Combined immunohistochemical study of tissue polypeptide antigen and cancer antigen 125 in human ovarian tumours

Recurrent squamous cell carcinoma arising in ovary mature cystic teratoma: A case report

RATIONALE

Malignant transformation of mature cystic teratoma is very rare, of which squamous cell carcinoma (SCC) is the most common type. Prognosis of SCC arising in mature cystic teratoma of the ovary is very poor. Our experience may provide new ideas for the treatment of this disease.

PATIENT CONCERNS

The patient was a 56-year-old woman and was admitted for a lower abdominal pain. She underwent a laparoscopic surgery with 4 cycles of chemotherapy and had achieved a complete response; 10 months after the completion of initial treatment, her cancer relapsed. She underwent a cytoreductive surgery with concurrent chemoradiotherapy and has achieved a complete response again.

DIAGNOSES

This patient was initially diagnosed with ovarian cancer (stage IIIB) arising from malignant transformation of mature teratoma; 10 months after the completion of initial treatment, she was diagnosed with recurrent ovarian cancer.

INTERVENTIONS

This patient was initially treated with laparoscopic bilateral salpingo-oophorectomy. After histopathological confirmation that she had ovarian cancer, she underwent laparoscopic total hysterectomy and omentectomy with 4 cycles of chemotherapy. After her ovarian cancer recurred, she underwent open cytoreductive surgery and concurrent chemoradiotherapy.

OUTCOMES

The patient achieved complete response after both initial and relapsed treatment.

LESSONS

Optimal cytoreduction and concurrent chemoradiotherapy may be an option to improve the prognosis of patients with recurrent SCC arising in ovary mature cystic teratoma.

Tissue and serum CA125 expression in endometrial cancer

Serum CA125 is elevated in some endometrial cancer patients. The purpose of the present study was to assess the correlation between the presence of CA125 in endometrial cancer tissue and elevated CA125 serum levels. Serum levels of CA125 were examined in 39 patients with endometrial cancer prior to definitive surgery. After diagnosis reconfirmation, additional slides were prepared from each case for immunohistochemical staining for anti-CA125 antigens. Of the 39 patients, 28 had endometrioid endometrial carcinoma (EEC) and 11 had mixed mesodermal sarcoma (MMS). In EEC, 21.4% of the patients had an elevated CA125 serum level, and that correlated with stage (P = 0.02) but not with grade. The percentage of EEC patients with positive tissue staining was significantly higher than the percentage with elevated serum levels (89.3% vs. 21.4%, P < 0.0001). No correlation between positive tissue staining and stage or grade was observed. In MMS the percentage of positive tissue staining was also higher than that with elevated serum CA125 levels and the percentage with elevated serum levels was higher than in EEC. However, the differences were statistically not significant. Our study indicates that the majority of EEC tissues contain CA125 and that the percentage of positive CA125 tissue staining is significantly higher than that of elevated CA125 serum levels. This indicates the presence of some mechanism that prevents the access of CA125 into the circulation. This mechanism is probably less effective in more advanced EEC's and in MMS.

Sarcomatoid carcinoma of the colon. Report of the second case with immunohistochemical study

Sarcomatoid Carcinomas are rare tumors composed of mixed malignant epithelial and mesenchymal cells. Only one case is reported in the colon, up to date. We describe the second case in an 86-year-old woman. The tumor, replacing the intestinal wall, consisted of carcinomatous and sarcomatous areas. The former was composed of differentiated superficial adenocarcinoma and of infiltrating epithelioid undifferentiated solid portion. The latter was mostly composed of undifferentiated spindle cells with focal chondrosarcomatous and pleomorphic anaplastic areas. A strong Cytocheratin (CK) and Epithelial Membrane Antigen (EMA) immunoreactivity (IR) with focal CA 125 positivity was detected in differentiated adenocarcinomatous areas. Solid carcinoma-like areas coexpressed CK and Vimentin (VIM). The sarcomatous spindle-cell component of the tumor was largely VIM positive, with focal CK IR. Both polyclonal and monoclonal antibodies for Carcino-Embryonic Antigen (CEA) did not display any reaction.

Immunocytochemical and serological expression of CA 125: a clinicopathological study of 40 malignant ovarian epithelial tumours

Elevated serum levels of the tumour-associated antigen CA 125 occur in more than 80% of cases of ovarian carcinoma. The antigen can be demonstrated in formalin-fixed tissue using the monoclonal antibody OC 125, which localizes it to the surface membrane or cytoplasm. This study was performed to determine the relationship between pre-operative serum levels of CA 125 and the subsequent immunocytochemical findings in the surgical specimen. Paraffin-wax embedded sections from 40 consecutive borderline and frankly malignant ovarian epithelial tumours were stained with OC 125. The pattern and distribution of immunostaining were investigated in relation to histological appearances. Serous tumours showed a 100% correlation between immunocytochemical findings and elevated serum levels of CA 125. Amongst the other histological types, correlation was less good; mucinous tumours and undifferentiated carcinomas showed a poor correlation. Immunostaining within tumours was heterogeneous and only loosely related to morphological appearances. Our finding suggests that, with the exception of serous tumours, immunolocalization of CA 125 is insufficiently sensitive to provide reliable clinical guidance to the likely value of serum CA 125 monitoring on follow-up.