| Abstrakt: |
Introduction. Ovarian cancer is the most common cause of cancer death worldwide. The incidence of ovarian cancer is higher in postmenopausal women. Endometriosis is common and found in about 10% of reproductive-age women, but the risk of malignant transformation in an individual patient is very low. Nonetheless, endometriosis is associated with up to 20% of ovarian cancers and is acknowledged to be the precursor of most endometrioid, clear cell, and seromucinous carcinomas. The relative proportion of endometrioid and clear cell carcinomas that are associated with endometriosis is much higher than that for the other cell types. Materials and method. We present the case of a 28-year-old female who presented in our medical unit for acute pelviabdominal pain associated with moderate leukocytosis. MRI showed a solid and cystic mass, associated with ascites, heterogeneous in T1-weighted sequence and hyperintense in T2-weighted sequence. Based on the clinical findings, we opted for a fertility sparing approach and unilateral ovariectomy was performed, followed by biopsies of the parietocolic fossae, great omentum and lomboaortic lymph nodes. Results. Gross examination revealed a large ovarian mass, with intact capsule, measuring 10/8/7.5 cm, showing a predominantly cystic structure filled with red-brown liquid and unremarkable internal surface except for a solid area measuring 8/7/4 cm, with friable consistency and diffuse grey-yellow color. The histopathological examination revealed a predominantly diffuse proliferation of polygonal cells with clear cytoplasm with PAS-positive material and hyperchromatic nuclei, arising in the setting of an endometriotic cyst. The immunohistochemical examination revealed diffuse positivity for CK7, PAX8 and Napsin A, consistent with the diagnosis of clear cell carcinoma. Inhibin, WT1, OCT4 and CD117 were diffusely negative. Conclusions. Although clear cell carcinoma occurring in the setting of an ovarian endometriotic cyst is a relatively common occurrence, its presence in a female below 30 years old is extremely rare. In this case report, we highlight the importance of prudent clinical and pathologic examination, since the misdiagnosis of such lesions may lead to erroneous therapeutic management and can lead to an unfavorable long-term outcome. [ABSTRACT FROM AUTHOR] |
