degeneration, necrosis, and hemorrhage. Microscopically, it was composed of gland-like spaces containing mucin-positive material and surrounded by scant fibrovascular tissue. The epithelial cells were low columnar with immature oval, basophilic nuclei. Immunoperoxidase staining for alpha-fetoprotein and alpha1-antitrypsin were positive. Enzyme histochemistry was negative for alkaline phosphatase and positive for alpha-naphthyl acetate esterase. Electron microscopy, including freeze-fracture analysis, showed desmosomes and tight junctions. No gap junctions were identified. Actin filaments, glycogen, and microvilli were abundant. This is the first case of an ovarian endodermal sinus tumor with exclusive enteric differentiation.
Adolescent↗
A human testicular germ cell tumor with borderline histology between seminoma and embryonal carcinoma secreted beta-human chorionic gonadotropin and alpha-fetoprotein only as a xenograft.
Two macroscopically distinguishable components (designated soft and firm) of a human testicular germ cell tumor with borderline histology between seminoma, embryonal carcinoma and yolk sac tumor, were maintained as xenografts in nude mice for over 20 passages. Levels of beta-human chorionic gonadotropin (beta-HCG) and of alpha-fetoprotein (AFP) were normal in the patient's serum and were undetectable by immunohistochemical studies of the surgical specimen. The xenografted soft part, however, with morphologic characteristics of an embryonal carcinoma, secreted beta-HCG and AFP during early passages. The firm variant, histologically resembling a seminoma, did not produce these markers. Chromosomal and flow cytophotometric analyses showed genetic differences between the clonally stable variants. A common origin, however, is indicated by two similar marker chromosomes present in both variants.
Animals↗
Endodermal sinus tumor of the mediastinum. A report of seven cases and review of the literature.
Primary mediastinal endodermal sinus tumor is rare, and to date only 49 cases have been described in the English-language literature. Seven new cases are reported. Light microscopic examination showed characteristic features including papillary, reticular, tubular and solid growth patterns, complete or incomplete Schiller-Duval bodies and intracellular or extracellular periodic acid-Schiff-positive material. Immunohistochemical studies showed alpha-1-antitrypsin in seven, alpha-fetoprotein in seven, keratin in six, and carcinoembryonic antigen in four cases. The beta subunit of human chorionic gonadotropin, albumin, fibronectin, and transferrin were not found in any case. Electron microscopic studies performed in four cases showed intracellular and extracellular basement membrane-like material, multiple large multivesicular bodies, desmosomes and microvilli. Mediastinal endodermal sinus tumor can and must be differentiated from poorly differentiated adenocarcinoma metastatic or extending to the mediastinum because of the distinctly different prognoses and therapies. In spite of modern chemotherapy, the prognosis of mediastinal endodermal sinus tumor remains poor. The single most important prognostic indicator is whether the tumor mass can be completely excised before or after chemotherapy.
Adolescent↗