SPLIT,Croatia AMR Slide Seminar Case # 76 Ovarian tumor Ivan Damjanov, MD, PhD Department of Pathology The University of Kansas School of Medicine, Kansas City, Kansas

Case # 76 Clinical History 60-year-old woman complaining of lower abdominal and pelvic pain Past history: 30 years ago had “her uterus and tubes removed” Left ovarian mass measuring 15 cm was found partially attached to the loops of the large intestine. Several tumor nodules on the mesentery and several pelvic lymph nodes contained tumor on frozen section. Right ovary contained an adenofibroma. Radical removal of all the neoplastic tissue was attempted. She received chemotherapy. Two years after surgery she was found to have liver metastases. Lost to follow up, presumably died of spreading tumor.

Case # 38 Macroscopic and Intraoperative Pathology Macro: Tumor received in several parts .Tissue soft friable and partially necrotic. Partial colectomy with tumor attached to the intestine. Partial omentectomy and lymph node dissection with apparent tumor. Frozen sections: Malignant tumor, favor adenocarcinoma. Metastases in the submitted lymph nodes and omentum.

GFAP

Grooved nuclei- cellular ependymoma Mitotic activity-anaplastic ependymoma (loss of ependymoma markers)

EMA

Fibrillary cytopalasmic processes, tapering of cytoplasm

GFAP

S100

CAM5.2

Ependymoma-extra-axial Michael O. Idowu, MD, MPH, Marc K. Rosenblum, MD, Xiao-Jun Wei, MD, Mark A. Edgar, MD, and Robert A. Soslow, MD Ependymomas of the Central Nervous System and Adult Extra-axial Ependymomas are Morphologically and Immunohistochemically Distinct—A Comparative Study With Assessment of Ovarian Carcinomas for Expression of Glial Fibrillary Acidic Protein Am J Surg Pathol 2008;32:710-718 =============== Extra-axial ependymomas preferentially express cytokeratins (which may be expressed in the CNS axial ependymomas as well, but less commonly) Extra-axial ependymomas-histologic patterns: solid,pseudopapillary,papillary, trabecular, cribriform

Vimentin

CD99

Case # 76 Diagnosis Ependymoma (malignant) of the ovary with extension to the left colon and metastases to the omentum and pelvic lymph nodes. Other diagnoses considered: Cellular ependymoma Ependymoblastoma Anaplastic ependymoma

Cellularity and grooved nuclei- cellular ependymoma—not papillary carcinoma of thyroid Mitotic activity-anaplastic ependymoma

Return to the classic paper! Kleinman GM, Young RH, Scully RE. Primary neuroectodermal tumors of the ovary. Report of 25 cases. Am J Surg Pathol 1993; 17: 764-778. Neuroectodermal tumors –ovary or testis Three groups A. Differentiated – ependymomas, astrocytomas, oligodendrogliomas B. Primitive tumors-neuroblastoma, medulloblastoma, ependymoblastoma C. Anaplastic tumors- glioblastoma like

Take home message Ependymoma can be typically axial or paraxial Paraxial ependymoma described in essentially any and all organs In the female genital tract—ovary or parametria Origin- either from teratoma or embryonic remnants Clinical prognosis –guarded or malignang

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